BPH treatment: What to ask your urologist
When it comes to treating prostate enlargement, also known as benign prostate hyperplasia (BPH), it may be confusing to know which minimally invasive urological procedure is right for you. We’ve asked one of our expert urologists Mr Jaspal Virdi to explain two of the commonest minimally invasive treatments used, Rezūm and UroLift. Here he discusses just how successful they are in treating the urinary symptoms associated with BPH, and he answers the potential questions that you might want to ask your doctor.
How do Rezūm and UroLift work?
Rezūm reduces the size of the enlarged prostate using steam therapy, which is steam-generated heat that destroys by convective heating the prostate tissue that is blocking the flow of urine from the bladder, The tissue shrinks during next few weeks up to 38% which in turn relieves the obstruction.
Instead of destroying the tissue, UroLift pulls backwards or sideways through the use of an implant or clip, which pulls back the prostate tissue to open up the urinary passage. This pushes the prostate tissue away from the urethra. We leave an implant during the UroLift which in time embeds into urethral tube. Leaving implant in the prostate require awareness should there be need for MRI of Prostate in the future. I tend to use more of Rezūm than UroLift particularly if there is family history of prostate cancer.
These two treatments are suitable for a prostate sized between 30—80 cc. UroLift is generally not performed in a patient who has large prostate tissue inside the bladder. The size of prostate is measured by transrectal ultrasound. Rezūm can be used to treat any type of prostate configuration and is performed in all scenarios.
How common are the procedures in the UK?UroLift is present in a number of centres across the UK. Rezūm on the other hand is very limited as it was only approved by NICE in July 2018 whereas UroLift was approved in 2015. I’ve been performing Rezūm since January 2019.
Who is a good candidate for REZUM or UroLift?Good candidates for the treatment include men over the age of 50 with either of the following reasons:
- An enlarged prostate – causing moderate to severe lower urinary tract symptoms: such as an increase in urinary frequency, difficulty in holding urine (urgency) and reduced urine flow with an increased retention of urine
- Preservation of Sexual function – for those who wish to retain sexual function
- Those who cannot take or tolerate oral medication – this is common in younger patients (aged 50-65) as the side effects are dizziness, blurred vision, reduced libido and semen
Is anaesthesia required?The option is with the patient to have treatment under local or general anaesthetic. Both are day procedures; hospital stay is between 4-6 hours. There is minimum pain and most of the discomfort with Rezūm is because of the urinary catheter, which is a soft tube that carries urine out of the body from the bladder. We don’t want patients to return with urinary retention so we leave the catheter in for 2-5 days before it is removed.
What does recovery involve?Patients can resume normal activity as soon as catheter comes out. I recommend that the patient takes one week off from work to recover. Ejaculation is refrained for six weeks.
How successful are the procedures? Are repeat treatments ever required?Some of the side effects commonly seen include the slight discomfort in passing urine, slight blood in the urine, which can persist for 2-3 weeks and a urinary tract infection (17%) and transient Retention of urine (14%)
At the present time we have about 4 years’ worth of follow-up results to reference. Of the results available, they show re-treatment 4.4% in Rezūm. With UroLift, we had repeat treatment of about 6.5% per cent.
At the moment in Rezūm is better than UroLift. In Rezūm we are seeing over 50% improvement in the symptoms and 69% improvement in the flow of the urine and reducing urinary urgency and poor flow symptoms, which is lasting 4 years. No late related adverse events occurred, and no de novo erectile dysfunction has been reported
How much does UroLift or Rezūm cost?The cost of both procedures is ranging from £4800, when self-paying at the River Hospital where I am based in Sawbridgeworth. The cost of UroLift can vary in some cases, depending on how many clips and applicators are used. Rezūm is a fixed price.
What’s the evidence that this is a safe procedure?
Both have been approved by the National Institute for Health and Care Excellence (NICE), whose main role is to establish safety and effectiveness, in the use of health technologies in clinical practice. Thanks to NICE, we know that these procedures are safe to use.
Content provided by Mr Jaspal Virdi, Consultant Urologist