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 urological procedure is right for you. We’ve asked one of our expert urologists Mr Jaspal Virdi to explain two of the commonest treatments used, Rezūm and UroLift.

Here he discusses just how successful they are in treating the urinary symptoms associated with BPH, and 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 the prostate tissue that is blocking the flow of urine from the bladder. The tissue shrinks and 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 regarding the follow-up MRI scan to assess for prostate cancer. We tend to use more of Rezūm than UroLift.

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 the prostate is measured by transrectal ultrasound. Rezūm can be used to treat any type of prostate size 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 the National Institute for Health and Care Excellence (NICE) in July 2018 whereas UroLift was approved in 2015. I’ve been performing Rezūm since January 2019.
 

Who is a good candidate for UroLift?

Good candidates for the treatment include men over the age of 50 with either of the following reasons:
 

• An enlarged prostate – which causes lower urinary tract symptoms.
• Urinary symptoms – such as an increase in urinary frequency, difficulty in holding urine (urgency) and reduced urine flow with increased retention of urine.
• Sexual dysfunction – for those who wish to retain sexual function.
• Intolerance of 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, which can take between four to six 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 two to five days before it is removed.
 

What does recovery involve?

Patients can resume normal activity as soon as the catheter comes out. I recommend that the patient takes one week off from work to recover.
 

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 two to three weeks and a urinary tract infection.

At the present time, we have about four years’ worth of follow-up results to reference. Of the results available, they show no patient follow-up treatment in Rezūm. With UroLift, we had repeat treatment of about 6.5%.

At the moment in Rezūm is better than UroLift. In Rezūm we are seeing over 50% improvement in the slow of the urine and reducing urinary urgency and symptoms, which is lasting four years.
 

How much does UroLift or Rezūm cost?

The cost of both procedures is £4,500 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 NICE, whose main rule is to establish safety in the use of health technologies and treatments in clinical practice. Thanks to NICE, we know that these procedures are safe to use.

Suffering from BPH? Do not hesitate to book an appointment with Mr Virdi for a first consultation.