Better Stream: Understanding BPH

July 22, 2021

Better Man Clinics 

We often hear about the prostate in terms of bad things like cancer or urinary problems.  What is the prostate and what does it do?

Dr Bui 

The prostate has a very important function- its primary function is in reproduction. The prostate contributes to making the semen, the fluid that carries the sperm, Without it, there’s no such thing as procreation. So that’s its main role.  The prostate grows at two times in our lives: it has a growth spurt at puberty, which is responsible for its maturity, and then it has another growth spurt at later stages in life when a man reaches his 50s and 60s.  We don’t understand the evolutionary purpose of this second growth spurt, but it’s responsible for a lot of urinary problems. The second growth spurt usually starts happening at around age 50 to 60. It continues to grow as we age and it’s responsible for many of the urinary issues that men complain about like getting up at night and needing to strain to urinate.

Better Man Clinics 

Why does the prostate have such an impact on urination?  Why does it matter if it increases in size?

Dr Bui  

The prostate is located deep inside the pelvis.  It sits beneath the bladder and wraps around the bladder opening. The bladder is like a funnel.  It is a container that holds your urine and then drains it  out through a funnel. Around this funnel is the prostate, which wraps around it, like a, like a scarf, so to speak. The prostate is located there for a purpose, because it taps into the urine channel, where it allows the semen and the sperm within it to exit through the same channel that the urine does. But as the prostate begins to grow, it begins to tighten up and, and close off on that bladder opening and starts to restrict the flow. That is what we refer to as Benign Prostatic Hypertrophy or BPH.  So its location is important for procreation, but it’s also in a very delicate place because as it grows, it starts to affect how a man empties his bladder.

Better Man Clinics 

So, using your example, the prostate constricts and tightens up that funnel so that the urine has to travel through a smaller and smaller opening to get where it needs to go?

Dr Bui 

Correct. And that makes it harder for the urine to flow and makes the bladder work more which creates many of the urinary symptoms we will be discussing.

Better Man Clinics 

We had mentioned how a growing prostate causes a slowing of the urinary stream.  What are the other symptoms associated with benign prostatic hypertrophy (BPH).

Dr Bui 

As a man ages, he often realizes that he does not urinate as strongly as he used to and that he has to urinate more often. He also may notice that the urine may not come out right away. These symptoms are classic indicators of the prostate beginning to affect the way you empty your bladder. A common BPH symptom that men complain about is a slow or weak stream. They say, “I used to be able to pee like a racehorse and put out fires and but now it’s like a drizzle.”  Some men complain that while they used to get up once a night to urinate, the now get up 2 or more times a night. This can be a problem for some men because it affects their rest and they are tired all day long. The stream may also not start right away(urinary hesitancy) and they may need to stand there and wait a while for it to come out. Some men may feel like they don’t empty their bladder completely. They feel like, when they’re done, they still have some urine left over and they need to come back and try a second time. BPH can also cause other issues like urgency and frequency where they have to urinate frequently and rush to a bathroom or they’re going to have an accident.

Better Man Clinics 

What is it about the prostate that makes men get up a lot at night to urinate?

Dr Bui 

The prostate doesn’t work in a vacuum.  It is connected to a lot of other things. The bladder is connected to the prostate and to the kidneys. The bladder is a muscle. It’s a muscle that works together with the prostate in tandem. They are like two dancers, like Ginger Rogers and Fred Astaire- they work together and adapt to one another through time. As the prostate makes it harder for the urine to pass, the bladder needs squeeze harder and harder to get the urine out. It has to adapt to the demands that it is presented with because the prostate is now creating an obstruction. As a result, the bladder has to work harder and harder. That change in the bladder can lead the bladder to become spastic and can cause the symptoms that men experience, like urgency the frequency and as well as repeated urination at night- this is due to the spastic behavior of the bladder. In addition, the prostate doesn’t allow a person to empty completely.  Maybe they only empty halfway and it doesn’t take long for their tank to fill up again. That triggers another urge to urinate quickly and can explain why they are getting up to urinate multiple times at night.

