I've had BPH for perhaps 20 years, very slowly the symptoms are getting worse, which is no big surprise.  At the moment medication (Flomax etc) means that I can still pee, but that ability is slowly getting worse.  I'm sure at some point I will need to consider surgical (invasive and slightly-invasive) options.

 

But when I read about the various surgical treatments, many seem to only offer relatively short-term relief of perhaps 5 years or so.  What happens after that time-frame?  I certainly wouldn't want to have surgery again in my dotage.

 

Is there a reliable treatment that minimises the risk of long-term incontinence and maximises the time-frame after treatment of no more BPH symptoms?

I'm surprised you haven't gone for TURP, probably cheapest, at govt hospitals, you don't seem concerned about sexual function in case of ED

TURP is the oldest procedure (and te4chniques have improved). No one can guarantee lifelong relief as it rather depends on how long you live, but TURP usually provides relief for  15 years or more.

 

 Newer techniques like Prostatic Artery Embolization (PAE),  Urolift, Rezum etc lack data for that long (which does not mean relief won't last as long....just that they do nto yet know because haven't been in use that long).

 

There rae patient specific factors that need to be factored into treatment choice, including prostate size, any co-morbidities that might affect surgucal risk etc.

 

Best thing to do is to consult a good urologist for personalized discussion. 

 

You say "flomax etc", does that "etc" include a 5-alpha reductase inhibitor like finasteride or dutasteride?  As medication options should be exhausted before trying other treatments, and normally both an alpha blocker like tamsulosin (Flomax) and an 5-alpha reductase inhibitor would be used.  The former provides only symptomatic relief whereas the latter actually shrink prostate tissue over time.

HoLEP is probably the best treatment for large prostates. If that's too expensive for you then TURP would be a good option.

PAE, Urolift, REZUM will be for smaller sized prostates and results might not last as long as HoLEP and TURP.

Go see a good urologist. Asking for advice here is like trying to take a drink from a fire hose.

 

That being said there are quite a few good newer treatments for BPH, if drug therapy has not given you good results. Some of the newer MIST treatments are offered here in Thailand. Rezum, iTind and Urolift are some minimally invasive options, but, again, the right procedure must be carefully chosen for the specific abnormality of the prostate, lateral lobe hypertrophy? Median lobe hypertrophy? High Bladder neck? Prostate size? etc are among the things that need to be checked to provide you the best option for treatment.

 

Myself I have opted for Rezum and I will be getting it done in Los Angeles USA. Not in Thailand.

14 hours ago, Sheryl said:

TURP is the oldest procedure (and te4chniques have improved). No one can guarantee lifelong relief as it rather depends on how long you live, but TURP usually provides relief for  15 years or more.

 

 Newer techniques like Prostatic Artery Embolization (PAE),  Urolift, Rezum etc lack data for that long (which does not mean relief won't last as long....just that they do nto yet know because haven't been in use that long).

 

There rae patient specific factors that need to be factored into treatment choice, including prostate size, any co-morbidities that might affect surgucal risk etc.

 

Best thing to do is to consult a good urologist for personalized discussion. 

 

You say "flomax etc", does that "etc" include a 5-alpha reductase inhibitor like finasteride or dutasteride?  As medication options should be exhausted before trying other treatments, and normally both an alpha blocker like tamsulosin (Flomax) and an 5-alpha reductase inhibitor would be used.  The former provides only symptomatic relief whereas the latter actually shrink prostate tissue over time.

 

Rezum has been approved for use since 2015 in the USA and lately there are some studies that indicate it's efficacy is quite good. 

 

Long-Term Durability: A pivotal five-year clinical trial has shown that Rezum provides significant, sustained improvement in lower urinary tract symptoms (LUTS) and quality of life for patients with BPH. The study reported a low surgical retreatment rate of just 4.4% over five years.

 

However, it does have a longer recovery period which is well documented. My urologist said "expect things to get worse for a few weeks before they get better" 

 

Buddy had TUMPS done, and his only regret was, didn't have it done a decade earlier.  I considered it, but the doc that did it seemed to have retired.   I moved away from that area, so never got around to it.

 

For me, cutting back on carbs, which meant losing weight and taking a magnesium supplement seems to work, as I can go all night now (6-8 hrs) vs P'ing 2 or 3X in the past.   Not just urge decreases, but stream pressure & volume while P'ing increased.  

 

Think more the cutting back on carbs, and the magnesium just helps with the sleep.  

On 9/16/2025 at 9:13 AM, chakatee said:

HoLEP is probably the best treatment for large prostates. If that's too expensive for you then TURP would be a good option.

PAE, Urolift, REZUM will be for smaller sized prostates and results might not last as long as HoLEP and TURP.

All true, except that PAE is most effective with large glands. The other great benefit of PAE is that leave the door open for any of the other treatments, if needed.

20 hours ago, Peter Crow said:

All true, except that PAE is most effective with large glands. The other great benefit of PAE is that leave the door open for any of the other treatments, if needed.

Yes, I agree much to be said for PAE though its availability in Thailand is lso far imited. Siriraj does it. 

