BPH (Enlarged Prostate)

The prostate gland is the male organ that produces semen, the milky-colored fluid that nourishes and transports sperm during ejaculation.9k It is located beneath the bladder and surrounds the urethra — the tube that drains urine from your bladder. When it becomes enlarged, the prostate gland can put pressure on your urethra and cause difficulty urinating.

For most men the prostate gland begins to enlarge in their late 40’s.  As the central portion of the prostate gland grows the urinary flow may decrease and aggravating voiding symptoms such as nocturia (waking up at night to urinate), urinary frequency, urinary urgency, difficulty initiating the urine stream, difficulty emptying the bladder or straining to void may occur.

Diagnosis of BPH or prostate gland enlargement is made using a combination of pertinent urinary symptoms, digital rectal exam and occasionally other tests such as cystoscopy or ultrasound.

Treatment of BPH depends on your signs and symptoms.  Treatment modalities may include medications, minimally invasive procedures or surgery.

Consultants in Urology offers an advanced comprehensive array of treatment options for BPH, including the latest laser prostate surgery.

Treatment Options

Medications.  In general oral medications for the treatment of BPH fall into two broad categories; alpha-blockers and 5-alpha reductase inhibitors.  The prostate contains two separate types of tissue, muscular and glandular.  Medications are designed to attack one cell type or the other.  Some patients may require only one of these medications and others may require a combination.

Alpha-blockers work to relax the muscular tissue and decrease the physical pressure the prostate is placing on the urethra.  The effect of these medications usually takes place with 1-3 weeks.

Terazosin (Hytrin)
Doxazosin (Cardura)
Tamsulosin (Flomax)
Alfuzosin (Uroxatral)
Silodosin (Rapaflo)

Five-alpha reductase inhibitors work on the glandular tissue.  These medications actually shrink the size of the prostate gland by inhibiting the growth of the glandular tissue.  The effect of these medications may take several weeks to several months.

Finasteride (Proscar)
Dutasteride (Avodart)

Minimally Invasive Procedures. These procedures are outpatient treatment modalities performed in the office.  They are non-invasive and require only oral pain medications with a local anesthetic.  The procedures are fast and typically have minimal to no recovery.  They are designed for patients with mild to moderate urinary symptoms who would like to discontinue their oral medications

TUMT (Transurethral Microwave Therapy of the Prostate)  This procedure uses heat in the form of microwave energy to safely destroy the inner portion of the enlarged prostate gland.  After the patient receives mild oral anesthesia and a local anesthetic a small catheter is inserted into the urethra.9k-1 A tiny internal microwave antenna inside the catheter delivers a dose of microwave energy that heats and destroys enlarged cells. You may feel some heat in the prostate and bladder area and have a strong desire to urinate. These responses usually disappear after the treatment is finished. Patients go home the same day of the procedure.  It may take several weeks to notice an improvement in voiding.

Surgery. Surgery is indicated for patients with moderate to severe voiding symptoms or any patient who prefers definitive management and wishes to stop their oral medications.  Thanks to the recent development of laser surgery the majority patients undergo outpatient, ambulatory surgeries.  Most patients are discharged the same day of their surgery without a catheter.

Laser Prostatectomy. This new technology uses a high-energy laser therapy to destroy enlarged prostate tissue.  Since the laser does not penetrate deeply it does not damage surrounding tissue.  It also causes minimal to no bleeding and can be safely performed on patients maintained on blood thinners.  The most common types of laser surgery are photosensitive vaporization of the prostate (PVP, GreenLight®), continuous wave 2-micron laser (RevoLix®) and holmium laser enucleation of the prostate (HoLEP).  Operative times are typically less than one hour.  Majority of patients are discharged the same day without a catheter.  Results are excellent and most men note a dramatic improvement in their urinary symptoms almost immediately.

TURP (Transurethral Resection of Prostate).  This surgery was the mainstay of BPH treatment prior to laser prostatectomy.  It is still an excellent 9k-2option for many patients as it has the best long term results.  The procedure is performed in a hospital setting and requires either spinal or general anesthesia.  A telescopic camera is inserted into the urethra.  Using a small electrode enlarged prostate tissue is resected opening the channel of urine of flow.  A catheter is typically left in place for 24-48 hrs.

Open Prostatectomy.  This surgery is reserved for patients with an extremely large prostate gland.  A small incision is made in the lower abdomen, the bladder is opened and the prostate is identified.  The inner portion of the prostate is cored out establishing a wide open urethra.  A hospital stay of 2-4 days is usually required.