Better Man Clinics 

One thing that men often aske when it comes to any kind of condition is, “am I doing something wrong?” Am I eating something wrong? Am I drinking something wrong? Is there anything that I should avoid, to at least some extent, to help me with my urinary symptoms? In other words, can BPH be prevented?

Dr Bui 

For the most part, these changes are pre-programmed.  These changes are not the fault of the man in terms of anything they’re doing or eating.  These are changes that that are biologically programmed into a man’s prostate. Some men begin to have these symptoms early in their 50s.  For others, it doesn’t happen to them until their 70s.  Its not necessarily related to anything that they can change.

Better Man Clinics 

Can any dietary habits make the symptoms of BPH worse?

Dr Bui 

Certain habits can actually worsen BPH symptoms. Take caffeine, for example.  Caffeine is a diuretic so it stimulates increased urine production by the kidneys. If a person drinks a lot of caffeine throughout the day, then that caffeine kicks in, often during the night. That wakes them up from sleep because suddenly their body is releasing more and more of the fluid from within their body.  I usually advise people to limit their caffeinated drinks to before noon, because it takes about 10 hours or so for the caffeine to really kick in. If they’re drinking caffeine in afternoon or evening, then it kicks in when they’re asleep. Alcohol has a similar effect.  In addition, Alcohol can also be an issue because it also relaxes the bladder. That can make the bladder a little weaker so that it doesn’t empty as efficiently. Even outside of diuretics, I advise people that, if they like to drink a lot of water, they should to try to fill up their tank earlier in the day and try to limit their fluids at nighttime. In so doing, they don’t have to get up and urinate throughout the night because they will have already urinated out that fluid earlier in the day.

Better Man Clinics 

I often hear men say that, because they get up so much at night, they become worried they are going to get dehydrated. So every time they go and urinate, they drink a little bit more to avoid dehydration. Is that a bad idea based on what you are saying in terms of limiting fluids at night?

Dr Bui 

I try to reassure them that the six or eight hours that they’re sleeping is not going to dehydrate them.  If they hydrate throughout the day, they are going to be fine throughout the night. If they do feel a dry mouth and a sensation to quench their thirst, then they can just take a little sip of water to swish and spit. That way, they can relieve that dryness but not to gulp a large amount of fluid at night

Better Man Clinics 

How do over the counter cold and flu medications affect urination in men with BPH?

Dr Bui 

Oftentimes, I’ll hear of a person who has a cold and takes Benadryl or an over the counter decongestant. He may notice that the urine flow is a lot slower and sometimes the urine flow can stop completely and cause urinary retention. Many of the over the counter cold medicines work through anticholinergic effects which not only dry out nasal passages, but also causes a relaxation effect on the bladder muscle. That relaxation makes it difficult to empty the bladder. Men with BPH should be careful with these types of medications.

Better Man Clinics 

You we outlined several symptoms that are typical BPH symptoms: frequency, urgency, nighttime urination etc.  Are there any red flag symptoms that men might come across that would indicate that there may be more going on than just BPH and that it may be time to consult with a doctor?

Dr Bui 

The symptoms that we mentioned are “bother” symptoms. These are symptoms that affect quality of life. If the symptoms are very bothersome, men can see a doctor to improve their quality of life. But there are symptoms that raise more concerns that something more serious is going on.  One is seeing blood in the urine. Another is having urinary tract infections which can cause symptoms of burning pain with urination, bladder pain, and occasionally fever. A typical man shouldn’t be getting a urinary infection. But if they’re getting an infection once, two, three times a year, that could begin to cause a problem. Sometimes men go for their health physicals and a blood test can show elevation in the kidney function test (creatinine) which indicates a problem with the kidneys. For men with BPH, this could be due to urinary retention and back up of urine from the bladder to the kidney.  This can occur even though the patient has no symptoms and is feeling fine.

