Episode # 329 • 15 Sept 2026
Surgical Approaches to Bladder Outlet Obstruction
With so many treatment options for bladder outlet obstruction, how do you select the best approach for each patient? On this episode of BackTable Urology, host Dr. Jose Silva is joined by Dr. John DiBianco for a practical discussion on evaluating lower urinary tract symptoms and matching patients with the right intervention. They emphasize confirming that symptoms are truly due to benign prostatic hyperplasia (BPH) before proceeding, and walk through triggers for intervention, including quality-of-life impact, UTIs, renal impairment, high post-void residual, bladder stones, and retention.
Timestamps
00:00 - Introduction
03:24 - Complex BPH Referrals and Symptom Assessment
06:07 - Deciding When to Operate
11:12 - Imaging and Prostate Sizing
14:27 - When to Use Cystoscopy and Urodynamics
16:43 - Incorporating Patient Preferences
21:53 - Medical Therapy and Pills
23:45 - Decision Aids and Personal Experience
27:13 - Managing HoLEP Complications and Leakage
32:57 - Advances in HoLEP Technique
36:07 - TURP Indications and Outcomes
38:36 - Special Considerations: Radiation and UroLift
39:58 - ThULEP vs. HoLEP
41:17 - Redo Surgery Strategies
43:52 - Counseling Through Case Scenarios
56:16 - Future Directions in BPH Treatment
59:05 - Wrap Up and Credits
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More about this episode
The conversation covers everything from surveillance and imaging-based prostate sizing to when to use cystoscopy and urodynamics for complex or high-risk patients. Drs. Silva and DiBianco compare procedure options like HoLEP, TURP, GreenLight, UroLift, PAE, iTind, and aquablation, highlighting how factors like prostate size, morphology, history, and patient goals drive decision-making. They discuss durability, redo surgery issues, management of radiation patients, and postoperative care including leakage management and pelvic floor therapy. The episode wraps up with future directions in BPH procedures and practical counseling tips for patient satisfaction.
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