Prostate therapy offers men hope for sexual function after treatment

Dr Winstar Mokua, Consultant Urologist at Aga Khan Hospital, Kisumu, confers with fellow medical specialists during preparations for the first Rezūm Water Vapor Therapy procedure in Western Kenya at the hospital. [Rodgers Otiso, Standard]

For nearly two years, 69-year-old Alex had learnt to live with a problem that slowly took control of his nights and began interfering with his daily life.

He would wake up several times at night to urinate, sometimes more than three times, yet still feel that his bladder had not emptied. During the day, he experienced frequent and urgent trips to the toilet, a weak flow and urine dribbling, sometimes accompanied by pain.

Medication offered temporary relief, but it did not give him the lasting solution he wanted.

Now, after undergoing a new minimally invasive procedure at Aga Khan Hospital, Kisumu, Alex is hoping to put the problem behind him while retaining an aspect of his health that he feared conventional prostate surgery could affect his sexual function.

Alex is among patients who could benefit from the introduction of Rezūm Water Vapor Therapy in Western and Nyanza Kenya, a procedure doctors say offers selected men with an enlarged prostate an alternative to conventional surgery.

The milestone marks the first time the technology has been used in the region, giving men with prostate enlargement another treatment option without the need for conventional cutting or removal of prostate tissue.

Dr Winston Mokua, a consultant urologist at Aga Khan Hospital, Kisumu, who performed the procedure, describes the development as an important step in advancing minimally invasive treatment in the region.

"We had a milestone in advancing minimally invasive therapies. We had the first procedure in this region of Rezūm Water Vapor Therapy, which is one of the minimally invasive procedures for managing prostate enlargement,” says Dr Mokua.

For years, one of the standard surgical treatments for prostate enlargement has been transurethral resection of the prostate (TURP), in which obstructing prostate tissue is resected to improve urine flow.There are also traditional procedures such as open prostatectomy. But Rezūm takes a different approach.The procedure uses a delivery device passed through the urethra to inject small amounts of water vapour into the enlarged prostate.

The heat generated by the vapour destroys targeted prostate cells. The cells then gradually die and shrink, creating more space in the urethra and allowing urine to flow more freely.There are no external cuts.

“It is actually a day procedure, meaning that we don't need to spend a long time in hospital. During the procedure itself, we don't do any cuts. We use the delivery device through the urethra,” says Dr Mokua.

Unlike some conventional surgical procedures, which may involve significant bleeding, pain and longer hospital stays, Rezūm allows suitable patients to go home the same day.

However, the results are not immediate.

Dr Mokua says patients begin to experience improvement from about two weeks, with the benefits continuing to develop over a period of up to three months as the treated prostate tissue gradually shrinks.

A catheter is usually kept in place for between three and seven days before it is removed.For many men, however, the attraction of the procedure goes beyond shorter hospital stays.

It is the possibility of preserving sexual function.

One of the common effects of conventional prostate surgery such as TURP is retrograde ejaculation, where semen flows backwards into the bladder rather than being expelled normally during ejaculation.

Dr Mokua says TURP generally does not affect a man's ability to achieve an erection, but it can affect ejaculation; a concern that discourages some men from seeking treatment even when their symptoms become severe.

“With the Rezūm Water Vapor Therapy, one of the key advantages is preserving sexual function, especially the ability to have antegrade ejaculation,” he says.

This, he adds, makes the procedure an option worth considering for selected men, particularly those who are concerned about maintaining their sexual function but doctors stress that not every man with an enlarged prostate needs surgery.

For some, lifestyle changes and medication may be enough.A procedure becomes necessary when symptoms persist despite medical treatment or when complications begin to develop.

These may include severe lower urinary tract symptoms, repeated waking at night to urinate, urinary retention, recurrent urinary tract infections, bleeding from the prostate, bladder stones and kidney dysfunction caused by prolonged obstruction.

