Minimally invasive therapy offers new hope for men with enlarged prostate

J O spent nearly two years measuring his nights by bathroom visits. The 69-year-old from Migori Municipality would wake three times some nights, his bladder demanding attention when he most needed sleep. What began as a minor inconvenience in 2022 had become something far more disruptive—a condition that eroded his confidence, fractured his social life, and left him incontinent at unpredictable moments. "It used to come even when you are sitting somewhere," he recalls. "Sometimes you can still wet your trousers."

His doctor diagnosed benign prostatic hyperplasia, or BPH—a non-cancerous enlargement of the prostate gland that presses against the urethra and obstructs urine flow. The condition is far from rare. A Global Burden of Disease analysis found that roughly 94 million men aged 40 and older worldwide were living with BPH in 2019, nearly double the 51.1 million recorded two decades earlier. In Kenya alone, the numbers climbed from about 64,600 men in 2000 to 126,000 by 2019. For two years, medication had helped J O manage the symptoms, but he wanted something more permanent. The prospect of conventional surgery terrified him. He had watched other patients undergo transurethral resection of the prostate—the standard procedure—and the experience left him convinced he would not survive the operation. At 69, he remained sexually active, and he feared that surgery might damage his ability to ejaculate normally.

Then, through social media, J O discovered Rezūm Water Vapor Therapy, a minimally invasive alternative that was beginning to reach Kenya. He contacted Dr. Winstar Mokua, a consultant urologist at Aga Khan Hospital Kisumu, who assessed him and confirmed he was a suitable candidate. The procedure was initially scheduled for August 21 but was delayed while equipment was transported from Nairobi. When J O finally entered the procedure room, the experience bore no resemblance to the surgery he had feared. "After that, I didn't feel it," he says. The entire process was painless.

Rezūm works by threading a small delivery device through the urethra to reach the enlarged prostate tissue. Controlled doses of water vapor are then injected into targeted areas, damaging selected cells. The body gradually breaks down and absorbs the treated tissue, shrinking the prostate and creating more space for urine to flow. Unlike traditional surgery, there is no external incision. Dr. Mokua emphasizes that improvement is not immediate—patients may begin noticing changes around two weeks, with full benefit sometimes taking up to three months. J O currently has a catheter in place and is in the early stages of recovery.

The sexual function question that had weighed on J O's mind carries real weight in treatment decisions. Traditional TURP can affect ejaculation, sometimes causing semen to travel backward into the bladder rather than forward. Rezūm is designed to preserve normal ejaculation in many appropriately selected patients, though individual outcomes vary. Dr. Mokua stresses that treatment decisions must follow careful conversations between patients and doctors about expected benefits, risks, and alternatives. Not every man with an enlarged prostate needs surgery. Treatment often begins with medication and monitoring, with intervention reserved for cases where symptoms remain severe despite medication or when complications develop—urinary retention, recurrent infections, bladder stones, bleeding, or kidney damage.

Dr. Simon Onsongo, director of Aga Khan Hospital Kisumu, sees the arrival of minimally invasive prostate treatment as significant for the region. "If we can get them locally in Kisumu and in this part of the world, that is a plus for us," he says. Bringing specialized urological care to Western Kenya could reduce the need for patients to travel to Nairobi or beyond for treatment. For J O, the journey has been about reclaiming ordinary freedoms—sleeping through the night, traveling, visiting friends without constantly calculating the distance to the nearest toilet. His family pushed him toward a permanent solution, and his personal medical insurance ultimately covered the cost. Now recovering at the hospital, he carries a simple message for other men: do not dismiss frequent night-time urination, urgency, weak urine flow, or leakage as merely part of aging. "Take charge of your health," he says. "It is very, very important to take charge of your health. Don't fear. Come to the doctor."