Ep. 329 Surgical Approaches to Bladder Outlet Obstruction with Dr. John DiBianco

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. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction03:24 - Complex BPH Referrals and Symptom Assessment06:07 - Deciding When to Operate11:12 - Imaging and Prostate Sizing14:27 - When to Use Cystoscopy and Urodynamics16:43 - Incorporating Patient Preferences21:53 - Medical Therapy and Pills23:45 - Decision Aids and Personal Experience27:13 - Managing HoLEP Complications and Leakage32:57 - Advances in HoLEP Technique36:07 - TURP Indications and Outcomes38:36 - Special Considerations: Radiation and UroLift39:58 - ThULEP vs. HoLEP41:17 - Redo Surgery Strategies43:52 - Counseling Through Case Scenarios56:16 - Future Directions in BPH Treatment59:05 - Wrap Up and Credits --- 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. --- Resources Love this episode? Check out BackTable.com and search “BPH” to get more information on a variety of the surgical options discussed in this episode, including HoLEP, Aquablation, PAE, and more! Further resources include the BackTable App, which has a course on treating Benign Prostatic Hyperplasia. --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app