Safer Minimally Invasive Treatments in High-Risk & Comorbid Patients with Prostate Enlargement (BPH)

SMPL
New Delhi [India], March 11: Prostate enlargement, which is called Benign Prostatic Hyperplasia (BPH) is a non-cancerous enlargement and is common in ageing men. As the prostate enlarges, it compresses the urethra and interferes with normal urine flow. BPH is extremely common: affecting roughly 50% of men by age 60 and up to 90% by age 80. Typical symptoms include:
- Weak urine stream
- Straining to pass urine
- Incomplete bladder emptying
- Frequent urination
- Nocturia (waking at night to urinate)
While these symptoms may appear manageable initially, the situation becomes significantly serious in men who already live with chronic medical conditions. These patients are termed as high-risk or medically complex patients. They are typically on two or more medications due to issues such as:
- Cardiovascular disease (History of angioplasty or cardiac stenting or patients on blood thinners)- increases the risk of bleeding in surgical procedures
- Diabetes Mellitus
- Chronic Kidney Disease
In such patients untreated BPH may further worsen the patient's condition by:
- requirement of frequent and long-term catheterization
- inoperable as condition worsens and is irreversible
- inadequate relief and side effects
- surgery required but pose a high risk
- worsening of bladder condition

In patients above 60 to 70 years of age, especially those with diabetes and / or cardiac disease, adding long-term BPH pills to an already heavy prescription list may mean the patient will have to pop minimum 1200 pills a year! This will potentially affect dose adherence and load on the kidneys of the patient. But with the help of minimally invasive surgical treatments (MISTs) in India, a simplified and better approach for these patients can be seen.
Dr. Sumanta Kumar Mishra, Senior consultant, Urology and Kidney Transplant, Care Hospital Bhubaneswar, explains that medical therapy (alpha-blockers and 5-alpha-reductase inhibitors) is often the first-line treatment for BPH in India. However, in medically fragile patients, these medicines have limitations as they may cause dizziness, postural hypotension, increased fall risk in elderly patients and fatigue. Patients are rushed in emergencies because of these injuries caused by the side effects which later turn out to be fractures and dislocations.
Long-term medication use may also:
- interact with cardiac or diabetic medications and increase overall medication load.
- It may contribute to sexual dysfunction in many cases due to prolonged use.
- In diabetic patients, incomplete bladder emptying despite medication can predispose to infections and bladder dysfunction.
Many elderly patients are already managing 4-5 daily medications. Adding long-term BPH therapy increases polypharmacy and may reduce medicine adherence. Reducing even one daily medication may significantly improve compliance and overall treatment quality.
Now MISTs are an opt which pose less risk for these patients and may reduce the complications compared to conventional surgeries. MISTs are a boon for these patients and relieving these patients from one pill can save a toll on their kidneys as they are already popping chronic meds. Additionally, these procedures in India are now increasingly covered under the medical insurance because of their safety and cost effectiveness.
Dr. Abhishek Singh, Sr. Consultant Urology, MPUH Nadiad, shared that conventional prostate surgeries are effective and have been used by urologists time and again. But they may not stand effective in all types of patients as they carry higher risk in patients who may be on blood thinners. These procedures require spinal or general anaesthesia, may involve bleeding risk, and usually need a pause on antiplatelet or anticoagulant therapy at least five days before surgery.
For instance, if we consider a patient who has recently had a cardiac attack and stents, stopping antiplatelets increases the risk of another attack or stent thrombosis. Post-operative recovery with conventional BPH surgeries (depending on patients) may be prolonged, involve catheterization, with risks of infection, and urinary complications. These realities make treatment decisions complex in comorbid patients both pre and post procedure. MISTs like Prostatic Urethral Lift (PUL) offered by UroLift system may not require catheterization or long-term hospital stay but therapies involving cutting or heating of prostate may involve the patient catheterized. And for these surgeries we can restart the antiplatelet without a long pause. We recently used the option of UroLift system on a 90-year-old patient who had a pacemaker too and these implants will improve his quality of life.
Dr. Muninder Singh Randhawa, Associate Director - Urology at Max Super Speciality Hospital, Mohali, added that over the past two decades, treatment options for BPH in India have evolved significantly. MIST offer safer alternatives for high-risk patients. There's an awareness rising amongst the patients too as they come asking if a particular MIST is suitable for them and they are aware that MIST implants help preserve their sexual function irrespective of their age. Options like Prostatic Urethral Lift (UroLift System) work by placing small permanent implants that gently retract the enlarged prostate tissue away from the urethra. Importantly, this procedure:
- does not involve cutting, heating, or removing prostate tissue
- is usually performed under local or light anaesthesia
- has minimal bleeding risk
- often avoids prolonged catheterization
- preserves sexual function
Because the procedure is short and minimally traumatic, it is often better tolerated in elderly patients and those with cardiac or diabetic comorbidities (subject to individual clinical evaluation). These implants have simplified the approach for BPH treatment in frail patients. We can select a wide range of patients suitable for implants as it has practically shown improvement with respect to IPSS scores and symptom improvement.
Men with BPH who also have heart disease, diabetes, CKD, or are on blood thinners should consult a qualified urologist. A multidisciplinary approach ensures that urinary relief does not compromise cardiac or kidney safety.
You can check your IPSS score to assess the severity of Lower Urinary Tract Symptoms associated with BPH and know more about BPH and MISTs.
In many suitable cases, patients may be able to reduce or discontinue long-term BPH medications after symptom improvement -- thereby lowering pill burden. Men with BPH who have heart disease, diabetes, or are on blood thinners should consult a Urologist to discuss MIST options such as Prostatic Urethral Lift, in coordination with their physician or cardiologist, to determine the safest and most appropriate treatment plan.
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Disclaimer: This initiative is undertaken in Public Interest. The Information is only suggestive for patient education and shall not be considered as substitute for doctor's advice or recommendations. the views/ suggestions/ opinions expressed in the article are the sole responsibility of the experts please consult your doctor for more information.
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