i get asked all the time what's the
difference between these two treatments
for bph eurolift or resume today i'm
going to give you the data on both of
these treatments for enlarged prostate
i'm dr rena malek urologist and pelvic
surgeon if you're new here i make weekly
content every monday and friday on
urologic health sexual health bladder
health and so much more
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so let's start off with the basics
benign prosthetic hyperplasia or bph is
a syndrome of enlarged prostate i've
made an entire video about this before
so if you want to learn more about it
make sure you check it out somewhere
between 50 to 70 of men after the age of
50 suffer from some urinary symptoms due
to bph that can include symptoms like
having difficulty emptying their bladder
having hesitancy meaning they have to
wait for their stream to start their
stream starts and stops they don't feel
like they're empty they're waking up a
lot at night or they're having the
sensation to go very frequently to the
bathroom or have a strong urge that they
can't delay many men choose to take
medications for this treatment studies
have shown that 70 of people either stop
taking medications or are really
non-compliant because they don't like
how efficacious they are or due to side
effects and many of these same men don't
want to undergo surgical procedures
because they don't want to stay in the
hospital they don't want to get
anesthesia and they don't want a lengthy
recovery specifically they don't want to
deal with side effects particularly
ejaculatory dysfunction meaning that
they when they ejaculate some of these
surgical treatments will often leave
them with the inability to ejaculate
completely and some of that ejaculate
will go back into the bladder called
retrograde ejaculation and this is seen
in up to 20 of people who undergo
surgical treatment depending on the type
of treatment they undergo that's where
these two treatments come in these are
called minimally invasive therapies and
while they are known by most of you as
eurolift or resume those are really the
company names that they've given to the
treatments but it's really called
prostatic urethral lift and convective
water vapor therapy to start off let me
tell you a little bit about these two
treatments the beauty of both of these
treatments is they are typically done in
the office and they can be done without
anesthesia so that really allows you to
get this done quickly efficiently go
home the same day without having to
spend a night in the hospital convective
water vapor therapy essentially creates
directed targeted sterile water vapor
into the prostate tissue this causes the
cells of the prostate to essentially die
or break apart and then causes the
prostate tissue to essentially ablate or
go away the nice part about this therapy
is it's very localized to the prostate
tissue itself it does not cause damage
to any of the other structures around
the prostate including the bladder neck
the sphincter of the bladder which is
where what keeps your urine in the
bladder and the capsule of the prostate
which is where the nerves travel that
are responsible for erectile function
during the procedure itself a
cystoscopic specialized camera is
inserted into the urethra and then a
small little
delivery device is deployed from that
device into the prostate under direct
visualization we can see it the whole
time and it delivers water vapor for
nine seconds and typically depending on
the size of the prostate most prostates
are getting four to six treatments
during one session afterwards most
people will have a catheter for
somewhere from two to five days after
the procedure to allow healing to occur
it's typically recommended at this time
for men who have a prostate somewhere
between 30 and 80 grams so when you come
in for an evaluation from your urologist
we will essentially assess the size of
your prostate through a couple of means
one is through a digital rectal
examination another is through either
looking at it cystoscopically with a
camera or using a transrectal ultrasound
to assess the size of the prostate so to
look at the results of this they did a
multi-center study meaning multiple
sites across the united states were used
all who had bph and related symptoms so
patients were then randomized to either
then get the water vapor therapy or get
a sham procedure i mean they put in a
cystoscope without the needle and did a
procedure that wasn't actually
causing water vapor to be inserted into
the prostate they essentially assess the
improvement in quality of life as well
as symptoms using valid questionnaires
as well as what's called a flow rate so
when you come to the urologist sometimes
we'll have you pee over a specialized
uroflow and what that is essentially is
when you're peeing it will measure how
quickly that urine flow is coming out
and that's one marker of telling us if
there is an issue with your flow it's
not going to tell us definitely why
there's an issue with your flow it will
tell us that there's a reduction
compared to normal it's very often used
in evaluating bph patients to see if
they're improving over time in all those
markers the validated questionnaires and
the euroflow we saw an improvement up to
five years that was somewhere between 44
to 48
the procedure took on average about 5.3
minutes so very quick they also looked
at surgical retreatment rates what does
that mean does someone need another
procedure because this one didn't work
well enough and what they found was that
4.4 of people underwent some sort of
surgical retreatment they did have pain
with urination which occurred in about
17 of patients bleeding in the urine
which is very very common blood in the
semen urinary frequency the difficulty
hearing after the catheter was removed
did happen in a small subset of patients
about five percent and decrease in
ejaculatory volume happened in about
five percent of patients so very small
subset of patients conversely prosthetic
urethral lift has a different mechanism
it essentially aims to lift and compress
the tissue rather than actually ablate
it or get rid of it so it uses an anchor
as well as a suture that goes across the
prostate and then lifts it up to then
make an opening that's wide enough that
will allow you to urinate easily it's
also recommended for men who have a
prostate from 30 to 80 grams and it
should be amenable anatomically to get
that procedure done they also had a
five-year study of about 200 patients
over 18 centers and they were randomized
again for every two patients who got the
prosthetic urethral lift procedure one
patient got a sham procedure or a not
urethral lift but a fake procedure this
procedure when it's done typically you
have a specialized camera again that
goes into the urethra and it helps you
deploy these anchors and then stretch
the suture across and deploy the other
anchor it's typically done with some
numbing jelly and numbing lubricant and
afterwards sometimes you can go home
without a catheter some people leave it
in for one or two days afterwards
depending on how large the prostate is
and or how many implants they have to
use similar to the water vapor study
they looked at again validated
questionnaires urinary flow and quality
of life and they saw that up to five
years they had improvements from 36 to
52 improvement surgical retreatment
meaning that patients who needed another
procedure was about 13.6 at five years
they had very similar side effects as
the water vapor therapy but they saw no
ejaculatory dysfunction and no erectile
dysfunction after this procedure
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you