Men suffering from an enlarged prostate may not necessarily need conventional surgery, with newer minimally invasive procedures providing alternatives aimed at improving urinary symptoms while preserving sexual function.
Speaking during an interview with Radio Generation on Monday, Consultant Urologist Dr Duncan Kimani says treatment for an enlarged prostate, or benign prostatic hyperplasia (BPH), normally begins with medication before surgery is considered.
“Treatment usually begins with medication, and the majority of patients respond well to medical therapy. Depending on the patient, we may use either a single drug or a combination of medications. For most patients, this is sufficient, with regular follow-up appointments, usually every three months,” Dr Kimani said.
He maintained that surgery is considered for patients who do not respond adequately to medication over an extended period.
“For those patients who do not respond, let's say within a period of eight months to one year, we then elect to do surgery for them,” he said.
BPH is common among ageing men and can cause lower urinary tract symptoms including difficulty starting urination, weak urine flow, frequent urination and incomplete emptying of the bladder.
The condition is distinct from prostate cancer.
However, prostate disease remains a significant health concern in Kenya.
Data from the International Agency for Research on Cancer shows that prostate cancer was the most commonly diagnosed cancer among Kenyan men in 2022, accounting for 3,582 cases, or 21.9 percent of all male cancer cases recorded that year.
Dr Kimani says when surgery is required for prostate enlargement, doctors can use endoscopic techniques to remove tissue obstructing the urinary passage.
He cautioned, however, that conventional procedures can affect ejaculation, with about 70 percent of patients potentially experiencing retrograde ejaculation.
“What we say is that around 70% may have retrograde ejaculation. That means you ejaculate back into the bladder. So if you've not had children or you plan to have children, it's something that we forestall until maybe you say now I'm good,” he said.
Retrograde ejaculation occurs when semen enters the bladder instead of leaving through the penis. Dr Kimani said the condition does not necessarily eliminate sexual pleasure.
“The orgasm will be there. The ejaculate will go inside the bladder.”
For men concerned about preserving ejaculation, Dr Kimani highlighted Rezūm, a minimally invasive procedure that uses water vapour to treat enlarged prostate tissue.
“We have now a new modality of surgery, which is known as Rezūm, but it's very new in the market, where we use now water vapor. We inject water vapor, and in three months it causes the prostate to shrink, and now that doesn't affect the sphincter in any way,” he said.
Evidence from recent research supports the potential sexual-function benefits of the procedure. A 2026 systematic review and meta-analysis covering 14 studies and 1,306 patients found that Rezūm generally preserved erectile and ejaculatory function.
A separate review published in 2026 covering 30 studies and 4,635 patients also found that ejaculatory function was preserved in most patients, although researchers cautioned that much of the available evidence was of low to moderate quality.
Longer-term evidence has also reported favourable results. A five-year study found durable improvement in urinary symptoms after Rezūm without clinically significant deterioration in sexual function.
Dr Kimani said Rezūm can be performed as a day-care procedure in advanced centres, although its cost can be higher because the equipment is relatively new and may need to be leased.
He stressed that conventional surgery can also be modified to reduce its impact on ejaculation.
“We can also spare your bladder neck. Like when we are doing the surgery, we normally do it with a system. So we are doing it under vision, so we can tell where your bladder neck is,” he said.
Dr Kimani maintained that doctors therefore need to consider the size of the prostate, severity of obstruction and whether a patient still plans to have children before choosing a treatment approach.
Research published in 2026 found that Rezūm preserved ejaculation in 87.5 percent of patients in one real-world comparison, compared with 50 percent among patients undergoing transurethral resection of the prostate, although the minimally invasive treatment had a higher retreatment rate.
For Dr Kimani, the choice of treatment should therefore be individualised, balancing relief from urinary symptoms with the patient's priorities, particularly where preservation of sexual and reproductive function remains important.