Benign Prostatic Hyperplasia BPH

Non-cancerous enlargement of the prostate is common for many men as they age. This condition, also called benign prostatic hyperplasia (BPH), affects 70% of U.S. men age 60 – 69, and 80% of men age 70 and older. Unfortunately, BPH often causes troublesome urinary tract symptoms such as the frequent need to urinate. These symptoms occur when the enlarged prostate compresses the urethra and blocks the flow of urine. Over time, this blockage can also lead to recurrent infections, bladder stones, and kidney dysfunction. While a huge percentage of urinary problems are due to BPH, many other conditions can cause the same symptoms including:

• Urinary tract infections (UTIs)
• Chronic prostatitis (prostate inflammation due to causes such as infection)
• Neurological conditions
• Urinary tract stones
• Cancers of the kidney, prostate or bladder

It’s important to get a thorough and correct diagnosis of your symptoms. Erlanger has a national reputation for treating BPH-related urinary symptoms and all prostate disorders. Our goal is to dramatically improve your quality of life through a personalized treatment plan.

Symptoms

• Frequent urination – going to the bathroom more often than usual
• Urgency – having a strong urge to urinate that’s often hard to delay
• Painful urination
• Nocturia – waking-up a lot to urinate
• Weak urine stream
• Dribbling or leaking urine after you’ve finished urinating
• Hesitancy – having to wait to start urination
• Intermittency – starting and stopping of the urine flow
• Feel like your bladder is not completely empty after you’ve finished urinating
• Urinary incontinence – involuntary urination

Risk factors

• Being over age 40
• Obesity
• Type 2 diabetes
• Sedentary lifestyle
• Erectile dysfunction
• Family history of BPH

Diagnosis

• A physical exam, including a digital rectal exam (DRE)
• Self-rating of your symptoms
• A complete medical history
• Urinalysis
• Discussion of sexual function
• Possible screening for prostate cancer

Treatment Options

Lifestyle Change and Observation

While age and genetics play a role in BPH, you can often treat mild symptoms through diet, exercise, and lifestyle modifications. Our urologist will tell about about these changes, and will start a plan of “observation” – closely watching your symptoms and progress over time. Typical lifestyle modifications include:

• Altering fluid intake
• Regular exercise
• Eating a healthier diet
• Adjusting current medications

Medication Therapies

Conservative drug treatments can also help reduce the risk of urinary retention and reversing the natural course of BPH. Typical medication therapies include:

Alpha Blockers

• How they work: Relaxes your bladder muscles, making it easier to urinate.
• Response time: Quickly treats symptoms
• Possible Side Effects: Dizziness (lower blood pressure), retrograde ejaculation (semen going back into the bladder), angina (if you have heart disease); Talk to your doctor if you take blood pressure medications; Talk to your surgeon if you plan to have cataract surgery

5-Alpha-Reductase Inhibitors

• How they work: Shrinks the prostate 20-30% by blocking male hormones; recommended for men with very large prostates
• Response time: Takes up to six months to start working; may take a year for full benefits
• Possible Side Effects: Birth defects (can’t be used if you and your partner desire to get pregnant); PSA reduction of 50% (alert your provider before prostate screening); erectile dysfunction, breast enlargement and tenderness; reduced sexual desire; sexual side effects may be irreversible

Your urologist may prescribe a combination of these drugs, as studies show combined therapy can reduce the risk of BPH progression 66% better than either drug alone.

Because BPH and erectile dysfunction (ED) often occur at the same time, your urologist may recommend a daily PDE-5 inhibitor like Cialis. Cialis is FDA-approved for the treatment of BPH alone and in combination with ED.

Surgical Options

If lifestyle and/or medication treatments are not effective, your urologist may recommend a minimally-invasive procedure to address urinary symptoms associated with BPH. 

Rezum

Rezum is a new minimally invasive, in-office treatment option that uses the natural energy stored in water vapor, or steam, to safely and effectively relieve lower urinary tract symptoms associated with BPH.

During each treatment, sterile water vapor is released throughout the targeted prostate tissue. When the steam turns back into water, the cells are gently and immediately damaged, causing cell death. Over time, the body’s natural healing response removes the dead cells, shrinking the prostate. With the extra tissue removed, the urethra opens, reducing BPH symptoms.

UroLift (Prostatic Urethral Lift Procedure)

UroLift uses tiny implants to lift or hold the enlarged prostate so that it no longer compresses the urethra, blocking urine flow. This innovative, FDA-approved procedure provides quick and lasting relief of urinary symptoms with minimal side effects – without cutting, heating or removing prostate tissue. Erlanger Urology is the first urology practice in the southeast to offer UroLift in-office – and the first to perform it under an anesthetic in Tennessee. This experience and expertise are essential to a good outcome.

The UroLift Procedure:

• Preserves sexual function and may even improve erectile dysfunction and issues with poor ejaculation related to an enlarged prostate
• Does not require a catheter or overnight stay
• Is durable and seldom requires retreatment (It will not complicate other treatments like laser prostatectomy if UroLift results are not satisfactory.)
• Uses implants that can be removed by a simple procedure, and which don’t interfere with MRIs or DREs.

UroLift side effects tend to be mild and usually go away within 2-4 weeks after the procedure. They may include hematuria, dysuria, pelvic pain, urgency, and urge incontinence.

Laser Therapy (Laser Ablation / Enucleation of the Prostate)

Minimally-invasive laser surgery targets the enlarged prostate tissue, providing fast and lasting relief from moderate to severe BPH. Our academic urologists stand apart by using a cutting-edge Thulium laser to vaporize excess tissue or remove obstructive prostate tissue. This laser provides better results than traditional surgery with less bleeding and shorter hospital stays. It also avoids TURP syndrome – a rare but potentially deadly side effect of standard transurethral resection of the prostate. Most men are able to have their catheters removed the following day, and can return to work within a week.

Candidates for laser therapy

• Elderly disabled patients
• Patients with severe medical conditions like uncontrolled diabetes, cirrhosis, active alcoholism, psychosis and serious lung, kidney or heart disease.
• Men on blood thinners

Laser surgery may not be appropriate for men with extremely large prostates. 

Robotic Suprapubic Prostatectomy

During this procedure, your physician will access your bladder through your abdomen by way of several robotic ports. Your physician will then remove the excess tissue currently preventing urine flow and your bladder will be closed. Unlike a radical prostatectomy, the capsule to the prostate is left in place. After surgery you will have a special catheter for irrigating the bladder. This will help avoid clotting and urinary retention. Catheter drainage typically continues for 10 days to allow proper healing.

If you suffer from the symptoms above and they are affecting your lifestyle, our board-certified and fellowship-trained urologists at Erlanger Urology can help. To schedule an appointment, call 423-778-5910.