When urine cannot flow properly, it can back up towards the kidneys, potentially causing swelling and affecting their function. Urine that remains in the bladder for long periods can also encourage bacterial growth and recurrent infections.“Every man has a prostate, but not every man needs to have a procedure, whether it is the traditional methods like open prostatectomy, newer methods like TURP, or the newer ones like Rezūm,” Dr Mokua says. “Those are selected patients, and we have to discuss with the patient and know what really their desires are.”

Prostate enlargement, medically known as benign prostatic hyperplasia (BPH), is common as men grow older. Dr Mokua says ageing is the main risk factor, with the likelihood of enlargement and urinary symptoms increasing after the age of 50.

The symptoms can include frequent urination, urgency, difficulty starting to urinate, a weak urine stream and a feeling that the bladder has not emptied.For some men, the condition can also lead to urinary incontinence, where urine leaks before they reach the toilet.

The effects can extend far beyond the bathroom.A man may struggle to sit through a meeting, travel long distances or attend social gatherings without worrying about finding a toilet and the condition can also disturb sleep, leaving men tired and affecting their quality of life.

Despite its prevalence, Dr Mokua says there are misconceptions surrounding prostate enlargement. One of the biggest is the belief that an enlarged prostate automatically means prostate cancer.

He say, the two conditions are different.BPH is a non-cancerous enlargement of the prostate that commonly occurs with ageing, although it can cause significant urinary problems.A normal prostate weighs about 20 to 25 grammes, but the size of the prostate alone does not determine the severity of symptoms.

A man can have a relatively small prostate and experience significant obstruction, while another with a much larger prostate may have few symptoms. “The bigger the prostate does not necessarily mean the more symptoms. You can have a small prostate and more symptoms, while another person can have a 100-gramme prostate and have no symptoms,” says Dr Mokua.

Another misconception is that every man diagnosed with prostate enlargement will eventually require surgery.Dr Mokua says treatment depends on the symptoms, complications and individual circumstances of the patient.He also cautions against assuming that a large prostate automatically means cancer.

Dr Mokua says men often ignore urinary and sexual symptoms until they become difficult to tolerate. “Men generally only go to hospital when things are too late,” he says.

A man may continue taking medication or endure symptoms until he develops urinary retention and is unable to pass urine and others only seek care after developing recurrent infections, bleeding or kidney problems.

Dr Mokua attributes the delay partly to men's health-seeking behaviour and cultural expectations that men should be strong and endure problems without seeking help.Men may also prioritise their families, particularly where they are the main providers, putting their own health needs aside.

Data also points to a significant burden of prostate-related conditions among Kenyan men.According to the Kenya Demographic and Health Survey, more than 14,400 men aged 15 to 54 were diagnosed with a prostate-related condition in 2022, yet only 14 per cent reported that they were undergoing treatment.

Globally, the risk of BPH increases significantly with age, while studies in Sub-Saharan Africa have documented high levels of lower urinary tract symptoms among older men.At the same time, prostate cancer remains the most prevalent cancer among Kenyan men, making it important for men to seek medical assessment rather than self-diagnose urinary symptoms.

For Alex, the journey began in 2022 when he started noticing that he was visiting the toilet more frequently at night. “I started feeling this frequency of going to the toilet during the night, many times, around 2022,” he says.

Alex says at the time, he was also dealing with a kidney cyst, which required an operation at the same hospital.He discussed the urinary problem with Dr Mokua and was advised on treatment.He could have undergone a prostate procedure in 2023, but his kidney operation took priority.

He experienced urine dribbling and pain and watched other patients undergo conventional prostate procedures as the years went by, the symptoms persisted.The experience left him uncertain about whether he wanted to undergo a similar operation.

His search for an alternative eventually led him to social media.About a month before his procedure, he came across information about a new method being offered at Aga Khan and contacted Dr Mokua. “I saw that there was a new method which takes about 10 minutes to 30 minutes, and you walk home,” he says.

