How to decide best BPH treatment

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I am 58 and have had gradually increasing BPH symptoms for years due to my large prostate. I see my urologist every year mainly to screen for prostate cancer since my father had it.

Every year he asks about BPH symptoms . For the most part my symptoms are not very bad. I get up some nights to urinate and sometimes feel I don't empty my bladder completely but it isn't that bad.

At last years checkup he did a UroCuff test to measure my flow and said it was too low and suggested I consider Urolift or start taking Flomax. I opted for Flomax and have been taking it for almost a year. We did another UroCuff test after 3 months of Flomax and it was better.

I am wondering if I should go ahead and get the Urolift or maybe one of the other less evasive procedures (PAE, iTIND, etc.). He has only sugested Urolift and highly recommends that but I plan to ask about the other options at my next checkup.

My symptoms are not really that bad other than I need to urinate more and it takes longer than it used to. It would be nice to go longer without needing to urinate so I am thinking it may make sense to have something done.

Is Urolift the way to go these days? Is there another option I should strongly consider? Since my symptoms are not really bad should I just continue with Flomax for now?

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  • Edited

    I had a Urolift 2 years ago . since I have a large median lobe and the doctor didn't tell me. He only treated the lateral lobes, which resulted in no improvement. if you only have lateral lobe issues I would go for the pae. it's less invasive and you won't have to go through the pain and suffering of a Urolift. I burned for almost 2 years after my procedure. looking back on it, it actually made me worse because of all the inflammation that it caused. you may get some inflammation from pae,, but the recovery is so much faster. I'm looking at a second procedure, so no pae option for me due to my large median lobe.

    A Urolift will only last you about 5 years if you're lucky. the prostate will grow over the Urolift clips.

    When you get ready to do another procedure, you can remove the internal clips, but the hooks/ anchors are left in place, that's the part I don't like. They claim no issue with leaving them in place, however you may find out later, they do cause an issue.

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    • Edited

      Thanks, I don't know my prostate specifics, just that it is large. I will ask about my lobes at my next appointment. My doctor makes the Urolift sound quick, simple and effective but I am always leary that I will have 'rare' side affects. He did tell me that the Urolift will probably only work for about 5 years but made it sound like a good way to address my issues for a few years rather than taking the Flomax. I'm not a fan of taking medicine but wasn't ready to jump right to the Urolift procedure.

      In addition to Urolift, the doctors office also lists Aquablation Surgical Therapy, Laser Vaporization, iTIND, Plasmabutton Vaporization, PAE , Rezum and Transurethral Microwave Therapy as minimally invasive treatments they offer for BPH. My doctor only mentioned Urolift but I will ask about the other options and why is recommends Urolift over the others.

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    • Posted

      Urolift is easily done in the office. I believe the rest take specially equipment, so they cannot be done in office.

      if you want something that's going to last longer than 5 years with a low possibility of sexual side effects , you might look at Aquablation. it's possible the pae would last longer than 5 years. the nice thing about the pae is that it can be repeated, no sexual side effects and it's has a much quicker recovery time than the other procedures.

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    • Posted

      I was up 8 or 10 times a night and after researching all the options and excluding most due to side effects of catheters, pain, loss of function etc I had urolift. Went In morning procedure took 20 mins and afterwards very little pain. Just had to wait until pee cleared from red to pink to clear which took 3 hours and was home in afternoon. Age 67 when done in 2016. Still all well. Good luck

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    • Posted

      That is good to hear. The Dr said the Urolift would take about 15 minutes in the office. He made it sound very simple and effective. I read about bad experiences and worry it will make things worse but it is good to hear it worked for you and you are still good.

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  • Edited

    The best summary info I came across was posted by someone else in another thread on this site. There are many factors, including size, shape, and trade-offs you're willing to make. What's unique about this chart is that it also relates symptom score to likelihood of success.

    https://prostatematters.co.uk/determining-suitable-bph-treatment-options/

    If I had seen this prior to choosing to do Rezum, I likely would have chosen something else. My prostate size was about 35, and my IPSS was around 21. As you can see by this chart, Rezum is not recommended. I had a Rezum procedure in April 2022, and it was completely unsuccessful. I'm now 6 weeks out from a bi-polar button TURP, and have experienced a life-changing improvement, and so far no negative side effects. I basically wasted a year and a half trying a less invasive procedure that honestly, considering Rezum was done while I was awake and the TURP while completely knocked out, was more traumatic than the TURP.

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    • Edited

      Thanks, this is helpful. My IPSS is moderate (8-10) but I don't know my prostate volume. I may email the doctor and ask the volume to see which procedures the article suggests. Since he has only recommended the Urolift I suspect that is what I will do if I decide to go off Flomax but I plan to ask about PAE. If he wasn't already suggesting the Urolift I would probaby pursue PAE based on what I have read.

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  • Posted

    Just my experience, and clearly I can't speak for others, but happy to share my Urolift experience.

    I was diagnosed with BPH, with a moderately enlarged prostate (including a median lobe protuding into my bladder) and a weak flow. Booked in for Urolift in November 2022 on the basis that it was the least invasive treatment, and that although it was originally considered unsuitable for large median lobes, a way had been found to deal with them in the hands of a skilled, experienced surgeon.

    The procedure itself was fine - some blood but I went home without a catheter the same day. Some initial improvement in flow but over the following weeks all of the previous symptoms returned, particularly a very weak flow, as well as some pain. So overall a fail, within a short period of time. After that I arranged for a PVP treatment, which after some improvement didn't work either, but that's another story..

    Hindsight is a great thing and my motivation for going with Urolift seems understandable looking back - no hospital stay, no effect on sexual function. When I asked the doctor beforehand about success rates he said something about how it was "all subjective" which should have set some alarm bells ringing. The downsides: I wasted time in trying to get my long-standing, and increasingly disruptive BPH problem fixed, and ruled out HOLEP treatment in the future (which based on what I know now would be my treatment of choice) because the laser tool it uses to remove prostate tissue can be affected by the Urolift clips.

    That said, I am aware that others have had good, long-lasting experiences with Urolift, and I wouldn't necessarily advise against if you do it with your eyes open. But I would press your doctor hard on his/her success rates, and would think twice about it if you have a large median lobe.

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  • Posted

    IT sounds like you would benefit, at least while pondering surgery... by doing some self-catheterizations (CIC)... in your case, maybe once or twice a day? One just before bed?

    I've been doing CIC for over 5 years and it is really not much of a hassle... I probably take around the same time peeing as a guy with BPH. Yes, somewhat inconvenient...

    I'm considering surgery, between a green light PVP and a TURP... leaning PVP, if I do it at all... I also need a BNI... some stories of failures and side effects are scary...

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