Benign Prostate Hyperplasia (BPH), or Enlarged Prostate

What is enlarged prostate?

Benign prostatic hyperplasia (BPH), often referred to simply as enlarged prostate, is called such because it occurs when the prostate gland in the male sexual organ enlarges. This growth in and of itself is completely harmless, or benign. Further, it’s both natural and normal. Every man’s prostate grows as he ages because of changes in hormone balance and cell growth. In fact, 60% of men over sixty and 80% of men over eighty years of age have been diagnosed with BPH.

There are two things we watch out for as your prostate grows with age. The first is prostate cancer. The second is whether or not, or “when”, its sheer size causes it to get in the way of other systems. We say “when” because for most men, their prostate eventually gets in the way of their urinary tract. Over 50% of men over the age of 75 experience uncomfortable urinary symptoms from an enlarged prostate, and in many men the symptoms begin to occur at a much younger age. So just as most of us eventually need glasses if we’re lucky enough to live a relatively long life, and many of us need surgery on our knees, or hips or joints at some point, so too do most of us (men) need a little prostate tune-up at some point.

Stages of BPH

As your prostate grows over time, it begins to put pressure on your urethra, impeding and eventually cutting off your ability to urinate with ease. The images below depict this change over time.

Normal Prostate Gland

Stage 1 BPH

Stage 2 BPH

Stage 3 BPH

Symptoms and Signs of BPH

As your prostate grows bigger over time, it eventually begins to press on the urethra. This is typically when the first symptoms of BPH begin, usually in the form of urination difficulties. Men with a more advanced, or severe case, may also experience one or more of the following signs:

  • dribbling at the end of urination
  • straining to urinate
  • being unable to control urination
  • having strong and sudden urges to urinate two to three times a night
  • having a weak urine flow
  • bleeding while urinating
  • not being able to urinate at all

How do you diagnose BPH, or enlarged prostate?

Many patients schedule an appointment with us when they begin to experience changes in their urine flow. Our staff is trained to ask you questions that allow us to begin detecting changes in the size of your prostate early. This helps us help you prepare for these changes.

We begin this process through the use of a validated questionnaire called the International Prostate Symptom Score, or IPSS. You can click this link to access the questionnaire. Bring the completed form in to your appointment. Moderate to severe symptoms have a score from 8-19 and 20-35, respectively.

During your office visit, your urologist at The Urology Place will confirm your diagnosis with a digital rectal exam. We may also run other diagnostic tests such as a urine flow rate test, post-void residual urine test, urinalysis, ultrasound or a cystoscopy.

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Treating Symptoms of BPH

Uncomfortable urinary symptoms can be treated in a number of ways depending on the severity of your condition. Treatments include:

Step 1: Start with these easy lifestyle changes at the onset of uncomfortable urinary symptoms

For patients with mild symptoms of enlarged prostate, a few easy lifestyle changes may be the best treatment.

  • Avoid caffeine and alcohol to decrease feelings of urinary urgency.
  • Obey your bladder. This means go when you feel the urge.
  • Urinate regularly even if you don’t feel like you need to.
  • Avoid any fluid intake two hours before bed.

Want one more tip? Perform Kegels!

Performing kegel exercises regularly will strengthen the muscles below your bladder that help control urination. How do you perform kegel exercises? It’s easy! To understand the muscle contraction, try stopping your urine flow mid stream the next time you’re using the restroom. That’s the exact movement or contraction you want to perform with kegel exercises, only you perform it while not urinating. Try performing that muscle contraction and holding it for 3 seconds. As you get better at this, add sets of 10 quick contractions to the mix. Over time, practice kegel exercises while sitting, standing, or walking. Do this 3-4 times a day and your bladder will thank you!

Step 2: Discuss BPH medications with your urologist

Alpha 1-blockers, antibiotics, finasteride and dutasteride may decrease the size of an enlarged prostate. Alpha blockers commonly prescribed are Flomax (tamsulosin) or Rapaflo. These medications are considered first-line treatments for enlarged prostate, which means that they are the first things your urologist will probably prescribe for treating early symptoms. Although not prescribed by doctors, many patients find some relief from BPH symptoms through the herbal remedy, Saw Palmetto.

As with all medications, there is a risk of side effects associated with BPH medications. Some patients feel dizzy when on alpha blockers. Other patients experience nasal congestion or loss of ejaculate. Patients taking Proscar and Avodart (finasteride and dutasteride) sometimes experience erectile dysfunction, loss of libido, and increasing hair growth.

It’s important to talk to your urologist about the presence and severity of these or any side effects from medication, as well as how well the medication is treating your BPH symptoms.

