BPH Treatment Comparison: Pros & Cons
Comparing Treatment Options for Benign Prostatic Hyperplasia
|Laser Focal Therapy
|Low blood loss
|Relatively low risk of retrograde ejaculation
|Get to keep the prostatic urethra
|Requires general anesthesia
|Results in the removal of excess tissue
|Requires a surgical device to be inserted into the penis
|Real time image guidance during ablation
 Descazeaud, A., Azzousi, A.R., Ballereau, C. et al. (2010). Blood loss during transurethral resection of the prostate as measured by the chromium-51 method. National Library of Medicine, 24(11), 1813-1816. doi: 10.1089
 Bruyère F, Huglo D, Challacombe B, Haillot O, Valat C, Brichart N. Blood loss comparison during transurethral resection of prostate and high power GreenLight(™) laser therapy using isotopic measure of red blood cells volume. J Endourol. 2011 Oct;25(10):1655-9. doi: 10.1089/end.2011.0104. Epub 2011 Aug 11. PMID: 21834657.
3 Preserving ejaculatory function in young patients with lower urinary tract symptoms: medium- to long-term follow-up of prostatic urethral lift at a single center https://pubmed.ncbi.nlm.nih.gov/34377154/
4 Rezūm Water Vapor Thermal Therapy for Lower Urinary Tract Symptoms Associated With Benign Prostatic Hyperplasia: 4-Year Results From Randomized Controlled Study https://pubmed.ncbi.nlm.nih.gov/30677455/
BPH is usually treated first with a medication called an alpha-blocker (e.g., Flomax, alfuzosin, Rapaflo). These medications help to relax the muscles in the prostate, taking some of the pressure off the urethra. Unfortunately, these medications often have side effects, including dizziness, decreased energy, and/or retrograde ejaculation.
Another class of medications is 5α-reductase inhibitors (e.g., finasteride or dutasteride). These medications block the body’s production of a version of testosterone that causes the prostate to enlarge. As a result, they can also decrease erectile function, energy, and libido.
If side effects are too extreme, the medication is not effective, or too much bladder damage is occuring, surgical BPH treatment options are often the next step.
Transurethral Incision of the Prostate (TUIP)
The surgeon makes small cuts in the bladder neck, where the urethra joins the bladder and in the prostate. This widens the urethra and reduces the pressure of the prostate on the urethra, making urination easier. The hospital stay is often one-to-three days. A catheter is left in the bladder for one-to-three days after surgery.
Photoselective Vaporization (PVP)
PVP (such as GreenLight laser) is a way to vaporize prostate tissue with a high-powered laser. It is typically an outpatient procedure performed. The procedure takes place at the hospital or sometimes in the doctor’s office. The high power laser is inserted into the penis and advanced to the prostate. It then literally vaporizes part of the urethra in the prostate and continues vaporizing part of the prostate itself. This is an invasive procedure, and there are commonly some side effects. Also, PVP is not recommended for men with the largest prostates.
Transurethral Resection of the Prostate (TURP)
A common surgery for men with BPH, the device is inserted into the penis and advanced to the prostate. The doctor then uses an electrical knife to cut through part of the urethra in the prostate and part of the prostate itself. Men with moderate-to-severe BPH symptoms may be good candidates for TURP. There is commonly a lot of blood loss with this procedure, and there is a maximum prostate size limit.
The entire prostate gland is removed via laparoscopic or robotic-assisted surgery. This treatment is generally only offered to men with very large prostate glands.
For those with BPH, laser focal therapy (LFT) / focal laser ablation (FLA) or transurethral ultrasound ablation (TULSA-PRO) may be worth considering.
After using an MRI to map the prostate gland, the physician targets the areas of enlargement. Those areas are then destroyed with a laser (LFT/FLA) or ultrasound (TULSA-PRO). Real-time MRI guidance and temperature mapping help to provide a safer patient experience and more positive results.