Enlarged Prostate (benign prostatic hyperplasia BPH) & Treatments Q&A
Enlarged prostate, also known as benign prostatic hyperplasia (BPH), is a very common disease in older men. By age 80, half of all men have enlarged prostate glands. The condition occurs when the gland swells and presses against the urethra (the tube that carries urine away from the bladder). This can block the flow of urine and cause problems with urination called lower urinary tract symptoms (LUTS). The main symptom of an enlarged prostate gland is trouble starting or stopping the stream of urine. Having to urinate often -- especially at night -- is another symptom. Enlarged prostate gland occurs naturally with age, so men over 50 are likely to have enlarged prostate glands. Symptoms can occur when an older man's prostate gets larger than about 40 grams (g). When the gland becomes this large, it may begin to block the urethra and cause problems with urine flow. When a man is first diagnosed with an enlarged prostate gland, doctors usually recommend watchful waiting. That means closely monitoring the symptoms for any changes. This approach might be reasonable if the symptoms of an enlarged prostate are mild and aren't bothering the patient much. But studies show that most men with BPH eventually need treatment as their symptoms worsen over time.
The prostate is a gland in the male reproductive system. The main function of this gland is to produce fluid that makes up semen. A healthy prostate is about the size of a walnut and is located below the urinary bladder at the bladder neck. Since the prostate surrounds the urethra enlarged prostates close off the urethra - a tube carrying urine out of your body.
Benign prostatic hyperplasia (BPH) is a very common disease in older men. By age 80, half of all men have enlarged prostate glands. The condition occurs when the gland swells and presses against the urethra (the tube that carries urine away from the bladder). This can block the flow of urine and cause problems with urination called lower urinary tract symptoms (LUTS).
BPH is not cancer, but the symptoms can be similar to those of prostate cancer.
The main symptom of an enlarged prostate gland is trouble starting or stopping the stream of urine. Having to urinate often -- especially at night -- is another symptom. Most men do not have symptoms at first. However, as prostate growth worsens, you may notice bothersome urinary symptoms.
There are no obvious symptoms for benign prostatic hyperplasia itself, but you might experience some urinary symptoms that BPH causes like:
- trouble starting or stopping urine flow (hesitancy)
- straining while peeing
- taking longer than usual to finish urinating
- urinary urgency
- urinary incontinence
- urinary frequency
- dribbling at the end of urination
- trouble starting or stopping urine flow (hesitancy)
- nocturia You also might feel like you have to go more often than normal, especially at night. Sometimes men find they can't go at all without waking up several times to use the bathroom.
The most common sign of benign prostatic hyperplasia in men over 50 is trouble starting or stopping the stream of urine when trying to relieve oneself. This is because the enlarged prostate tissue pinches off the urethra, the tube that carries urine from your bladder through your penis. The bladder continues to try and push this fluid out but it's blocked along the way. As a result, frequent trips to the bathroom will be made often for you to alleviate this pressure on your urethra without any blockage by urinating. Meanwhile, you may also experience some dribbling at the end of urination after making sure everything has been expressed from your bladder.
Nocturia is the need to wake up at night to urinate. An enlarged prostate can cause this symptom by putting pressure on the urethra, the tube that carries urine away from your bladder. When you lie down flat, gravity forces urine to collect in your bladder. This can make it difficult for your bladder to empty completely because the pressure of the urine against your urethra acts as a plug. As a result, you may feel an urgent need to urinate during the night because there isn't enough room inside your bladder for both urine and blood flow back into circulation.
Urinary retention can have multiple causes. However, in BPH, as prostate cell growth increases and your prostate gland presses against the urethra and blocks it, urine builds up in your bladder. As a result of this pressure, you may not be able to completely empty your bladder when you urinate. This causes urine to back up into your kidneys, ureters, and bladder causing temporary urinary retention. Bladder stones, urinary tract infections, chronic inflammation, and bladder cancer can result. As urine "backs up" kidney diseases can result including infection and kidney failure.
