Choosing Between In-Office and Surgical BPH Treatment

Benign prostatic hyperplasia, or BPH, is a common concern as men age and represents a significant cause of lower urinary tract symptoms ranging from mild to severe. Due to the prevalence of this condition, there are plenty of treatment options, from medication to office therapies and surgery. With all the available options, it can be confusing for patients to make the best choice for their circumstances. This article will discuss office versus surgical treatment options and when they make the most sense for your circumstances.

When patients first begin to experience lower urinary tract symptoms, many believe that they may have prostate cancer. However, prostate cancer rarely presents with urinary symptoms in its earlier stages. Most patients are relieved to find out that their symptoms are caused by benign prostatic enlargement, and they often, at this point, may or may not pursue therapy. Unfortunately, BPH is a progressive condition and tends to get worse. The gradual worsening, however, is often managed through lifestyle changes, including not going out to events or dinner or limiting fluid intake. These slowly creep up on a man, and their life can be severely limited before they know it. Many patients do not understand the breadth of minimally invasive options, including in-office ones, and consequently wait too long for treatment.

In Office BPH Therapies, and Why to Choose Them

For many patients, in-office BPH therapies like Rezum and Urolift can be likened to “free play” to improve symptoms. What does this mean? These minimally invasive in-office procedures are safe and effective for well-selected patients and do not preclude trying more invasive options later. Rezum, as an example, uses heat therapy to ablate or destroy excess prostatic tissue. Because this represents an effective and low-risk option, Dr. Kapadia often recommends early intervention for qualifying patients. Patients who respond well to these therapies can get five or even seven years of relief before having a follow-up in-office or surgical procedure.

Surgical BPH Therapies

Several surgery-center-based BPH procedures are also available and can be excellent options for certain patients. TURP, Aquablation, Greenlight Laser, simple prostatectomy, and HoLEP are all available. Dr. Kapadia has worked with or researched each of these procedures and is happy to help patients find the best surgery for their needs and anatomy.

When Is a Patient Ready for Surgical Intervention?

First, a surgery center-based procedure can be considered if a patient is not responding to less invasive treatments or if the prostatic tissue has regrown and the patient wishes to pursue something more aggressive. These surgeries are also an excellent intervention for larger prostates—those over 80g. During most surgical interventions, much of the “pulp” of the prostate is removed, leaving only the capsule. This removes far more tissue than an in-office procedure. Aquablation particularly offers a unique advantage due to its ability to treat any prostate size up to 150g while also preserving ejaculation in men who are interested.

The Bottom Line

Depending on your circumstance and the progression of your BPH, in-office therapy may or may not be preferable to surgical intervention. Unless otherwise necessary, we take a stepwise approach toward patient care, starting with the least invasive option and moving up the scale if the more conservative option no longer works.

Most importantly, if you are experiencing BPH, understand that it is a ubiquitous and normal part of aging. You should also seek professional urologic care early to arrest the continued growth of the prostatic tissue and better understand treatment options.

Dr. Kapadia has worked with every modern BPH therapy and, with his breadth of experience, can recommend anything from medication to minimally invasive in-office therapies to surgery, knowing firsthand how patients have responded. Schedule a consultation with Dr. Kapadia to learn more.