After consultations and further tests, doctors confirmed that his prostate was enlarged and explained that he could be a suitable candidate for Rezūm and was booked.The procedure was eventually performed this week. “When they took me to the procedure room, after that I didn't feel it, even when I came back up here,” he says.

Alex says he is already feeling more comfortable and the blood he had previously noticed has cleared.He is now waiting for the catheter to be removed.But his greatest relief is the possibility that the procedure will allow him to retain his sexual function.

At 69, Alex says he remains sexually active and did not want treatment that would unnecessarily interfere with that part of his life.“That is another thing some people might fear. They ask, ‘Am I going to lose my sexuality if I undergo this procedure?’ But this one preserves it,” he says.

The symptoms had also affected his social life. At night, he could wake up more than three times to urinate. Visiting other people became uncomfortable because he worried about having to repeatedly get out of bed.

Sometimes the urgency was so severe that he would leak urine before reaching the toilet. “You can even wet your clothes, and sometimes when it comes, it comes with urgency,” he says.

For nearly two years, he relied on tablets to control the symptoms but medication required consistency, and sometimes he would forget to take them.“If I can get a permanent solution, that is why I decided to do it,” he says

His experience, he says, has taught him the importance of taking charge of one's health rather than waiting until a condition becomes severe.“Take charge of your health. It is very, very important to take charge of your health. Don't fear. Come to the doctor,” he says.

The introduction of Rezūm in Kisumu comes at a time when the cost of specialised healthcare continues to push some Kenyans to seek treatment outside the country.

More than 10,000 Kenyans travel abroad each year for specialised medical treatment, spending an estimated Sh10 billion annually, according to Health Ministry data.

Treatment abroad is estimated to cost an average of about Sh1.5 million per patient, creating a heavy financial burden for families and insurers.

The African Export-Import Bank has estimated that Africa loses about $7 billion annually as patients seek treatment abroad.

Bringing advanced procedures closer to patients could therefore help reduce the need for some patients to travel long distances in search of specialised care.

The milestone in Kisumu follows the successful performance of Kenya's first Rezūm procedure at Kenyatta National Hospital in January 2026, making it the first public health facility in the country to offer the technology.

Its introduction in the private sector is expanding access, although cost remains a concern.Dr Mokua says the procedure, like many minimally invasive technologies, can be expensive, but some insurance providers are now willing to cover it.

He says increased awareness and a growing number of procedures could eventually contribute to lower costs.

For Dr Simon Onsongo, a consultant pathologist and Head of Pathology at Aga Khan Hospital, Kisumu, the arrival of new technology is an important development for patients in the region. “New technology that brings benefit to the patient that we serve in this region is important,” says Dr Onsongo.

He says men have for years undergone extensive procedures that could affect their quality of life even after surgery.The availability of minimally invasive options gives doctors and patients more choices depending on the individual condition.

The hospital is also hoping to perform more procedures and build the expertise needed to serve a larger number of patients locally.“We do not want patients to be travelling to Nairobi or other countries to seek these services. You can give them locally in Kisumu and in this part of the world. That is a plus for us,” says Dr Onsongo.

Rezūm, doctors emphasise, is not a replacement for every other form of prostate treatment.Some men will continue to benefit from medication, while others will require conventional surgery.

Dr Mokua says he encounters men with erectile dysfunction across different age groups, although it becomes more common with age and with conditions such as diabetes, hypertension and other chronic illnesses.Among younger men, psychological factors such as performance anxiety can also play a significant role.

He estimates that about 30 to 40 per cent of patients in his clinic may have a complaint related to erectile dysfunction.Yet many will not mention it unless the doctor asks.“It is a very common thing. Almost every single day, I cannot fail to see a man with erectile dysfunction,” he says.

His message to men is that changes in urination or sexual function should not be ignored. “If you are having any changes in your body, you are realising that you are frequently urinating, you have developed erectile dysfunction, come out and visit a hospital because it could be many things. It could even be diabetes,” says Dr Mokua.