Non-Surgical Benign prostatic hyperplasia treatment

Non-Surgical Benign prostatic hyperplasia treatment

Benign prostatic hyperplasia (BPH) is one of the most prominent health issues that many men suffer from as they age. This condition causes many annoying symptoms, such as difficulty urinating, excessive urination frequency, frequent nighttime urination, which affects sleep quality, inability to control urination when feeling the urge to urinate, and a feeling of incomplete bladder emptying. 
Among the most prominent methods developed to treat BPH without surgical intervention are modern techniques such as holmium laser, Rezūm therapy, laser vaporization, and bipolar vaporization. These are performed by Dr. Enmar Mohamed Habib, a pioneer in urological surgery. These methods provide safe and effective treatment and overcome the complications of traditional surgeries for the following reasons:
• Performed without any surgical incision.
• Capable of removing any size of prostate enlargement.
• Preserve bladder nerves by using a laser rather than electric current; therefore, it does not affect erection.
• Suitable for elderly patients and those with chronic diseases.
• Safe for patients with heart diseases and those with bleeding disorders or on blood-thinning medications.
• Provide faster recovery time.
In this article, we will review each of these treatments in detail, explaining how they work, their benefits, and how they can be a safe and effective option for patients with benign prostatic hyperplasia (BPH). We will also highlight the expertise of Dr. Enmar Habib, Professor of Urology and Pediatric Urology at Cairo University and Fellow of McGill University, Canada, who is a pioneer in this field in Egypt and the Arab world.

1. Holmium Laser Enucleation of the Prostate (HoLEP):

Holmium laser prostatectomy is a minimally invasive surgical procedure that aims to reduce the size of the prostate and improve urine flow immediately. This technique offers several advantages, including no bleeding even with blood-thinning medications, discharge without a catheter, a 24-hour hospital stay, and fewer risks than traditional surgery.
The holmium laser technique is one of the most advanced and reliable treatments for severe benign prostatic hyperplasia. It uses laser pulses absorbed by saline solution instead of penetrating tissue, thus avoiding bladder irritation. 

How is a holmium laser prostatectomy performed?

•  After the patient is given spinal anesthesia, the endoscope is inserted to deliver the laser beam through the urethra into the prostate.
•  The holmium laser pulses help the surgeon push and separate the more significant portion of the inner prostate from its outer layer. The three inner lobes of the prostate are separated individually. These lobes surround the urethra (the tube leading from the bladder to the urinary opening).
•  The separated lobes are pushed into the bladder.
•  A morcellator is used to suction and cut the separated tissue, which is then removed from the body through the endoscope without surgical incisions.
•  A urinary catheter is placed for only 12 hours, so the patient remains in the hospital for only 24 hours until his condition stabilizes and he can urinate without a catheter.
•  The removed tissue is sent for analysis to ensure it is free of cancer cells.

Advantages of holmium laser prostatectomy:

•  Avoiding all the disadvantages of traditional surgery, thanks to the following advantages:
-  The ability to treat all degrees of prostate enlargement, ranging from 20 grams to 1200 grams.
-  No risk of bleeding, even for patients on blood thinners, because the laser closes the veins and arteries in the targeted area before separating the tissue. This adds a complete safety element to all stent patients who cannot stop blood-thinning medications.
-  Rapid recovery with a shorter catheter placement period, not exceeding 12 hours, unlike traditional surgery
•  The holmium laser is a unique type of laser that can be used for multiple minimally invasive interventions without using electrical current, which can negatively affect the heart or brain. These additional interventions include:
-  The ability to fragment bladder stones during the same procedure and remove them from the body with irrigation fluid before addressing the enlarged prostate.
-  The ability to treat superficial tumors associated with prostate enlargement, which occurs in 8-10% of cases due to bladder tissue irritation.
-  The possibility of incising the urethra in cases of urinary tract strictures to access the prostate for removal.
•  Removing more prostate tissue than other procedures intended to treat benign prostatic hyperplasia (BPH) without incisions. 
Some other surgical methods only remove enough tissue around the urethra to restore urethral flow. However, the remaining prostate tissue can cause pain and irritation after the procedure and may grow back, causing a recurrence of symptoms. Therefore, the more prostate tissue removed, the better and more lasting the outcome. This is what the holmium laser achieves due to its ability to handle severe enlargement cases, with prostate size reaching up to 1200 grams.
•  Achieving results similar to traditional prostatectomy, but performed through the urethra using an endoscope, without any incisions or complications.
•  Effective for cases that may not respond to medication.
Dr. Enmar Habib has extensive experience in using holmium laser technology. He is considered one of the first to introduce this technology in Egypt and the Arab world. He is an expert in treating prostate enlargement with holmium laser, due to his high skill in achieving excellent results and improving the quality of life for elderly people suffering from benign prostatic hyperplasia, in complete safety, as it is performed without surgery, under spinal anesthesia, and with the fastest recovery period.

2.  Rezūm:

The Rezūm procedure is a minimally invasive treatment for benign prostatic hyperplasia (BPH), ranging in size from 30 to 80 grams, using the thermal energy of water vapor to shrink and remove obstructive prostate tissue. The minimally invasive Rezūm procedure offers men another treatment alternative that reduces some of the unwanted side effects (including erectile dysfunction and urinary incontinence) that can result from drug therapy or other more invasive procedures.

How is Rezūm applied?

