The technique here is often used in operations on other tissue—in eye surgery, for example—and now doctors have begun applying it to BPH. It uses a special ultrasound probe that works through an endoscope, a lighted “periscope” used in exploration and treatment of many diseases. The ultrasound targets tissues high in water content, like BPH tissue, while leaving surrounding tissue in the bladder neck, urethral sphincter, and elsewhere in the prostate unscathed (this surrounding tissue has a different makeup—more collagen, less water). The probe simultaneously breaks up the BPH tissue and flushes it out of the body; an aspirator device in the instrument vacuums up the tissue fragments.

In one study of fifty-nine men who were followed a year after the procedure, there was no incontinence, and no men reported urinary problems; two men had bladder neck contractures, and one man developed a stricture in the urethra at the tip of the penis. About 85 percent of men reported retrograde ejaculation. Men who may not benefit from this procedure are patients with middle lobe enlargement, because the ultrasound does not work as well in tissue near the bladder neck.

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