Better Man Clinics 

One common concern that comes up for men with BPH symptoms is that their symptoms may actually be caused by prostate cancer. Is there an association between BPH and prostate cancer? Does prostate cancer cause this same symptoms as BPH?

Dr Bui 

I reassure men that that prostate enlargement and prostate cancer are, as far as we know, not related. One does not cause the other.  They are separate conditions that can occur at the same time and they just happen to occur in the same organ. Why is prostate cancer such a big deal? It is the number one most common solid tumor, aside from skin cancer, diagnosed in men. It is the number two cause of cancer death in America behind lung cancer. Sometimes, prostate cancer can present with the same symptoms as because if the cancer grows to a large size within the prostate, it can can cause very similar symptoms to benign prostate enlargement. So again, these conditions are not related as far as we know. They can occur at the same time and it can be a challenge to sometimes know what is causing the symptoms.  For that, we rely on a blood test called PSA or prostate specific antigen, which can help identify prostate cancer in men.

Better Man Clinics 

Many men like the concept of natural solutions to their medical and wellness issues.  Are supplements something that you feel can be a first line treatment for BPH?

Dr Bui 

Clinical studies have looked at some of the supplements but not all of them. Saw Palmetto, for example, is a very common supplement that men take for the prostate. Studies have shown that it’s not any better than placebo for helping with urinary symptoms. There are a lot of things we don’t know about supplements. They are not regulated and we don’t know what goes in them. But, you know, I try to keep an open mind with patients that find supplements that they think are helping them. I don’t use supplements in my practice. But if a patient comes in taking a supplement and as long as it’s not something that is going to harm them, I usually try to keep an open mind and say it’s up to them. I don’t particularly use them in my practice because I don’t see supplements moving the needle very much in terms of affecting the quality of a person’s urinary function.

Better Man Clinics 

With is the right time for a man with BPH symptoms to go and see a doctor?

Dr Bui 

The right time to see a doctor for BPH is when it begins to affect quality of life. Everybody is very different in this regard.  Some people get up two, three times a night and they fall back right back to sleep.  They say “I’m fine with that.  I’ve been living with it for years and it’s not a big problem.”  And there are some people that get up once a night and they’re miserable, because they can’t rest. When it begins to interfere with your activities, when you have to plan your car rides around where the next bathroom is, you should see a doctor. When the problems begin to grow to the point that you feel that cannot live it, you should start having that discussion with your family doctor or maybe with a urologist. We usually recommend for prostate health, in general, whether you have symptoms or not, that men around the age of 50 should start to have regular PSA blood tests and prostate exams by their family doctor or by a urologist. Again, this is for all men, even if they really don’t have a lot of symptoms because prostate cancer is so common and so treatable. During those routine checkups, the doctors will probably ask them about BPH symptoms.  If the answer is that they don’t have symptoms or that the symptoms don’t bother them, then that’s great.  Otherwise, if they are bothersome, that is a good opportunity to address them.

Better Man Clinics 

What should a man expect when visiting a doctor for BPH symptoms? What kind of exams might you do? What type of tests might you perform?

Dr Bui 

Well, it depends on the severity of their symptoms.  It obviously involves a brief discussion with the doctor about what we call the history.  We want to hear about the severity of the symptoms. We might ask them to fill out a questionnaire. We have a list of questions that will assess their symptoms. If the symptoms are not very severe, the visit usually involves a brief discussion and then an examination. The doctor will probably examine the abdomen, the genital area, and a prostate exam.  This exams involves placing a finger into the rectum to actually feel the prostate.   The visit might also involve a blood test to make sure that the kidneys are functioning as well as a PSA test. If any of these tests raise any red flags, then we have to pursue them further. But that’s pretty much it- a quick talk, quick examination and a blood tests. That’s usually what’s involved.

Better Man Clinics 

Are there any other conditions that could mimic BPH?  In other words, could other conditions be causing BPH symptoms?

