I am 50 with fairly severe BPH symptoms that I have been treating
primarily with Flomax for the past 3 or so years.  I've been seeing my
urologist every six months at which time we have an ultrasound and a
flow meter test.  My prostate is a bit under 50 cc according to the
ultrasound measurements.  The prostate protrudes into my bladder right
at the urethra so when my bladder is full it is especially difficult to
urinate.  Up to recently, I have been OK with the situation and waiting
until it worsened before taking another step in treatment.

My symptoms have been getting more severe with more frequent urgency
problems and very slow flow with straining at times.  So the urologist
performed a cystoscopy recently to see if there were any obstructions
(strictures) in the urethra.  There were none.  He confirmed that the
prostate is poking out right at the bottom of the bladder and said it
was "longer" than he had felt it was based on the ultrasound.

So we are now discussing what type of procedure I should have to reduce
the size of my prostate.  He hasn't given me his final recommendation
on treatment, but during our most recent conversation he said that for
someone as young as I am he would prefer to use a combination of a TURP
and PVP or HOLAP.  I think the reason he mentioned TURP is that he
wouldn't want me to have to have another procedure too soon after this
one.  I have told him about the favorable things I've reado about PVP
and my preference for this type of procedure.  But I don't remember
reading anything about the use of both procedures at the same time.  He
also provided me with a reprint of an article from Urology Today that
compared PVP and HOLAP and concluded that HOLAP was preferable to PVP -
although my reading of the article was that the two were similar.  I
had asked him earlier about his experience with PVP and he said he has
used it but not too frequently.  So I think he might be steering me
away from PVP.  I haven't asked him this directly but I plan to when we
next meet.

He will be giving me his recommendation later in the month, and I may
try to get a second opinion before making a decision on what to do.

I'd be curious to hear from others, especially the Dr. from Madrid!

Warm regards to all