BPH (Enlarged Prostate)

As a man ages, his prostate typically grows. The additional tissue may cause urinary problems, and eventually a loss of bladder function.

Benign prostatic hyperplasia (BPH) is a common condition. As men age a non-cancerous enlargement of the prostate often occurs. This can lead to a blockage of the urethra and cause issues with urination. This condition may block urine flow from the bladder a condition known as LUTS (Lower Urinary Tract Symptoms).

Learn more with this booklet about BPH.

Some or all of the following symptoms may occur with BPH:

• Difficulty starting your urinary stream
• Inability to completely empty the bladder
• Straining to urinate
• Sudden urge to urinate
• Urinating more often
• Urine leakage
• Waking up at night to urinate
• Weaker urine stream

Your prostate may become larger as you age, often beginning in your 40s – 50s, sometimes earlier. The condition, called BPH, is non-cancerous and very common. But it’s important to have BPH treated because the enlargement tends to block the urethra and urine flow out of the body. Without treatment, an eventual loss of bladder function can occur which can be permanent.

Other conditions with similar symptoms:

• Urinary tract infections
• Bladder or kidney stones
• Urethral stricture/scar tissue formation
• Inflammation of the prostate (prostatitis)
• Problem with the nerves to the bladder
• Cancer of the bladder or prostate

That’s why it’s important to see your urologist if you experience symptoms.

During your visit, your doctor will ask about your medical history and will exam your abdomen and genitalia. You may be asked to complete a short questionnaire about your urinating patterns.

Tests that may be performed during or after your visit:

• Digital rectal exam: The size of your prostate, and any possible abnormalities, are determined as your physician inserts a finger into your rectum.
• Urinalysis: A urine test evaluates for blood in the urine or infection.
• Cystoscopy: This is a procedure performed in the office where the physician inserts a small scope into the penis to assess the urethra for any scar tissue and evaluate the prostate for any evidence of blockage.
• Prostate ultrasound: A probe is inserted into the rectum to check the size and shape of the prostate.
• Blood test: A blood test called a PSA (prostate-specific antigen) test will help determine your risk for prostate cancer.
• Post-void residual: You are asked to urinate and a non-invasive ultrasound scan is done to make sure you are emptying your bladder.
• Urine flow: You urinate in a funnel to assess the speed of your urinary stream.
• Urodynamics: A very small catheter is inserted into the penis and another into the rectum to help measure the pressures in the bladder during filling of the bladder and urination.
• Urocuff test: You will be asked to urinate into a small device placed outside the body at the tip of the penis which measures both urine flow and pressure.

NON-SURGICAL TREATMENTS

• Lifestyle modifications: The most conservative course of action is best to try first, unless circumstances warrant a more aggressive approach. These simple steps may include changing bathroom habits and dietary changes.
• Alpha blockers: Medication to relax the prostatic urethra and bladder neck, making urination less difficult. Most common are tamsulosin (Flomax), silodosin (Rapaflo), and alfuzosin (Uroxatral).
• 5-alpha reductase inhibitors: Medication to shrink the prostate (takes at least 4-6 months to shrink the prostate enough to notice a difference). Most common are finasteride (Proscar) and dutasteride (Avodart).
• Tadalafil (Cialis): Improves quality of life related to urination and is used to treat erectile dysfunction.

SURGICAL TREATMENTS

• Prostate Artery Embolization (PAE): Is a non-surgical procedure that can improve lower urinary tract symptoms by blocking the blood flow to the prostate, thereby reducing the size of the prostate. PAE is a revolutionary treatment for BPH at our Interventional Radiology Centers. Learn more.
• UroLift®: This incision-free procedure involves retracting, not removing, the tissue that blocks the urethra. The surgeon inserts small implants into each side of the prostate, pulling the walls of the prostate away from the urethra and opening the channel.
• Rezum: A treatment that uses the natural energy stored in water vapor, or steam, to remove excess prostate tissue that is compressing the urethra. A catheter may be required for a short time after the procedure.
• Transurethral Incision of the Prostate (TUIP): This procedure involves a precise pair of incisions being made in the bladder neck where the prostate merges with the bladder. This will release the restriction of the bladder outlet and dramatically improve symptoms of BPH.
• GreenLight™ Laser Therapy and Holmium Laser Enucleation of Prostate (HOLEP Laser Therapy): These approaches rely on a laser to vaporize or remove obstructing prostate tissue. A catheter is typically required temporarily after the procedure, and an overnight stay in the hospital may be needed.
• Aquablation therapy: Using robotic technology, the surgeon delivers heat-free water jets to trim invasive prostate tissue. This procedure requires anesthesia, and an overnight hospital stay.
• Transurethral resection of prostate (TURP): This remains the gold standard of treatment against which all other options are compared. During the procedure, the physician passes a thin instrument called a resectoscope through the urethra to the prostate while visualizing with a camera. An electric cautery loop is used to trim away tissue that appears to be blocking the urethra and urine flow.
• Optilume® BPH Catheter System: Optilume is a drug-coated balloon inserted into the urethra to the prostate via a telescopic camera. The balloon expands and creates an opening to release the safe and proven drug, paclitaxel, into the prostate. When the drug is fully released, the balloon is deflated and removed. The applied drug prevents re-fusion of the lobes during healing, keeping the prostate open, restoring the flow of urine, and relieving symptoms.
• Open Simple Prostatectomy: Simple prostate removal, or prostatectomy, is a procedure to remove the inside part of the prostate gland to treat an enlarged prostate. It is done through a surgical incision and generally requires a 2-4 day hospital stay and 6-8 weeks recovery.
• Robotic Prostatectomy: This is an enucleation procedure (removing almost all enlarged prostate tissue while keeping the capsule intact). It may be done through a single incision approximately 1 ½ inches long below the belt line and accessing the prostate directly through the bladder. Alternatively, it may be done through several small punctures in the lower abdomen. This is less invasive and a faster recovery than an open prostate procedure and typically is for men with extremely large prostates.