•  This technique relies on a special device that applies radiofrequency energy to a few drops of water to create hot water vapor below 70°C. 
•  The patient is under local or spinal anesthesia, as desired.
•  A very thin device is inserted into the urethra to inject the water vapor. This device is equipped with a lens that allows visualization of the prostate and bladder.
•  The enlarged prostatic tissue blocking the urine flow from the bladder is injected with the vapor. The steam condenses immediately into water, releasing stored energy into the cell membranes. This damages and kills the targeted cells immediately and gently.
•  The body naturally absorbs the dead tissue through its healing response. With the excess tissue removal, the urethra opens, reducing the symptoms of BPH. 
•  Symptoms improve within two weeks, with maximum benefit in about three months.

Advantages of Rezūm:

•  The procedure is very simple, requiring less than 30 minutes.
•  It can be considered an extension of medical therapy for benign prostatic hyperplasia (BPH) due to its minimally invasive nature.
•  It does not require general anesthesia; therefore, it is a good option for patients who want to avoid open surgery, as it can be performed while awake using local anesthesia.
•  It provides safe and effective symptom relief, as Rezūm has been shown to significantly improve the symptoms of benign prostatic hyperplasia (BPH), including urinary frequency, urgency, weak urinary stream, difficulty urinating, and frequent nocturia.
•  It provides noticeable symptom relief within 6 weeks; with complete resolution after three months.
•  It is a non-surgical and generally safe treatment.
•  It preserves sexual function and erection nerves, thus helping to avoid the risk of sexual dysfunction that may accompany some surgical procedures, the most serious of which is retrograde ejaculation, which occurs in less than 5% of cases, thus preserving a man's reproductive capacity.
•  The patient is discharged only two hours after surgery. It also allows patients to return to normal activities within a few days.
Rezūm is a safe and effective non-surgical treatment for benign prostatic hyperplasia (BPH). Dr. Enmar Mohamed Habib, the most experienced BPH surgeon in Egypt and the Arab world, uses Rezūm with high proficiency. This shortens recovery time and improves outcomes with minimal risk.

3.  Laser Vaporization:

Laser vaporization removes enlarged prostate tissue in cases under 70–80 grams. It uses laser energy to generate high heat, which vaporizes obstructive tissue.

How is laser prostate vaporization performed?

• You receive general anesthesia to keep you asleep and pain-free during the procedure. 
• A scope with a light and camera is gently inserted into the urethra using anesthetic gel.
• Dr. Enmar Mohamed Habib locates the obstructive tissue.
• He uses a laser through the scope to vaporize and destroy the excess prostate tissue, removing the obstruction to facilitate urine flow.
• The scope is removed after the procedure.
• The surgeon inserts a catheter to help drain urine. A catheter is a thin tube placed through the urethra into the bladder. The tube keeps the bladder empty to allow for healing and greater comfort. The catheter can be easily removed by deflating the balloon, and the tube is then simply slipped out.

Advantages of laser vaporization:

•  Quick procedure with no bleeding.
•  Safer for patients with bleeding risks.
•  Faster recovery and return to normal daily activities within 2-3 days.
•  Immediate symptom relief and significantly improved urine flow.

Limitations of laser vaporization:

Laser vaporization does not allow the analysis of enlarged prostate tissue because the enlarged prostate tissue is destroyed, not removed. Furthermore, the enlargement may reappear because the enlarged tissue is not fully removed.

4.  Bipolar Plasma Vaporization (BPV):

Bipolar vaporization is a modern, minimally invasive option for BPH. It removes obstructive prostate tissue using low-temperature plasma energy generated by a bipolar electrical current.

How is bipolar plasma vaporization performed?

•  A scope with two electrodes is inserted through the urethra into the prostate.
•  An electric current is applied to the enlarged tissue, vaporizing the prostate tissue that comes into contact with this plasma field, gradually reducing the prostate's size.
•  The procedure not only vaporizes the enlarged tissue but also coagulates the remaining healthy tissue, leaving a smooth surface.

Advantages of bipolar plasma vaporization:

•  Maximum safety and effectiveness.
•  Long-lasting results.
•  Less bleeding.
•  Faster recovery and less pain compared to other surgical treatment options.
•  Shorter hospital stay.
•  Quick return to daily activities.

Limitations of Bipolar Plasma Vaporization (BPV):

Bipolar Plasma Vaporization (BPV) is not recommended for prostates weighing more than 80 grams, as there are risks of hypothermia, blurred vision, and postoperative bleeding. 
With his extensive practice and interest in scientific developments in urology, Dr. Enmar Mohamed Habib achieves the best results using the bipolar technique. He is known for his proficiency in treating cases requiring advanced techniques.

Comparing non-surgical BPH treatment techniques: Which is best for each patient?

Non-surgical treatment for benign prostatic hyperplasia (BPH) represents a revolution in managing this common condition, allowing patients to achieve effective symptom relief with minimal risks and fewer side effects. As technology advances, treatment has become more precise and effective, making these non-surgical solutions the preferred choice for many patients, especially the elderly.
Each method has unique advantages and features. The optimal choice depends on several factors, including prostate size, the patient's overall health, and the patient's treatment priorities. 
Dr. Enmar Mohamed Habib, with his extensive experience and specialized training, is one of the most prominent doctors in this field, providing each case with the appropriate treatment to ensure the best outcome without any complications.