Lower urinary tract symptoms are problems with the organs that make up the lower urinary tract. These structures include your bladder and urethra. A common symptom of an enlarged prostate is trouble emptying your bladder completely, which can result in one or more of the following:
- Frequent urination
- Having to go right away when you get a strong urge to urinate
- Weak stream or taking a long time to start urinating
These are all signs that your bladder muscles aren't working properly due to pressure from an enlarged prostate gland. As described above, this pressure makes it difficult for urine to leave your body, even after you've emptied as much as you can.
Prostate surgery to remove or destroy prostate tissue can provide relief from lower urinary tract symptoms caused by benign prostatic hyperplasia (BPH) - prostate enlargement. Moderate and severe symptoms can be addressed. When performed correctly, they can help stop or prevent further problems. Common surgical options for benign prostatic hyperplasia are:
- Transurethral needle ablation of the prostate (TUNA). In this benign prostatic hyperplasia treatment, your doctor inserts a thin, flexible tube through the tip of your penis and passes it into your urethra up to your prostate. He or she then injects a saline (saltwater) solution near the base of your prostate to destroy prostate tissue that is pressing on and narrowing your urethra. This procedure can be repeated as necessary to remove enlarged tissue
- Transurethral resection of the prostate (TURP). In this procedure, your doctor makes a small incision in your urethra and inserts a surgical tool with a cutting loop to remove excess prostate tissue that is pressing on and narrowing your urethra. During TURP, the doctor flushes the inside of your urethra to remove all prostate tissue. This procedure can be repeated as necessary.
- Open prostatectomy. For this procedure, your doctor makes an incision in your abdomen and removes part or all of your prostate gland through that opening. The surgery has a higher risk than other types of prostate surgery is performed in a hospital and requires a longer recovery time.
- Transurethral microwave ablation (TUMT). This is a procedure for relieving the symptoms of an enlarged prostate gland by heating and destroying part of the prostate gland with microwaves.
- Laser surgery. Several types of laser surgery are used to treat an enlarged prostate gland.
Transurethral resection of the prostate (TURP) is a surgery used to treat urinary problems that are caused by an enlarged prostate.
An instrument called a resectoscope is inserted through the tip of your penis and into the tube that carries urine from your bladder (urethra). A transurethral incision is made. The resectoscope helps your doctor see and trim away excess prostate tissue that's blocking urine flow.
TURP is generally considered an option for men who have moderate to severe urinary problems that haven't responded to medication. While TURP has been considered the most effective treatment for an enlarged prostate, several other, minimally invasive procedures are becoming more effective. These procedures generally cause fewer complications and have a quicker recovery period than TURP.
All procedures have risks. Some possible problems after TURP include:
- Bleeding, which may require a blood transfusion or return to surgery for hemostasis. Some bleeding from the internal incision is usually controlled with injections of medications that help the blood clot.
- An infection in your urinary tract
- Damage to your urethra and bladder
- Erectile dysfunction
- Retrograde ejaculation
Laser prostatectomy is the removal of part or all of the prostate gland using a laser. This treatment is also called laser ablation, laser surgery, laser vaporization, and photoselective vaporization of the prostate (PVP).
During this procedure, a surgeon inserts a thin, flexible tube (cystoscope) with a camera through the tip of your penis and into your urethra. The cystoscope gives the surgeon a close-up view of your prostate on a video screen. Then, the surgeon passes a laser fiber through the cystoscope to your prostate. The fiber delivers focused energy (laser light) to heat and destroy excess tissue in your prostate that's blocking urine flow. Re-treatment may be necessary.
GreenLight® laser photoselective vaporization of the prostate (pvap) is a treatment option for men diagnosed with benign prostatic hyperplasia (BPH). During pvap, your doctor uses light energy from a specialized laser fiber through your urethra to remove part of your prostate gland. An incision is needed to insert a thin laser fiber through the urethra and into the targeted area of the prostate gland. The surgery is typically performed on an outpatient basis. Your doctor will monitor you for any pain or side effects related to recovery.
The urolift (prostatic urethral lift) is a minimally invasive surgical treatment that has been approved by the FDA since 2001.