On 9/15/2025 at 5:45 PM, simon43 said:

I've had BPH for perhaps 20 years, very slowly the symptoms are getting worse, which is no big surprise.  At the moment medication (Flomax etc) means that I can still pee, but that ability is slowly getting worse.  I'm sure at some point I will need to consider surgical (invasive and slightly-invasive) options.

 

But when I read about the various surgical treatments, many seem to only offer relatively short-term relief of perhaps 5 years or so.  What happens after that time-frame?  I certainly wouldn't want to have surgery again in my dotage.

 

Is there a reliable treatment that minimises the risk of long-term incontinence and maximises the time-frame after treatment of no more BPH symptoms?

Well, if the prostate is removed, it can't grow anymore.

Whatever solution you prefer, ask how many times this method was carried out per year. Also ask who will do it and ask for the background; where studied, where specialized aso.

(Green laser was painless and successful for a friend of mine).

However, the best method can only found by an experienced specialist.

Go to the main Hospital's websites Here,

what Google says

BPH surgery methods include TURP (Transurethral Resection of the Prostate), laser surgery (PVP, HoLAP, HoLEP), open surgery (when the prostate is greatly enlarged), and robotic/laparoscopic surgery for prostate removal. Newer techniques include Aquablation, which uses high-pressure water, and TULSA-PRO, which uses MRI-guided ultrasound to destroy prostate tissue. The best method depends on prostate size, symptom severity, and overall health. 

On 9/15/2025 at 5:45 PM, simon43 said:

I've had BPH for perhaps 20 years, very slowly the symptoms are getting worse, which is no big surprise.  At the moment medication (Flomax etc) means that I can still pee, but that ability is slowly getting worse.  I'm sure at some point I will need to consider surgical (invasive and slightly-invasive) options.

 

But when I read about the various surgical treatments, many seem to only offer relatively short-term relief of perhaps 5 years or so.  What happens after that time-frame?  I certainly wouldn't want to have surgery again in my dotage.

 

Is there a reliable treatment that minimises the risk of long-term incontinence and maximises the time-frame after treatment of no more BPH symptoms?

 

I suffer the same, yet about 15 years ago I talked to a friend who refused any invasive intervention, and he gave  the advice to eat regularly red bell pepper and  tomatoes (the latter in any cooked form). I follow his recommendation since then. If you did not try this nefore, please do, starting tomorrow. With me it works since then. Would like very much to hear from you, whether it worked for you. 

1 minute ago, moon0205 said:

I suffer the same, yet about 15 years ago I talked to a friend who refused any invasive intervention, and he gave  the advice to eat regularly red bell pepper and  tomatoes (the latter in any cooked form). I follow his recommendation since then. If you did not try this nefore, please do, starting tomorrow. With me it works since then. Would like very much to hear from you, whether it worked for you. 

Lycopene at work there.

On 9/15/2025 at 7:10 PM, Sheryl said:

You say "flomax etc", does that "etc" include a 5-alpha reductase inhibitor like finasteride

I have taken Finisteride for about 5 years. I go to the Govt University hospital here in P'lok. Only one ultra-sound in that time, showing 93ml prostate, but never any DRE. I am considering stopping it. I take Doxadozin as well.

No problem peeing, sometimes 3 or 4 in the night, sometimes not.

On 9/23/2025 at 12:10 PM, Sheryl said:

Yes, I agree much to be said for PAE though its availability in Thailand is lso far imited. Siriraj does it. 

• Phyathai Hospital: Offers PAE with special pricing available. 
• Bangkok Hospital: Provides a range of minimally invasive options, including PAE, often with comprehensive pre-procedure assessments. 
• Other Hospitals: Other major hospitals and medical centers across Thailand also provide this treatment. 

4 hours ago, moon0205 said:

eat regularly red bell pepper and  tomatoes (the latter in any cooked form).

How do you eat red bell pepper ? salad ?

I eat tomatoes as well and since everyone is different I had to cut alcohol and caffeine that caused muscle spasm and dehydration. I understand that diet is very important. 

 

18 hours ago, OneManShow said:

 

• Phyathai Hospital: Offers PAE with special pricing available. 
• Bangkok Hospital: Provides a range of minimally invasive options, including PAE, often with comprehensive pre-procedure assessments. 
• Other Hospitals: Other major hospitals and medical centers across Thailand also provide this treatment. 

This reads like it came from AI, which is notoriously unreliable for this purpose.

 

Do you have an actual link to these hospitals stating PAE is available there (not a general article on the hospital website describing all treatments - actual statement that they offer PAE)? ? Doctor's name?

5 hours ago, Sheryl said:

This reads like it came from AI, which is notoriously unreliable for this purpose.

You'r right. 

 

"When considering a hospital, it's advisable to directly contact the hospital's urology or men's health department to confirm they offer PAE."  

 

 

I read this article just now and thought of posting the link here:

 

Minimally invasive procedure a quality of life saver for men with enlarged prostate https://share.google/WkaKjU5H9vcgto9Le

 

It is about a procedure known as Aquablation.