When medications work to relieve symptoms, many patients find this to be the easiest solution. For patients unrelieved of symptoms through medication, or patients experiencing undesirable side-effects from BPH medications, our urologists specialize in some of the newest, most advanced next-level options including laser prostate treatment, surgery, and non-surgical options UroLift and Rezum vapor therapy.

Step 3: Consider Non-Invasive Procedures UroLift and Rezum

For medium to advanced benign prostatic hyperplasia symptoms, many patients find exceptional results through one of two new procedures leading the way in urologic technological innovation – Urolift and Rezum. Both procedures are non-invasive and can typically be done in the office setting, saving patients time and money. Additionally, both procedures have a very low risk of sexual side effects. Most Urolift patients can have sex within 2 weeks of the procedures and are thrilled with the quick recovery.

Dr. Kella was the first surgeon in Texas to perform the Urolift procedure, and is proud that The Urology Place continues to lead the way in offering the newest, most cutting-edge procedures to our patients.

Our expert team is highly skilled in both modalities and can work with you to determine if one of these options is likely to provide relief for your specific case. We have dedicated an entire section to each of these new treatment options. Read more about UroLift, the “facelift for the prostate” here and more on Rezum Water Vapor Therapy here.

Step 4: Laser Prostate Surgery, Robotic Surgery and Other Surgical Options

When less-invasive options are ineffective at treating symptoms of BPH, surgery is often the answer and usually requires complete removal of the enlarged prostate. All of the surgical options for managing severe BPH symptoms show greater improvement in urine flow rate than oral medications. Our patients have several surgical options. Most of these options are performed in the hospital setting, although some laser procedures can be done comfortably in the office.

Transurethral resection of the prostate (TURP) has been the predominant surgery for treatment of BPH since the 1960s, but that is beginning to change. The procedure itself isn’t changing much, but the cutting electrodes used for years in the TURP procedures are now being replaced by lasers. With the new laser techniques, patients experience substantially less bleeding and reduced risk of needing re-operation.

Another form of TURP is a bipolar TURP. With the bipolar, we use a “button” that creates a plasma that vaporizes tissue. The button TURP also has less bleeding than a conventional TURP. The restrictions and results of the button turp are similar to laser therapy for enlarged prostate.

Transurethral incision of the prostate (TUIP) is a surgical modality where the urologist makes a small incision in the prostate tissue to simply widen the opening between the urethra and bladder outlet.

And finally, simple prostatectomy is an option for some patients. It is an open surgery to remove the inner part of the enlarged prostate gland. The robot can be used to perform this procedure, allowing for a faster recovery than a conventional open surgery. Read about robotic surgery and the importance of surgeon experience before electing this procedure.

About Prostate Laser Surgery at The Urology Place

The most advanced lasers on the market today are the Thulium, Holmium, and GreenLight lasers. We use a Thulium laser as it allows for a more shallow depth of tissue penetration than the Holmium laser, which is highly advantageous during surgery. Our Thulium laser has a 2013nm wavelength that allows for 0.25mm penetration into the tissue, and performs remarkably to to vaporize the prostate tissue while minimizing bleeding.

What’s Up & Coming With Laser Surgery?

We are closely watching outcomes from tests of the GreenLight laser technology, which adds fiber optic technology to the mix as the newest addition to minimally-invasive surgical techniques for the treatment of benign prostate hyperplasia. Long term studies are not complete on the GreenLight laser, but we believe this new technology potentially stands to set a new standard of excellence in surgical outcomes.

What happens during the procedure?

Both TURP and prostate laser surgery involve inserting a scope into the penis to reach the prostate and remove it in small pieces. The laser offers the advantage of minimal char, which allows for faster healing and less irritation.

What is recovery like?

Some patients may still need to spend a night in the hospital after surgery, with removal of your catheter after 24 hours. Laser therapy allows most patients to return to work in just a few days, but strenuous activity should be avoided for approximately 4 weeks. Most patients will have some slight burning for a week or so after the procedure, but it is easily managed with a mild pain and anti-inflammatory medication. For the first few weeks, symptoms may actually be worse as the tissue can actually swell from the inflammation and eventual healing associated with treatment.

Are there sexual side effects to the surgery?

Fewer than 1% of men experience sexual dysfunction after laser therapy. And while traditional TURP caused retrograde ejaculation (semen during orgasm enters the bladder instead of out of the body via the urethra, causing “dry” orgasm) in most patients, Thulium laser enucleation of the prostate has shown to conserve both ejaculation and erectile function.

How long do the results of prostate laser surgery last?

Clinical studies show that laser therapy can offer rapid and lasting relief lasting for at least 5 years.

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