BPH Procedure in Cape Town – The perfect fit.
30 June 2025What does it mean to care for a patient with an enlarged prostate?
Benign prostatic hyperplasia (BPH) is an alarmingly common progressive condition, with almost 80% of men affected in some way at the age of 70, and 90% at the age of 80yrs. Many of these men, have enjoyed a good quality of life up to this point and find the condition especially debilitating. In a short space of weeks to months, symptoms of a worsening stream, waking up several times at night due to poor emptying develop which could affect every aspect of active life.
In a worse case scenario, he might need to be catheter dependant or be forced to insert a catheter several times a day himself just to empty. Activities are severely restricted and even a routine trip to the shops requires careful planning.
The old doctrine is that all men with BPH (once cancer is excluded by a GP or Urologist), should be started initially on medication. Tamsulosein (or similar class) is meant to relax the smooth muscle of the prostatic urethra and improve the flow of urine. Side effects are relatively uncommon and most men tolerate the medication reasonably well.
The problem arises when the condition has progressed beyond the ability of the tablet. What should be the next phase of care?
Again, the old doctrine would dictate that a second tablet should be added to the cocktail. A far more aggressive active-testosterone suppressing variant (finesteride/dutasteride). It might be argued that taking a tablet that might cause you to be impotent, depressed, anxious and affect your general hormonal balance might be justified. A further suggestion might be to numb the bladder - treat the symptoms rather than the cause. In the old alternative universe, an open operation of the prostate was a major event, even considered life threatening. A transurethral shaving of the prostate was also associated with prolonged bleeding and burning after. Men had to bare the side effects of hormone altering tablets as there was no acceptable alternative.
Fortunately this era has passed.
The care of these men have been revolutionised by an entirely new armoury of minimally invasive therapies focusing on reducing the prostate size without affecting the quality of life of these patients. An example is REZUM (focused steam treatment to the prostate). A simple two minute treatment done in the clinic or day theatre under light sedation or local anaesthetic is replacing the old order. We have proven that following treatment, 80% of men can stop their hormone manipulating medication with an obvious improvement in quality of life. Only 4% of men require a surgical re-treatment in 5 years!
If the prostate is to large for REZUM, or a permanent solution is needed, Holmium Laser Enucleation of the Prostate (HOLEP) regarded as the “King” of all procedures to the enlarged prostate, can now be done as a day procedure with a short anaesthetic. Symptom relief and improvement in quality of life is unmatched.
Although the management of BPH might be regarded as complex, there is however one certainty. The concept that one size fits all and that medication is always the first line in flawed. Modern therapies like REZUM and HOLEP will continue to lead the way for now and the foreseeable future.
