Non-Surgical Alternatives to TURP for BPH Q&A
In the USA enlarged prostate also called benign prostatic hyperplasia (BPH) affects 50% of all men by age 60 and up to 90% of all men by age 85. It is one of the most common conditions affecting older men.
BPH occurs when the prostate gland enlarges, causing benign urinary obstruction (BPO). BPO causes lower urinary tract symptoms (LUTS).
The prostate gland is a walnut-sized gland at the bladder neck which is located just below the urinary bladder in men. The urethra carries urine from the bladder out of the penis. With excess prostate tissue, the urethra becomes compressed. The prostate secretes a fluid that becomes part of semen.
With prostate cell growth the prostate gland enlarges and the excess prostate tissue pushes on the urethra at the bladder neck causing benign urinary obstruction (BPO) which in turn causes lower urinary tract symptoms (LUTS).
Benign prostatic hyperplasia causes lower urinary tract symptoms due to benign prostatic obstruction BPO) at the bladder neck causing urinary blockage. This gives rise to urinary symptoms. The 5 warning signs of benign prostatic hyperplasia are:
- Weak or interrupted urine flow
- Hesitancy starting urination
- Urinary urgency
- Dribbling after urination
If you have any of these 5 warning signs, it is important to see a doctor so that the cause can be diagnosed and treated if necessary.
As the disease progresses urinary retention can result and enlarged prostate tissue encircles encloses of the urethra at the bladder neck. urinary retention can result in urinary tract infections, kidney diseases, and overactive bladder symptoms due to enlarged bladder muscles. Bladder stones can result which are a risk factor for bladder cancer. To relieve symptoms and drain urine a urinary catheter may be needed initially to improve urine flow.
The risk factors for benign prostatic hyperplasia are:
- Age - the incidence of BPH increases with age
- Family history - men with a family member (e.g., father or brother) who has had BPH are more likely to develop BPH
- Ethnicity - African American and Caribbean men have a higher risk of developing BPH
BPH is usually diagnosed by a combination of medical history, physical examination and urine tests. The doctor may also perform a digital rectal exam and order a blood test to check for prostate specific antigen (PSA). Prostate specific antigen is a protein produced by the prostate gland. An enlarged prostate can increase PSA levels. Your doctor will exclude prostate cancer.
In some cases, the doctor may also order a transrectal ultrasound (TRUS). A TRUS is an imaging test that uses sound waves to create a picture of the prostate gland. The doctor may also order a cystoscopy. During a cystoscopy, the doctor inserts a small telescope through the urethra into the bladder to examine the prostate gland and urethra.
The treatment options for BPH include:
Watchful waiting or active surveillance
This is usually recommended for men with mild symptoms who are not bothered by their symptoms. The doctor will monitor your symptoms and may offer medication if your symptoms get worse.
Medical therapy involves several types of medication that can be used to treat BPH. The most common types are alpha blockers and 5-alpha reductase inhibitors. Alpha blockers work by relaxing the muscles around the urethra, making it easier to urinate. 5-alpha reductase inhibitors work by reducing the size of the prostate gland.
Surgery is usually only recommended for men with severe symptoms who have not responded to medication. The most common surgical procedure for BPH is transurethral resection of the prostate (TURP), a prostate surgery designed to treat prostate enlargement by removing excess tissue. During TURP, a surgeon removes part of the prostate through the urethra via a transurethral incision. TURP is done under general anesthesia. iI can treat large prostate glands and treat symptoms from both severe and moderate symptoms.
TURP is major surgery with potential complications including:
- Blood in the urine
- Inability to urinate
- Urinary incontinence
- Erectile dysfunction and decreased sexual function
- Retrograde ejaculation In up to 80% of patients
- Transurethral microwave thermotherapy (TUMT)
- Transurethral needle ablation of the prostate (TUNA)
- High intensity focused ultrasound (HIFU)
- Cystoscopy with laser ablation of the prostate (CLA or PVP)
- Prostatic urethral lift (PUL)
However, they are not suitable for all men and may not be available in all areas.
Over the past 20 years a newer, cutting edge, minimally invasive procedure has emerged becoming more and more popular called prostate artery embolization (PAE). In this alternative to surgical management the blood vessels feeding the prostate are targeted. A small catheter is inserted into the groin and threaded up into the arteries that go to the prostate. Tiny beads are then released through the catheter and lodge in these arteries effectively cutting off the blood supply to the prostate. PAE seals blood vessels which stops prostate growth. Indeed this results in shrinkage of the prostate and relief of symptoms in most patients.
The potential side effects of PAE include:
- Mild to moderate pain in the lower back or abdomen that goes away within a few days
- Urinary frequency or urgency for a few days after the procedure as your body adjusts to having a smaller prostate
An expert physician at Imaging & Interventional Specialists we will perform a history and physical as well as a prostate specific antigen (PSA) blood test. A digital rectal exam (DRE) may be performed, although imaging tests are more accurate. They will also assess your urinary symptoms using the International Prostate Symptom Score questionnaire (IPSS). Sometimes a trans-rectal ultrasound (TRUS) is performed to assess the size of the prostate. Usually, a magnetic resonance imaging (MRI) study will be obtained as well as magnetic resonance angiography (MRA).
If you are deemed a good candidate for PAE, they will schedule you for the procedure after discussing it in detail with you.
Prostate artery embolization aims to restore urinary flow by starving prostate cells of nutrients by disrupting their blood flow. Therefore the enlarged tissue shrinks relieving benign prostatic obstruction (BPO). 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. 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 prostate artery embolization 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.