BPH Archives - Grand Rounds in Urology

Sphincter-Saving Technique in HoLEP Surgery

by Seung-June Oh, MD, PhD | Jul 2021

As part of Grand Rounds in Urology’s ongoing series highlighting urologists working in Asia, Seung-June Oh, MD, PhD, Professor of Urology at Seoul National University in Seoul, South Korea, explains and demonstrates his sphincter-saving technique for holmium laser enucleation of the prostate (HoLEP) surgery. After an introduction by Peter K.F. Chiu, MD, PhD, FRCSEd, Dr. Oh goes over the benefits and difficulties of HoLEP for benign prostatic hyperplasia, emphasizing the problems of post-operative urinary incontinence. He then goes over strategies for maximally preserving the continence mechanism during HoLEP and introduces his Early Inverted V-shaped Apical Mucosal (EVAMI) Technique before showing footage of a routine HoLEP surgery. The presentation concludes with a question and answer session led by Dr. Chiu.

When All Else Fails: Holmium Laser Enucleation of the Prostate as Retreatment for BPH

by Nicole L. Miller, MD, FACS | Sep 2020

Nicole L. Miller, MD, FACS, Associate Professor of Urology at Vanderbilt University Medical Center, discusses Holmium laser enucleation of the prostate (HoLEP), particularly focusing on the retreatment setting. AUA guidelines have recently been updated and now mirror EAU guidelines which suggest sizing a prostate before determining treatment options. Dr. Miller examines case studies that underscore the effectiveness of HoLEP in removing large prostates after the patients had previously undergone unsuccessful treatments, including transurethral resection of the prostate (TURP) and prostatic urethral lift. She then analyzes outcomes of a study that compared primary HoLEP (pHoLEP) to retreatment (rHoLEP) observing that the retreatment setting patients experienced shorter operative times, shorter length of stay, had less tissue resected, and had a higher rate of urethral stricture and clot retention. In spite of its utility, HoLEP has not been widely adopted and represents 4% of procedures, which Dr. Miller attributes to the steep learning curve associated with HoLEP. Lastly, she enumerates the barriers within the US medical system to physicians undertaking the HoLEP learning process and concludes that while Europe has numerous options for physicians to learn the technique, the American focus on robotic surgery means that fewer students learn open orifices surgical procedures.

Treating BPH: Comparing HoLEP, Rezūm, UroLift, and Aquablation

by Mitchell R. Humphreys, MD | Dec 2019

Mitchell R. Humphreys, MD, reviews the current society recommendations addressing when to intervene with surgical management in patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). He provides an overview of new minimally-invasive surgical therapy technologies for these patients.

Updates in LUTS: Treating Overactive Bladder and Nocturia

by Mitchell R. Humphreys, MD | Dec 2019

Mitchell R. Humphreys, MD, describes the shifting landscape of lower urinary tract symptoms (LUTS) management from a symptom-focused approach to a paradigm of altering the underlying disease progression. He focuses on changes in the medical management of nocturia and bladder outlet obstruction due to benign prostatic hyperplasia (BPH).

Treating BPH: Comparing HoLEP, Rezum, and Urolift

by Scott M. Cheney, MD | Jan 2019

Scott M. Cheney, MD, reviews the background and practical application of minimally-invasive surgical therapies and definitive therapies for benign prostatic hyperplasia (BPH). He then discusses patient selection for these therapy options based on recommendations, level of evidence, and comparative outcomes.

Surgical Management of Refractory Bladder Neck Contracture after BPH Surgery

by Brian J. Flynn, MD | Jun 2018

Brain J. Flynn, MD, identifies the frequency of bladder neck contracture (BNC) following benign prostatic hyperplasia (BPH) surgery, prevention strategies, and endoscopic and surgical management. Furthermore, he explains his BNC management algorithm and the currently available lower urinary tract reconstructive procedure options.

Men’s Health from the Heart

by Tobias S. Köhler, MD, MPH | May 2018

Tobias S. Kohler, MD, MPH, demonstrates the correlation between cardiac pathology and erectile function, other sexual function, testosterone levels, and lower urinary tract symptoms (LUTS). To illustrate this, he describes the methodology and results of his Cardio-Urologic Pathology/Prevalence Interplay Determination (CUPID) study. He also discusses ED risk factors, sex hormone binding globulin (SHBD), and the connection between testosterone levels and benign prostatic hyperplasia (BPH).

Fexapotide for BPH

by Ronald F. Tutrone, Jr., MD, FACS, CPI | May 2018

Ronald F. Tutrone, Jr., MD, FACS, summarizes two Phase III clinical trials testing the safety and efficacy of fexapotide, a novel treatment for benign prostatic hyperplasia (BPH).

Association of BPH with OAB: The Plumbing or the Pump?

by Ryan P. Terlecki, MD, FACS | Dec 2017

Dr. Ryan P. Terlecki, MD, FACS, discusses concomitant treatments of overactive bladder and BPH, properly diagnosing sources of LUTS, and when it is appropriate to order urodynamics for a patient.