Dr Bui 

It really depends on their symptoms. If they are having pain or pain and fever, you would think of inflammation or an infectious process such as a urinary tract infection, prostatitis, or a sexually transmitted disease. If there’s blood in the urine, it could be a sign of bladder cancer. As we discussed before, obstructive symptoms common in BPH could also be signs of prostate cancer.

Better Man Clinics 

When you have made a diagnosis of BPH in a patient, how do you then treat Is there a certain set of medications that you might rely on?  Are there different kinds? What is your approach with medications for BPH?

Dr Bui 

If a patient is looking for help with BPH symptoms, the first treatment option that we that we discuss is medication. There are prescription drugs that we can prescribe that will help alleviate some of the symptoms. One type of drug is called an alpha blocker.  Common examples include Terazosin(Hytrin), Doxazosin(Cardura), Alfuzosin (Uraxatral), Tamsulosin (Flomax), and Sildosin (Rapaflo).  These are some of the different versions of alpha blockers and the mechanism of actions of these drugs is to relax the smooth muscle of the prostate.  If you can relax the prostate, the urine flows through it much easier. A second type of drug is called a five alpha reductase inhibitor.  Drugs in this category include Finasteride (Proscar) and Dutasteride (Avodart).  These medications work in a different way- they shrink the prostate. There is another kind of drug that’s often used called Cialis. This is a drug that is usually used to treat erectile dysfunction but studies have shown that Cialis (or its generic version Tadalafil) at low doses can improve a man’s urinary flow. In my practice, I have noticed that Cialis does help but not to the same degree as the alpha blockers.  I do not usually use it for men with significant symptoms.  It can alleviate milder symptoms and is good for men concerned about the side effects of alpha blockers. I usually have a very in-depth discussion as to the side effects of these medications because these drugs are not without side effects.

Better Man Clinics 

What are the side effects of these prostate medications?  Let’s start off with alpha blockers- what kind of side effects can men expect?

Dr Bui 

The biggest difference that that these men will notice is in their sexual function.  Alpha blockers cause a condition called retrograde ejaculation. With this condition when a man has sexual relations, he will notice that very little semen comes out during ejaculation. That can sometimes be alarming to them if they are not aware that this is a known side effect. This medication relaxes the prostate so much that it doesn’t close the bladder opening during ejaculation. As a result, the semen can flow into the bladder, the path of least resistance, rather than out of the penis. As a result, they don’t see a lot of semen come out. I tell my patients that it is mainly an impact on the direction of the flow of the semen -it’s not a contraceptive.  Some men do say that the quality of these orgasms are not as good. But for the most part, if they’re aware that the semen is not going to be there, it’s not a deal breaker for most of them. The other thing that I tell people to be aware of with alpha blockers is that it can impact their blood pressure. This can make some men dizzy, particularly when changing their position from a lying down to standing position, to the point that some may even pass out. Men should be aware that this could happen and should get up at night slowly while they get adjusted to the medication. Sometimes the effects are so prominent that we have just to have them stop the medication.

Better Man Clinics 

A lot of men have concerns about the retrograde ejaculation caused by alpha blockers. They ask whether the condition is dangerous.  Specifically, the wonder if the buildup of semen in the body represents a blockage and could be harmful.  Is that the case?

Dr Bui 

It is not dangerous. The semen goes into the bladder and, with the next urination, it gets flushed out. The semen is still being produced and released; it’s just going through a different path. It’s not dangerous, it’s not harmful, and it’s reversible. If they stop the medication, then it goes forward again.  Common question I get from patients include how long they are going to be on this medication and what will happen if they have side effects.  I tell them that this is a long term treatment.  The medication can work for several years. However, when I prescribe a medication like an alpha blocker, I also tell my patients that they are not committing to this treatment for life.  If the medication does not agree with them, they can always stop it.

