patient education > medical procedures and conditions > enlarged prostate (BPH)

Enlarged Prostate (BPH)

Benign prostate hyperplasia (BPH) is not simply a case of too many prostate cells. Prostate growth involves hormones, occurs in different types of tissue and affects men differently. As a result of these differences, treatment varies in each case.

There is no cure for BPH and once prostate growth starts, it often continues, unless medical therapy is started.

BPH is a condition of aging. Nearly all men over the age of 50 have an enlarged prostate.

The cause of benign prostatic hyperplasia is unknown. It is possible that the condition is associated with hormonal changes that occur as men age.

Common symptoms of benign prostatic hyperplasia include the following:

• Blood in the urine caused by straining to void
• Dribbling after voiding
• Feeling that the bladder has not emptied completely after urination
• Frequent urination, particularly at night
• Hesitant, interrupted, or weak urine stream caused by decreased force
• Leakage of urine
• Pushing or straining to begin urination
• Recurrent, sudden, urgent need to urinate

There are several treatment options for men with benign prostate hyperplasia, depending on the severity of symptoms.

Men with mild symptoms may choose to return for annual examinations. This is called “watchful waiting.” The physician will perform an examination that includes a DRE, PSA tests, and a urinary flow rate. The patient will be asked to describe symptoms in order to determine if the condition is worsening.

There are medications available to help treat BPH. These medications include apha-blockers, which relax the muscles of the bladder neck and prostate, increasing urinary flow and improving symptoms. Alpha-blockers typically are taken orally, once or twice a day.

There are also several surgical treatments available to treat BPH. The treatments we use in our office include the following:

Prostiva RF (radio-frequency) Therapy

Prostiva RF (radio-frequency therapy) is a minimally invasive, office procedure that alleviates urinary symptoms and improves urination in most men with prostate enlargement. It previously was referred to as transurethral needle ablation (TUNA) therapy. It is FDA approved, and one of the few treatments for prosptate enlargement recommended by the "American Urological Association Guideline on Management of BPH." It is covered by Medicare and almost all private insurance companies.

Click here for more information about Prostiva.

GreenLight™ Laser Therapy

GreenLight™ Laser Therapy is a procedure performed with a small fiber that is inserted into the urethra through a cytoscope. The fiber delvers high-powered energy which quickly heats up the prostate tissue, causing the tissue to vaporize. This process is continued until all of the enlarged prostate tissue has been removed. Natural urine flow is rapidly restored and urinary symptoms are quickly relieved in most patients.

To learn more about GreenLight Laser Therapy, click here.

TURP

Transurethral resection of the prostate (TURP). This procedure is performed under general or regional anesthesia and takes less than 90 minutes.

The surgeon inserts an instrument called a resectoscope into the penis through the urethra. The resectoscope is about 12 inches long and one-half an inch in diameter. It contains a light, valves for controlling irrigating fluid, and an electrical loop to remove the obstructing tissue and seal blood vessels. The surgeon removes the obstructing tissue and the irrigating fluids carry the tissue to the bladder. This debris is removed by irrigation and any remaining debris is eliminated in the urine over time.

Prostatectomy

Another surgical procedure is called the Prostatectomy. If the prostate is greatly enlarged, if the bladder has been damaged, or if the patient has complications prohibiting transurethral surgery, prostatectomy (removal of the obstructing prostate) may be necessary. This procedure is sometimes the best and safest approach.

Prostatectomy is performed under general or regional anesthesia. The surgeon makes an external incision in the lower abdomen or in the perineum (area between the rectum and the scrotum). If the surgeon accesses the prostate from the abdomen, the procedure is called suprapubic or retropubic prostatectomy; surgery through the perineum is called perineal prostatectomy. Once access is gained, the prostate is removed.