When is the right time to undergo prostate surgery? The urologist’s advice. Prof. Bove speaks
Overcoming fears and false beliefs with the urologist’s guidance.
Benign prostatic hyperplasia is a very common condition which, with advancing age, affects a large proportion of the male population. One of the most frequent questions that Professor Pierluigi Bove receives from his patients concerns the right moment to proceed with surgical treatment.
Many men approach this prospect with reluctance, fuelled by fears and prejudices: the belief that prostate surgery automatically means loss of sexual function or incontinence.
“In reality,” explains Professor Bove, “in the vast majority of cases none of this happens at all. The procedure is safe and offers a high level of post-operative satisfaction.”
Why you should not wait too long
Surgery is not only a response to symptoms, but above all a preventive measure against more serious complications. If neglected, benign prostatic hyperplasia can lead to consequences such as:
- Bladder dysfunctions such as overactivity (increased urinary frequency and urgency; a sign of decompensation which, in some cases, may not regress after surgery) or, conversely, hypocontractility or areflexia (loss of the bladder’s ability to contract and generate adequate pressure, resulting in urinary retention);
- recurrent urinary tract infections;
- bladder stones;
- dilation of the upper urinary tract (hydronephrosis), potentially progressing to renal function impairment.
“Our goal,” stresses Professor Bove, “is to prevent potentially disabling complications. One should not reach a point of no return, when the bladder has already lost or altered its function in an irreversible way.”
How the decision to operate is made
The decision is based on two main factors:
- When the patient’s symptoms significantly affect quality of life: frequent night-time awakenings, urgency, weak urinary stream, or difficulty emptying the bladder.
- Diagnostic tests: uroflowmetry is the cornerstone of diagnostics because it provides a clear idea of urinary flow morphology and supplies data on flow rate reduction (ml/sec). Even a simple bladder ultrasound can provide information on prostate morphology and size (important data for determining the most appropriate therapeutic strategy), as well as an estimate of post-void residual urine.
These tools allow detection of urinary flow obstruction even when the patient is not fully aware of it. It is not uncommon for some men to minimise symptoms or gradually adapt to them.
“One of the most common mistakes,” explains Professor Bove, “is thinking that if you get used to urinating in a certain way, then there is no problem. In reality, progression is slow but inevitable, and arriving late makes clinical management more complex.”
The relationship with the patient
Every man experiences his symptoms and fears differently. Some arrive at the urologist with significant symptoms, while others report nothing out of reluctance, fear, or embarrassment. There is also an even more challenging category: patients who, despite having evident obstructive disorders, underestimate them because progression has been gradual.
“In these cases,” observes Professor Bove, “it is not about convincing the patient, but about explaining clearly. Only once he has understood and processed the information will he be ready to face surgery with peace of mind.”
This approach reflects Professor Bove’s clinical philosophy: listening, explaining, personalising. Every patient has his own history, fears, and timing.
Fears and false beliefs
Much of the resistance to surgery stems from incorrect beliefs, often fuelled by informal stories or “bar talk.” It is thought that surgery inevitably leads to serious complications, but reality is different.
Procedures for benign prostatic hyperplasia, in the vast majority of cases, do not involve problems of incontinence or erectile dysfunction. These complications are mainly associated with oncological procedures, that is, surgeries for cancer (where the entire prostate is removed: “prostatectomy”), and not with benign disease (where only the central portion is removed: “adenomectomy”).
The most common complication is retrograde ejaculation, meaning the backward flow of semen into the bladder at the time of orgasm (“dry” orgasm). Semen is therefore not seen externally and is eliminated with urine during the subsequent voiding. This condition, already known to patients using alpha-blocker medications (tamsulosin, silodosin, etc.), is NOT a pathology and does not affect sexual desire, erection, or orgasm. It is nevertheless an alteration of a physiological process that the patient must be aware of prior to surgery and which, in some cases, may cause psychological discomfort, particularly in younger patients. There are techniques and technologies (MIST) that offer the possibility of preserving ejaculation to varying degrees, with results dependent on optimal patient selection (“there is no one technique suitable for everyone, but many available treatments that must be chosen appropriately”).
“Prostate surgery for hyperplasia,” reiterates Professor Bove, “is a routine, safe, and effective procedure. Within one month, at most one and a half months, recovery is complete and patient satisfaction is very high.”
Who surgery is for
Although the most affected age group is over 60, there are cases in which prostatic obstruction appears as early as the forties. What matters is not underestimating symptoms and relying on an experienced urologist capable of carefully assessing the situation and proposing the most suitable solution. With increasing life expectancy, it is now increasingly common for patients over eighty to request treatment for benign prostatic hyperplasia. These are often “fragile” patients with multiple comorbidities and polypharmacy. Even in these cases, surgical treatments are possible within high-level facilities with expert teams (nurses, anaesthesiologists, and surgeons) and appropriate technology (mini- and micro-invasive).
A message of clarity and trust
Prostate surgery should not be perceived as a traumatic event, but as an opportunity to prevent future damage and improve quality of life. Thanks to modern techniques and specialist expertise, it is now a safe procedure with rapid recovery times and excellent outcomes.
Professor Bove therefore encourages men not to be held back by unfounded fears, but to speak openly with their urologist.
“It is the physician’s role,” he concludes, “to guide the patient with balance, reassure him, and indicate the right time to intervene, avoiding complications and restoring well-being.”
References:
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