Better Man Clinics 

One other side effect that patients sometimes attribute to alpha blockers like Tamsulosin is erectile dysfunction. Have you seen that on your practice?

Dr Bui 

Tamsulosin normally doesn’t cause erectile dysfunction. That’s seem more frequently with five alpha reductase inhibitors like Finasteride and Dutasteride.  I tell my patients that, with Finasteride, a small percentage of men (3-5%) who report that their libido isn’t as good and, as a result, their erections are not as strong. And it affects the men who already have sort of weak erections to begin with. The other drug, Avodart, does have a higher incidence of erectile dysfunction of anywhere between 10 to 20%. That is something that is very important to tell me prior to having then start these medications.

Better Man Clinics 

Are there any other side effects that you counsel men about in regards to taking these five alpha reductase inhibitors?

Dr Bui 

There has been a controversy with regards to the relationship between five alpha reductase inhibitors and prostate cancer. Some men will read the medication inserts or an article online and raise a concern that these drugs cause prostate cancer. This has been a debate in the field of Urology. Many years ago, there was an idea floated that taking these drugs could actually prevent prostate cancer. A well known study was conducted to evaluate the possible effect. What they found was that, in men who took five alpha reductase inhibitors like finasteride, there was a significant reduction in prostate cancer. However, in men who got prostate cancer while taking these drugs, it appeared that a more aggressive version of prostate cancer was found. This has led to the concern of the relationship between these medications and the risk of prostate cancer.  I try to reassure my patients that these studies probably indicate a kind that the medication causes a microscopic change in the way the tissue looks that makes it appear more aggressive. What we do know though, is that taking Finasteride did not lead to any increase in death in men who were later diagnosed with prostate cancer. So it is not more deadly but, rather, it just it just looks more aggressive under the microscope.  It does not behave like aggressive cancer, however. The interpretation of this findings is that the hormonal effects of the medication causes so much shrinkage of the prostate that it affects the way you view the architecture of the prostate under the microscope- that makes it look more aggressive. At the end of the day, if there is an indication to use 5 alpha reductase inhibitors to treat BPH symptoms, then it is safe to use. However,  we don’t recommend these drugs solely for the prevention of prostate cancer.

Better Man Clinics 

One other side effect that is sometimes mentioned in relation to five alpha reductase inhibitors is gynecomastia, or abnormal growth of breast tissue in men.  Have you seen this in your practice?

Dr Bui 

I have heard from some men that these drugs led to some breast growth. It is not common, but it can occur. And when it does happen, it is certainly stressful for these people. They then have to stop the medication. It is a known side effect and can discourage some men from taking the medication.

Better Man Clinics 

What happens when the medication you prescribe for a man with BPH either does not help his symptoms or causes side effects that prevents him from taking it?

Dr Bui 

When a man fails medication or doesn’t want to take medication or can’t take it because of side effects, then we have to talk about more aggressive options. In the past, the only other pathway was surgery, where we would have to operate on the prostate. However, in the past five years or so, there have been more office based interventions that we can offer.  One is called Urolift and the other is called Rezum. They take 5 to10 minutes to perform in the office and they can provide quick and durable relief. Many of the patients who undergo these office based procedures can avoid surgery and come off all their medication.

Better Man Clinics 

That sounds very impressive. What is involved with these procedures?  How do they work?

Dr Bui 

The Urolift  is a 5-10 minute procedure where the urologist gives the patient a local anesthetic or a gas anesthetic( something to help them get through the procedure comfortably. The urologist inserts a little camera through the penis channel and is able to visualize the prostate.  Through the camera, the urologist deploys little implants or anchors which helps to pull the prostate apart and widen the channel.  This widening of the channel allows for easier passage of the urine.  For Rezum, instead of using the anchors, a special needle is used to inject a little puff of steam into the prostate tissue. The steam causes the prostate to shrink and open up the channel. Both procedures takes 5-10 minutes and patients go home the same day. There can be a delay of a week or up to 10 weeks to reach maximum effect in terms of relief of symptoms.

