Benign Prostatic Hyperplasia. Interview with Prof. Pierluigi Bove.

Benign prostatic hyperplasia (BPH) causes obstruction to urinary flow and is an issue that affects many men. Thanks to ongoing technological innovation, this can now be treated with increasingly minimally invasive techniques.

Professor Pierluigi Bove, a surgeon specialized in urology at UPMC Salvator Mundi International Hospital, explains the best approach to BPH, depending on the case, and the benefits of traditional and innovative minimally invasive surgical therapies (MIST).

Professor Bove, with reference to benign prostatic hyperplasia we often refer to the so-called MIST techniques.  What does this acronym stand for?

MIST techniques are all the most recently adopted minimally invasive technologies for the treatment of benign prostatic hyperplasia, offering greater patient comfort and addressing the issue of urinary flow obstruction that affects many men.

What are the advantages of MIST?

The main advantage is particularly relevant for younger men. Many men know that undergoing surgery for benign prostatic hyperplasia often results in the loss of ejaculation, known as retrograde ejaculation, which significantly impacts their sexual health. These procedures have the benefit, in the majority of cases, of preserving ejaculation.

Can MIST techniques be considered effective in the long term for treating benign prostatic hyperplasia?

According to statistical data, five years after the procedures, 60% of patients still benefit from them, while 40% may need to resume medical therapy, particularly alpha blockers traditionally used for obstructive issues, or consider more invasive interventions.

I generally recommend MIST techniques for younger patients motivated to preserve ejaculation. These treatments can offer benefits and, if necessary, can be repeated over time.

What are the traditional surgical techniques for treating BPH?

The traditional technique for treating prostate hypertrophy is transurethral resection of the prostate (TURP). This technique is still highly effective but has limitations based on prostate size, typically suitable for prostates with volumes of 40, 50, or 60 ml. As prostate volumes increase, laser techniques are considered the preferred methods. These are the thulium laser and the holmium laser, known as ThuLEP and HOLEP, which are extremely effective allowing for complete eradication of the adenoma. The prostate adenoma is the central part that causes obstruction as it grows.  Lasers allow for complete removal of the prostate, minimizing the risk of recurrence over the years.

Professor Bove, what are the advantages of traditional techniques compared to MIST techniques?

The main advantage is the complete eradication of the disease. If we assess patients 10 years after the intervention, more than 80% still experience effective results from the treatment. An important aspect to consider is the patient's age. If we operate on a 50-year-old with a life expectancy of 30-35 years, there is probably a risk of recurrence over time.

Are there risks associated with traditional techniques?

The primary risk is retrograde ejaculation, although it is not considered a disease. In this regard, I also want to reassure patients. Many are frightened and concerned about potential erectile issues or orgasm problems, which are more related to cancer treatments rather than BPH interventions.

In benign prostatic hyperplasia surgeries, the only permanent side effect is retrograde ejaculation. In contrast, radical prostatectomy for cancer can lead to different consequences, such as incontinence and erectile dysfunction.

Other complications that may follow surgery are generally perioperative, meaning they tend to resolve within a month or a month and a half, and are related to frequency and urgency. In the immediate postoperative period, patients may also notice traces of blood and, at times, a certain degree of incontinence, which is usually linked to surgical stress and almost always temporary.

What are the recovery times for BPH surgery?

Recovery times today vary depending on the type of procedure performed. Patients can generally be discharged the first or second day after surgery. Typically, within one week they can resume normal activities, although always with moderation, and a full return to all pre-surgery activities is usually achieved within a month to a month and a half, in most cases.

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