SMPL
Thiruvananthapuram (Kerala) [India], February 10: Benign Prostatic Hyperplasia (BPH) is a common, progressive condition affecting men over the age of 50. As the prostate gradually enlarges, it compresses the urethra, narrowing the urinary passage and obstructing urine flow. This leads to lower urinary tract symptoms such as weak urinary stream, increased frequency, urgency, and frequent nighttime urination. The prevalence and severity of BPH increase with advancing age, and if left inadequately treated, the condition can progress silently.
Traditionally, first-line management of BPH has relied on medical therapy, primarily alpha-blockers and 5-alpha reductase inhibitors (5-ARIs). Alpha-blockers relax smooth muscle in the prostate and bladder neck to improve urine flow, while 5-ARIs gradually reduce prostate size. Although these medications can relieve symptoms, they do not eliminate the mechanical obstruction caused by prostate enlargement. As a result, disease progression may continue even when symptoms appear controlled.
A Paradigm Shift in BPH Management
According to Dr. Harigovind Pothiyedath, Chief Consultant Urologist & Transplant Surgeon, Baby Memorial Hospital, Calicut BPH management is undergoing a paradigm shift with the growing adoption of Minimally Invasive Surgical Therapies (MISTs). Procedures such as Prostatic Urethral Lift (PUL), including the UroLift system, allow urologists to relieve obstruction earlier in the disease course--before irreversible damage to the bladder and kidneys occurs.
PUL works by placing small permanent implants that retract obstructing prostate tissue away from the urethra, restoring urine flow without cutting, burning, or removing tissue. The procedure is typically performed under local anaesthesia as a day-care intervention, often without catheterisation, enabling rapid recovery and early return to normal activities.
Delayed surgical intervention in BPH has been associated with progressive bladder dysfunction and other complications. Long-term dependence on medications may also lead to systemic side effects and, in some cases, worsening renal outcomes.
The Hidden Cost of Delaying Obstruction Relief
Dr. Krishnamohan R, Senior Consultant Urologist & Transplant Surgeon, Baby Memorial Hospital, Calicut highlights that while medications may improve urine flow, the condition of the bladder is often overlooked. Persistent obstruction forces the bladder to generate higher pressures to empty urine. Over time, this chronic strain weakens the bladder muscle, resulting in incomplete emptying, urinary retention, recurrent urinary tract infections, and long-term bladder dysfunction.
In advanced cases, these changes may become irreversible, reducing the effectiveness of later surgical interventions. Recognising these risks, urologists are increasingly counselling patients toward early minimally invasive procedures. By relieving obstruction at its source, MISTs help preserve bladder function, protect renal health, and reduce long-term medication dependence.
Effective Relief Without Compromising Sexual Function
Preservation of sexual function remains a major concern for men undergoing BPH treatment. Dr. Suresh Patankar, Chairman, Department of Urology, ACE Hospital and Research Centre, notes that several oral medications and conventional surgical procedures--particularly those involving tissue removal or thermal injury--have been associated with erectile dysfunction and ejaculatory disorders such as retrograde ejaculation. Fear of these side effects often leads patients to delay definitive treatment.
Minimally invasive therapies such as UroLift provide effective symptom relief while preserving erectile and ejaculatory function. Since the procedure avoids cutting or removing tissue, clinical evidence supports excellent sexual function outcomes. Many patients can walk out the same day without catheterisation and resume routine activities shortly thereafter, enabling timely treatment without compromising quality of life.
Early Intervention in Patients with Comorbidities
Dr. Ishwar Ram Dayal, Head of Urology at Dr. RML Institute of Medical Sciences, Lucknow explains that lifestyle-related disorders such as cardiovascular disease, diabetes, and obesity are increasingly common. Many BPH patients therefore present with significant comorbidities or require long-term anticoagulation, complicating conventional surgical approaches.
Common BPH medications may cause hypotension, dizziness, or renal deterioration in susceptible individuals. Traditional surgeries such as TURP or HoLEP carry higher risks of bleeding, urinary retention, and incontinence, particularly in patients on anticoagulants or those unfit for general or spinal anaesthesia.
PUL offers a safer alternative for such patients. The ability to perform the procedure under local anaesthesia, with minimal physiological stress and faster resumption of chronic medications, makes MISTs an attractive early intervention option in medically complex cases.
Redefining the Timing of BPH Intervention
BPH is not merely a condition of inconvenience--it is a progressive disease. Management is shifting from asking how long symptoms can be controlled to determining when and how obstruction should be relieved. Symptom control alone does not halt disease progression.
Early intervention with Minimally Invasive Surgical Therapies allows obstruction to be treated before irreversible bladder and renal damage occurs. Procedures such as UroLift provide effective symptom relief, preserve sexual function, and enable rapid recovery, allowing patients to maintain quality of life without waiting for complications to dictate treatment timing.
Men experiencing bothersome urinary symptoms should consult their urologist early. Based on prostate anatomy, symptom severity, and overall health, an appropriate treatment plan--including MISTs--can be tailored for optimal long-term outcomes.
Disclaimer: This initiative is undertaken in public interest. The information provided is for patient education only and should not be considered a substitute for professional medical advice. The views expressed are those of the experts. Please consult your doctor for personalised guidance.
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