Better Man Clinic

Can you share how you counsel men on these BPH procedures?

Dr Bui

First, I tell them that the gold standard of treatment for BPH is surgery. The common surgical treatments are a transurethral resection of prostate (TURP), also known as a “roto rooter”.  It’s an actual surgery, takes about 90 minutes to complete, often requires a general anesthetic, is performed in an operating room, and sometimes requires an overnight stay in the hospital. The main benefit of a TURP is that it works mostly all the time and that it lasts for 10 years. But with any surgery, there’s always risk involved including the risks of anesthesia, bleeding, and  infection. With office based procedures like Urolift and Rezum, you avoid the invasiveness of the surgery (TURP) and the hospitalization. The other benefits of Rezum and Urolift are that there are minimal effects on urinary control (continence) of erectile function (potency).  Also, the majority of the patients can come off their medication after these treatments. The negative aspect of these less invasive procedures is that its benefits do not last as long as those of a TURP. The typical timeframe during which Urolift can provide continued relief of symptoms is about three to four years. After that time, patients are likely going to need to be treated again or by some other modality.  The timeline for the continued benefit of Rezum can get a little bit longer, maybe four to five years of control.  However, that is also not as long as the 10 years of durable relief provided by the traditional surgery (TURP).

Better Man Clinics 

You had mentioned the risk of erectile dysfunction for men undergoing BPH surgery.  Is the risk of erectile dysfunction high after the TURP procedure?  Is the risk equivalent to that experienced by men undergoing surgery for prostate cancer?

Dr Bui 

No, not at all.  The main risk from a TURP with regards to sexual function is the retrograde ejaculation  we discussed previously with regards to alpha blockers.  After the TURP procedure, a high percentage of men have retrograde ejaculation and it is not reversible. With regards to impotence or erectile dysfunction, the risk is less of a worry with a TURP.  Because all the nerves that control erections live on the outside of the prostate, they are usually not affected by a TURP which involves work done on the inside of the prostate.  There are a small percentage of men that will report their erections are weaker after a TURP. I’m not sure if these men have underlying weak erections and may notice them more after the procedure because they may be more aware of them.  The retrograde ejaculation, in contrast, is a high risk.

Better Man Clinics 

You had mentioned that leakage or urine or incontinence is not a big risk for UroLift and Rezum. Is incontinence a big risk after the TURP procedure?

Dr Bui 

Not a large risk. It’s about a 1% risk.

Better Man Clinics 

One of the values of UroLift and Rezum that have been marketed has been that there procedures do not cause retrograde ejaculation like TURP.  Have you found this to be the case?

Dr Bui 

In my experience, with UroLift, I have seen a very low rate of retrograde ejaculation. However, with Rezum, I have seen retrograde ejaculation occur, especially when there is a very dramatic shrinkage of the prostate that occurs as a result of the procedure. So, while for UroLift, the risk of retrograde ejaculation is minimal, I due quote a 20% risk of retrograde ejaculation for Rezum

Better Man Clinics 

Are men required to maintain a catheter in their bladder after TURP?

Dr Bui 

It depends on the urologist and their approach. In my practice, I generally send people home with a catheter for a few days. If a patient is able to urinate after the procedure and they are not having any bleeding, then they technically do not require a catheter. But in my practice, I tend to use a catheter for a few days just to provide a smoother experience. There is nothing more distressful for a patient than to not be able to urinate. In that way the catheter helps to avoid stressful visits to the ER for patients that may have trouble urinating or have some bleeding. So I generally use a catheter after TURP for about 48 hours and then take it out in the office. That said, it can also be done without a catheter too.

Better Man Clinics 

After a TURP, is the relief of symptoms instantaneous or does it also take up to 10 weeks for symptoms to resolve as you had mentioned for UroLift and Rezum?