A scope is inserted into your body through your urethra to your prostate gland. Your physician will make one small incision and insert a device called a "urethral lift". The urethral lift can be adjusted to place pressure on the diseased portion of the urethra and allow more space for urine flow. You may experience some blood in your urine and discomfort while urinating for the first few days. It does not destroy excess prostate tissue. It does not shrink the prostate.
Non-surgical options for an enlarged prostate (BPH) include medications, dietary and lifestyle changes, and minimally invasive procedures. If you're not a good candidate for surgery or prefer not to have surgery, these nonsurgical options can help reduce your signs and symptoms and preserve your quality of life.
Medications, such as alpha-blockers or 5ARIs, which may help ease urinary irritation and improve urine flow may be prescribed. When taken regularly medical therapy can help control urgency and frequent urination. Several types of this medication are available. It is important not to stop taking these medications without first talking with your doctor since doing so abruptly could worsen your symptoms.
Side effects from alpha-blockers may include dizziness, lightheadedness, or fainting when rising too quickly from a sitting or lying position. These side effects tend to go away with time as your body adjusts to the medication.
Prostate artery embolization is a new, non-surgical effective outpatient procedure that is becoming more popular as an alternative to more invasive surgery. PAE is a “pinhole” procedure performed by Imaging & Interventional Specialists. A small needle is used to access your arteries and X-rays guide miniaturized equipment to the prostate artery responsible for feeding your enlarged prostate. Then tiny particles are selectively injected to slow blood flow to your prostate. This starves your enlarged prostate of nutrients so it shrinks and relieves your urinary symptoms.
This is an outpatient "pinhole" procedure which means you can go home on the same day as your treatment, usually with just a bandaid.
Study results are promising and show an over 90% success rate in symptom improvement after one year.
The Imaging & Interventional Specialist team has in-office diagnostic technologies to help assess whether prostate artery embolization will be suitable to treat your enlarged prostate. Besides our careful history and physical exam, the team at Imaging & Interventional Specialists may obtain imaging studies such as an MRI to aid with accurate diagnosis and to help develop your treatment plan.
Besides history and physical exam Imaging an Interventional Specialists may recommend an MRI, MRA, ultrasound, and a urodynamic study. A digital rectal examination may be performed although imaging studies are more accurate. Blood tests including prostate specific antigen will be ordered. These rule out prostate cancer. Your prostatic volume is also given.
An MRI can provide detailed images of the inside of your body using strong magnetic fields and radio waves. During an MRI, you lie on a table that is sometimes moved into a tunnel-shaped scanner. Your doctor may inject you with a special dye so the different parts of your prostate can be seen more clearly.
Imaging and Interventional Specialists will get a baseline study and then another after treatment to evaluate how effective the treatment has been to shrink.
Your doctor may also order a urodynamic study to monitor how well your bladder is working. For this test, you will need to wear an external, portable device for several hours that collects information about the strength and timing of your urine stream. This often includes pressure and flow measurements and recordings of sounds as you urinate.
Imaging & interventional Specialists' “pinhole” procedures: fast recovery, less risk, less pain, comfortable setting
Our experienced board-certified specialists successfully perform “pinhole” procedures every day offering this region's leading, state-of-the-art solutions for enlarged prostate/benign prostatic hypertrophy. The PAE seals blood vessels, prostate cells die and your prostate shrinks, and urinary flow improves. Our minimally invasive image-guided procedures are cutting-edge technology without the cutting, without the scalpel. You leave with a Band-Aid!
- Procedures are usually done in a comfortable outpatient setting with familiar friendly staff
- Pinhole procedures offer fast recovery, less risk, and less pain
Imaging & Interventional Specialists are leaders in interventional radiology and experts in the minimally invasive procedures that will address your enlarged prostate/benign prostatic hypertrophy.
Using state-of-the-art equipment, our experienced board-certified specialists are focused on your best outcome.
At Imaging & Interventional Specialists board-certified physicians offer in-house testing for diagnosis and to develop an individualized treatment program for your enlarged prostate/benign prostatic hypertrophy.