Mr Rajesh Kavia
Consultant Urological Surgeon, London North West University Healthcare NHS Trust
Surgeons are urging patients with prostate problems to seek diagnosis and treatment at the earliest opportunity to avoid treatable conditions becoming much more serious.
Benign prostatic hyperplasia (BPH), also known as an enlarged prostate, has been described as ‘practically inevitable’ in the older men. The condition is relatively common, affecting more than 40% of men in their 50s and up to 70% of males in their 60s, but if left untreated or undiagnosed it can have an impact on quality of life.1 The enlarged prostate presses on and blocks the urethra, causing bothersome urinary symptoms.
Dangers of delays
Consultant urological surgeon Rajesh Kavia, who is an expert in the field of prostate conditions, explains that symptoms of BPH, can vary from patients complaining of slow urine flow or incomplete bladder emptying, to wanting to go to the toilet more often or with a degree of urgency.2
Mr Kavia, from the urology department within the London North West University Healthcare NHS Trust, explains: “A lot of men put off asking for referral to secondary care from their GP, because they think that their only options are medications or the traditional surgical options which do carry a risk of sexual dysfunction and incontinence.”
“One of the dangers of delaying treatment for this condition is about 4% of patients may not be able to pass any urine at all and their pain and discomfort has to be relieved via a catheter. This becomes more serious with high-pressure chronic retention.”*
“This can cause damage to the kidneys,” he says, “but if we catch it reasonably early it can be reversible.”
A patient having the procedure can usually go home the same day after passing urine often within a few hours of the procedure.
Mr Kavia says after diagnosis there are various treatment options available to patients from tablets, minimally invasive procedures through to the more traditional surgical options.
For the majority of men, the first course of treatment is still medication. Specifically, alpha blockers, which relax the muscles and make it easier to pass urine. Another group of medications are 5alpha reductase inhibitors, which shrink the prostate. They are effective but are also a lifetime commitment and some men do experience side effects from the medication. Surgery is another option offered to men who experience side effects from the medication or who find that it is no longer effective.
Traditional surgery is available to BPH patients but involves cutting away enlarged tissue and can cause sexual dysfunction, among other side-effects. It also requires an inpatient stay and a more prolonged recovery time.3
He says: “When I counsel patients for their surgical options, one of the key factors on deciding which option will be most suitable for them is the size of their prostate. If the prostate gland is very large, a patient may be offered more traditional surgery, such as laser or TURP, but if it is smaller, we can look at minimally-invasive techniques.”*
For that approach, he opts for the UroLift® System technique which lifts the enlarged prostate, so it no longer blocks the urethra. This is a proven approach to treating BPH and has been extensively studied.4
The UroLift® System does not require heating, cutting, removal, or destruction of prostate tissue.5-10 Available on the NHS, it is generally performed under a local anaesthetic, or with slight sedation as a day-case.11
“A patient having the procedure can usually go home the same day after passing urine often within a few hours of the procedure. The majority of patients do not need a catheter following the procedure, which makes it unique as most procedure options may require this,” he adds. “The procedure is the leading BPH procedure shown to not cause new onset, sustained sexual dysfunction*.
“Most patients will experience a quick recovery, though some can experience pain or burning with urination, blood in the urine, and have an urgent need to urinate. Occasionally, a catheter may be required.”
One of the major risks that may lead to poor outcomes after treatment, is if patients wait too long before speaking to their GP and subsequent seeking diagnosis and treatment. Therefore, it is important to seek help if you have concerns.
*This information reflects the opinion of Mr Kavia
 Berry et al, 1984
 Roehrborn, J Urol 2013;
 AUA Guidelines 2003, 2020;
 Mirakhur, Can Assoc Rad J 2017;
 McVary, J Urol 2016,
 Gilling, Can J Urol 2020;
 Kadner, World J Urol 2020
 Shore, Can J Urol 2014
 Roehrborn, Can J Urol 2017 LIFT Study
**No instances of new, sustained erectile or ejaculatory dysfunction in the LIFT pivotal study.