Dr Bui 

After a TURP, generally, people have a great mechanical flow, meaning that the urine flows very quickly and very easily. But what they can experience is a six to eight week period of urinary irritation. During a TURP, that prostate area has to be shaved, which leaves a raw surface. And so it can lead to irritation. The way I explain this to patients is that it is like when they were little and they would fall and scrape their knee – water would splash against their wound and that would sting a little- that’s sort of how it feels. I tell people that for about six weeks or so you need to watch what you eat and drink. Certain foods will irritate the bladder like spicy foods, caffeine, alcohol, garlic, onions and tomatoes, Those kinds of things will really irritate and sting and cause bladder spasms. It takes about six weeks for that for that raw surface to heal and seal off that area of surgery. After that period of time, there is usually no more burning or irritation, just a great stream

Better Man Clinics 

So regardless of whether you go with a TURP versus Rezum or UroLift, there is going to be some recovery time until they reach a steady state where they understand what the true outcome of the surgery will feel like?

Dr Bui 

With a TURP, the flow improvements are immediate, but the irritation lasts about six weeks. With UroLift, the improvements are also more immediate (because the procedure provides a mechanical change) and there is usually not a lot of irritation because you are not scraping the tissue. With UroLift, patients are urinating better within 1-2 weeks. The resume takes about eight to 10 weeks for people to really feel the improvements because it relies on the body to clear out some of that prostate tissue that’s been treated with the water vapor. And that doesn’t happen quickly. So, with Rezum, I tell patients to assume that that their flow will not be better immediately. It can take 10 weeks for that to happen.  With UroLift, you can get a quicker improvement in your flow, but the effects may not last as long.

Better Man Clinics 

What if a man decides to go with UroLift or Rezum and they do not provide him with enough relief?  Is TURP still an option in that scenario?

Dr Bui 

Absolutely. They are not burning any bridges. If they choose to do the office based procedures, there’s a good chance they’ll work for them, at least for a finite period of time. If they fall in the group of 20% of patients for whom those procedures do not work out to your satisfaction, they can likely have the option of a TURP later on.

Better Man Clinics 

UroLift and Rezum are newer procedures.  Do men looking to have these procedures need to ask potential surgeons any specific questions prior to agreeing to proceed? Should they be asking about experience performing the procedure?

Dr Bui 

Yes, but to a certain extent.  These procedures are not as involved as robotic surgery. These procedures are not technically that complicated. First, the patient should feel comfortable with the doctor and his or her explanation. Obviously, you want someone who’s not doing their first procedure on you. But this technology is only about four or five years old, so its not likely that you will find to many surgeons who have done thousands of these procedures.  Also, it doesn’t mean you won’t get as good a result from someone who does fewer. Again, you have to feel comfortable with the explanation. You have to have a clear, detailed explanation for what your expectations will be from the procedure. I think that if a surgeon can convey those kinds of things to a patient to make them feel comfortable, then I think that there shouldn’t be a problem with the surgeon performing it.

Better Man Clinics 

What role does laser surgery have in the treatment of BPH

Dr Bui 

Laser therapy is relatively new and falls into the area of the more aggressive type of treatment like the TURP. Laser therapy accomplishes the same goal as TURP, removing prostate tissue, but just uses a different tool. Instead of using an electrical loop that scoops he prostate tissue out, you use a laser to try to either vaporize the tissue, or remove the tissue from the prostate. There are two kinds of lasers: a green light laser, and there’s a holmium laser. The green light laser vaporizes the tissue and seals blood vessels.  It a tool I use quite often.  The holmium laser is a little in that it cuts the prostate tissue so the surgeon can use it to carve the obstructing prostate tissue out of its current location and remove those pieces. All three modalities are effective: the TURP, the green light laser, and the holmium laser. It really depends on the experience of the urologist. Some urologists are very, very good at TURPs. Other urologists are very good at holmium while still others are good at a green light laser.  In the right, competent hands, whatever tool is chosen is going deliver a good result.