Enlarged Prostate (BPH)
The prostate is a walnut-sized gland that forms part of the male reproductive system and produces the fluid that carries sperm during ejaculation. The prostrate surrounds the urethra, the canal that carries urine from the bladder out of the body. Having benign prostatic hyperplasia (BPH), means you’re suffering from an enlarged prostate gland. As the prostate gets bigger, it may squeeze or partly block the urethra, causing problems with urinating.
Benign prostatic hyperplasia is also known as benign prostatic hypertrophy and occurs in almost all men as they age. About half of men 75 years and older have symptoms. BPH is not a form of cancer; it is more of a nuisance more than a serious problem.
BPH occurs by changes in hormone balance and in cell growth, and causes urinary problems such as:
- Trouble getting a urine stream started and completely stopped (dribbling)
- Often feeling like you need to urinate, sometimes even waking you up at night
- A weak urine stream
- A sense that your bladder is not completely empty after you urinate
In a small number of cases, BPH may cause the bladder to be blocked, making it impossible or extremely hard to urinate. This problem may cause backed-up urine (urinary retention) which leads to bladder infections, kidney damage and stones. BPH does not cause prostate cancer, affect a man's ability to father children or cause erection problems.
By asking questions about your symptoms and past health, and by doing a physical exam, your doctor can diagnose BPH. Tests may include a digital rectal exam (which lets your doctor feel the size of your prostate), a urine test and in some cases, a prostate-specific antigen (PSA) test. The PSA allows the doctor to rule out prostate cancer. Although not related, prostate cancer and BPH can cause some of the same symptoms.
Your doctor may ask you how often you have symptoms of BPH, how much they affect your life and how severe they are. Home treatment may be all you need if your symptoms are mild to moderate and do not bother you much. In this case, your physician may want to see you regularly to check on your symptoms and make sure other problems haven't arisen. Use this tool to help you consider how bothersome your symptoms are:
With mild symptoms, your doctor may simply need to monitor and track your condition and symptoms before deciding if any treatment is necessary.
Dr. Hsieh may feel that prescription medications are necessary to manage your symptoms. These include alpha blockers which relax the muscles around the neck of your bladder, making it easier to urinate, and alpha reductase inhibitors which act to shrink the prostate. Patients must continue taking medications long-term to maintain the effects.
Some patients may experience side effects such as headaches, sexual dysfunction or dizziness, headaches and may not get adequate relief of their symptoms. Over 20 percent of men on medication for BPH discontinue treatment early citing dissatisfaction with side effects and non-adequate symptom relief as reasons.
UroLift® System Treatment
The UroLift System is a minimally-invasive procedure treats the symptoms of BPH by lifting or holding the enlarged prostate tissue out of the way, like opening curtains on a window. Unlike other BPH procedures, there is no cutting, heating or removal of prostate tissue with this method. Read more about the UroLift System treatment as well as its benefits, risks and recovery by visiting our FAQ page for more information.
Thermotherapies uses heat energy such as microwave or radiofrequency that is applied to prostate tissue. It is minimally-invasive treatment, even less than TURP (see below), and treatments are generally safe. Thermotherapies can be performed under local anesthesia and provide moderate symptom relief for some patients.
Applying high heat to the prostate can cause tissue swelling, and during the healing period can cause uncomfortable urinary symptoms. Relief does not occur immediately, and during the recovery process, patients will often need to use a catheter that is attached to a urine bag inserted into their bladder.
GreenLight Laser Therapy is used in combination with the “gold standard” transurethral resection of the prostate (TURP) surgical procedure and offers fewer side effects. Several studies have shown comparable outcomes between the two procedures. During the GreenLight Laser Therapy, the physician uses a laser to remove the excess prostate tissue, resulting in a larger channel for urine flow to pass through. Removing the excess tissue eliminates most lower urinary tract symptoms.
The criteria used to select patients for GreenLight Laser Therapy are the same as those for TURP, so any. The procedure can be performed in a hospital outpatient center, surgical center or specially-equipped physician’s office. Typically, no overnight stay is needed, and the patient is put under with general or spinal anesthesia during the treatment. In some cases when a patient travels a long distance, has other medical conditions to consider, or is in frail condition, an overnight stay may be recommended.
Transurethral Resection of the Prostate (TURP)
TURP is often considered the “gold standard” for long-term results and is the most common surgery to treat BPH. During this procedure, patients undergo general anesthesia to remove internal prostate tissue. After it has been removed, the body needs time to heal.
Before the desired shrinking effect occurs, the remaining prostate tissue may swell and become inflamed. Some may need to use a catheter after the procedure and symptom relief may not occur immediately. However, once it does occur, it lasts for a long time. Some long-term side effects include ejaculatory dysfunction, erectile dysfunction or incontinence (leaking of urine).