How has your management of BPH patients changed?

September 24, 2019

"I basically choose the procedure based on the patient’s anatomy," says one urologist.

Urology Times reached out to three urologists (selected randomly) and asked them each the following question: How has your management of BPH patients changed?

"The gold standard is still TURP [transurethral resection of the prostate], and, of course, medications and transurethral microwave thermal therapy. I don’t try anything new unless it’s been tried a million times by somebody else. I’m not an early adopter.

I don’t think anyone says those newer treatments can compare to the TURP. Heated steam is not as good; microwave is not as good; GreenLight laser is not as good, although that’s a form of transurethral vaporization of the prostate gland. Those are pretty equivalent. That’s the only thing that comes close to the results you get with TURP.

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My motto is, stick with what works.

I did five microwaves today because guys requested it, as opposed to a TURP. They’re all going back to work tomorrow. They’ll have hardly any side effects. It doesn’t work that great, however. The good thing is, it has no sexual side effects. I tell them it’s not good as a long-term treatment, that in about 4-5 years they’ll need something else, but they still want TUMT. I do it because patients ask.”

D. Mark Brown, MD / Olympia, WA

Next: “The way I work up BPH patients has changed considerably because of these new treatments."“The way I work up BPH patients has changed considerably because of these new treatments. Previously, I’d usually go right to laser vaporization of the prostate, but now that UroLift and Rezum are available, I like to know the shape and size of the gland. It’s important in order to figure out the best procedure for the patient.

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We offer both the Rezum and the UroLift. I also do the TURP and laser prostate vaporization. I tell patients that improvements in the flow and their symptoms are probably going to be best with traditional treatments, such as TURP or laser. But patients who are very motivated in preserving ejaculatory function aren’t going to be happy with the TURP; that usually includes the younger guys. I tell them there’s a treatment that helps preserve sexual function, but it may not be as good as traditional treatments at improving your prostate symptoms, so it’s a trade-off.

Also, UroLift and Rezum have only been around for a couple of years. We don’t know what the long-term improvements will be.

Personally, I like laser prostate vaporization. Historically, TURP was the gold standard, but results with laser vaporization are comparable, with lower bleeding risks, and patients go home the same day. That’s the gold standard. I trained in the era of lasers, so I’m a big believer in them. It’s the same operation as TURP, just with newer technology that makes it easier.

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I think new procedures like UroLift and Rezum are here to stay for very specific patients-patients with mild to moderate symptoms, who are mainly interested in preserving their sexual function.”

Michael Holzer, MD / Oklahoma City

Next:"I basically choose the procedure based on the patient’s anatomy."“For the vast majority of my patients, I usually stick to either traditional TURP-I’m a fairly young urologist, just 8 years out of residency-or GreenLight photoselective vaporization.

I basically choose the procedure based on the patient’s anatomy. If they have a large or medium lobe, I do a traditional TURP because I like to resect it. GreenLight works as well as traditional TURP. The benefit is that most of my patients go home the same day.

We looked at Rezum and UroLift as potential new therapies, but UroLift was hard to get off the ground. We had to get a bunch of patients interested right off the bat and try to coordinate them for the same day, because they wanted to do multiple cases all at once to get us up to speed. That was just a logistical challenge.

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Then, while we were looking at Rezum, patients who had these procedures elsewhere, both Rezum and UroLift, came to me with complications. Granted, it’s very anecdotal-I’m sure many people had good experiences.

My chairman used to say, it seems these new procedures come along, but we always go back to TURP. Alternative therapies make their run, but none seem to have the legs to be meaningful long-term options.

One of my partners refers people to a local interventional radiologist for prostatic artery embolization, but I don’t know what he uses for his basis.”

Brian Kowal, MD / Hyannis, MA

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