Personalizing BPH treatment: Meaningful conversations get to the heart of patient needs

Zorn is a leading authority in urology, known for his contributions to the development of minimally invasive surgical therapies for benign prostatic hyperplasia (BPH). He has authored numerous peer-reviewed publications and book chapters on the subject and is a sought-after speaker and teacher worldwide. He is the lead practitioner at BPH Canada in Montreal and director of the Canadian Prostate Surgical Institute.

Zorn is the senior author of the Canadian Urological Association's 2018 and 2022 male lower urinary tract symptoms (LUTS)/BPH guidelines and an invited reviewer of the American Urological Association BPH guidelines, and his expertise is widely recognized. His involvement in creating national online programs in robotic prostate cancer care and rehabilitation, as well as a BPH patient decision-aid tool, further demonstrates his commitment to improving patient outcomes. Zorn is a former associate professor of urology at the University of Montreal (Centre hospitalier de l'Université de Montréal) and the University of Chicago, subspecializing in robotic and BPH surgical care.

Today, more than ever before, men who receive a diagnosis of benign prostatic hyperplasia (BPH) are demanding treatment options that not only improve flow and relieve symptoms but also minimize adverse events, particularly those that negatively affect sexual functions. As urologists, we have an expanding platform of treatment options in our surgical toolbox, unlike ever before, that address our patients’ concerns about preserving ejaculation. We must engage in open, candid conversations with our patients, educate them on their options, and tailor our BPH treatment approach to each patient’s specific needs.

Over the past decade, the advent of minimally invasive surgical techniques (MISTs) and robot-assisted procedures has allowed us to treat BPH effectively while preserving sexual function, including ejaculation. MIST options cleared by the FDA to be safe and effective include the following:

Optilume BPH catheter system. This is the newest MIST treatment available, combining a mechanical prostatic urethral dilation and concurrent delivery of paclitaxel to the treatment site for treating BPH. Mechanical dilation with a double-lobe balloon technology achieves an anterior commissurotomy (split), releasing the constricting lateral lobes. At the same time, the delivery of paclitaxel prevents refusion of the lobes during healing, keeping the prostate open, restoring the flow of urine, and relieving bothersome BPH symptoms. This procedure has no cutting, heating, burning, lasering, steaming, or implantations. The Optilume BPH TURBO (transurethral radial balloon opening) prostate procedure is unique among all the MIST options, with no thermal energy and no metal implants.

Prostatic urethral lift (UroLift). Permanent implants lift the prostate and hold it away from the urethra, allowing urine to flow more freely.

Water vapor thermal therapy (Rezūm). Water vapor (steam) is used to destroy targeted prostate tissue, shrinking the enlarged area of the prostate and improving urine flow.

Temporarily implanted nitinol device (iTind). A temporary device made from a shape-memory alloy is implanted and gradually expands within the prostate to reshape the tissue over 5 to 7 days. After this period, the device is removed, leaving an expanded pathway for urine flow.

Robotic water-jet treatment (Aquablation). A robotically guided camera and ultrasound imaging are used to map the prostate and precisely direct a heat-free high-pressure water jet to resect excess prostate tissue.

With the advent of these MIST options, a new era has arrived, providing us with cutting-edge tools to help relieve our patients’ BPH symptoms, minimize potential adverse events, and improve patient comfort and efficacy.

Personalizing BPH Treatment Plans

While tailoring treatment plans for each patient, we must consider the severity of symptoms, prostate size, patient age, comorbidities, and medical history when evaluating MISTs or other treatment options. Thanks to patient demand for better treatment options with fewer adverse events and more therapies now available, BPH management has advanced into a personalized, patient-centered approach. Preserving ejaculatory function is as critical as relieving urinary symptoms.

From innovative imaging technologies and novel treatment options combined with in-depth patient conversations, we are transforming and delivering personalized, holistic care. With continued research and new technologies coming online, the future is looking even more promising for helping men with BPH preserve not only their urinary function but also their sexual health.

The Future of BPH Treatment

As a community, let’s continue to gather longer-term data on ejaculatory preservation strategies to better understand their impact on treatment durability. Will we see a day when we can preserve ejaculation in 100% of the men we treat for BPH? I think it is possible as advancements in BPH treatments continue, especially if we can improve intraoperative visualization of the ejaculatory duct system so we can prevent inadvertent injury.

Our patients are in the driver’s seat, and we are lucky to be in the position to offer so many treatment options customized to address their needs and help them enjoy life.