Patient Selection for GreenLight & Other BPH Treatments

In this episode of BackTable Urology, Dr. Jose Silva interviews urologist Dr. Francisco Gelpi about GreenLight laser therapy and other BPH surgical treatments.

Although he was originally trained in urologic oncology, Dr. Gelpi decided to expand his expertise and incorporate BPH treatment into his medical practice as well. He also explains his decision to enter private practice and his role as a Boston Scientific proctor for Rezum and GreenLight.

When initially evaluating a male patient with voiding issues, Dr. Gelpi emphasizes the importance of lower urinary tract imaging. Although he goes through the basic questionnaire to assign the patient an AUA symptom score, he usually performs a pelvic ultrasound on the first visit. In subsequent visits, he will perform an in-office cystoscopy and teach the patient about his urinary tract anatomy simultaneously. His main goal in evaluating patients is to find ways to preserve bladder health and function.

Dr. Gelpi uses individual prostate anatomy to guide his decision on BPH treatment for each patient. If there is a substantial median lobe, he prefers to use GreenLight laser therapy. He notes that overtreating patients with GreenLight laser therapy may cause irritative symptoms post-operatively. He also acknowledges UroLift and Rezum as two very good options for patients without substantial median lobes and presents different surgical complications for each treatment. His post-operative medication regimen (pyridium, meloxicam, and colace) is identical for all three BPH treatments.

Finally, because some BPH treatments may result in post-operative pain and/or reduction of ejaculation ability, Dr. Gelpi prioritizes having transparent and honest conversations with his BPH patients. He always presents all relevant treatment options to his patients and allows them to share their expectations and priorities before reaching a decision about BPH treatment.