What is BPH?

Sometimes it’s called enlarged prostate. Sometimes it’s referred to as benign enlargement of the prostate (BEP). But most often it is referred to as benign prostatic hyperplasia (BPH). Whatever you call it, you probably never have to be reminded of how an enlarged prostate feels or how it can interrupt your life.

WHAT IT IS

The prostate is a male reproductive gland that surrounds the urethra, the tube through which urine passes out of the body. The prostate grows to normal size—about the size of a walnut—during a male’s teenage years. Though not fully known why, the prostate may begin to grow again when a man reaches middle age. This enlargement of the prostate is considered to be benign: it is not cancer, and it does not raise your risk for prostate cancer.

normal-bph-bladder-diagram

WHO GETS IT

One of the most common diseases of aging men,2 BPH causes health problems among older men.3 About 1 in 4 men will experience BPH-related symptoms by age 55; by age 60, half of all men have BPH symptoms; and 90% of men experience BPH by age 85.3,4Although it affects many men differently, it can be associated with bothersome lower urinary tract symptoms.2

SYMPTOMS

As the prostate enlarges, it puts pressure on the urethra similar to a clamp on a garden hose. With continued growth, the expanding prostate may constrict the urethra, causing symptoms such as difficulty starting urination or a weak urine stream.4

Symptoms can include1,4,5:

  • Sudden urge to urinate (urgency)
  • Difficulty starting and stopping your urine stream (hesitation)
  • The need to push or strain when urinating
  • Dribbling
  • Incomplete emptying (the sensation that the bladder is not empty after urinating)
  • Weak urine flow
  • Increased or decreased frequency of urination
  • Frequent nighttime urination (nocturia)
  • Burning or pain during urination
  • Incontinence
  • Blood in urine (hematuria)

These bothersome symptoms can have a profound effect on a man’s life, as men often change their lives to accommodate the need to urinate frequently. Treatment for the condition is necessary only if symptoms become intolerable. By age 80, 20% to 30% of men experience BPH symptoms severe enough to require treatment.4

Treating Enlarged Prostate (BPH)

Until recently, the main goal of BPH treatment was to reduce bothersome lower urinary tract symptoms that had become intolerable.2 However, newer data suggest that another legitimate goal of BPH therapy is the reduction in the risk of future health-related complications.2 For complications, click here.

  • If the goal is to reduce bothersome symptoms, your doctor may make a treatment recommendation based on the frequency, severity, and degree of bothersomeness associated with your lower urinary tract symptoms2
  • If the goal is to reduce the risk of future complications, it is important to assess the size of the prostate gland, because prostate size can be a predictor of future risks2

Treatment Options for BPH

WATCHFUL WAITING

In general, no treatment is needed for men who have only a few symptoms and are not bothered by them. In these cases, when enlarged prostate symptoms are mild to moderate, doctors may recommend a “watch and wait” approach, often asking patients to track BPH symptoms before pursuing other courses of treatment. It is appropriate for patients with moderate symptoms and bother to choose watchful waiting if they feel that the benefits outweigh the risks of an active therapy.

MEDICATIONS

Physicians will often prescribe medications to manage enlarged prostate symptoms. These medications include:

  • Alpha blockers, which relax the muscles around the neck of the bladder, making it easier to urinate. Common side effects include reduced semen released during ejaculation, low blood pressure, dizziness, headache, stomach or intestinal irritation, and a stuffy or runny nose. There is also a risk of floppy iris in the event of cataract surgery in anyone who has ever taken an alpha blocker
  • Alpha-reductase inhibitors, which are intended to help shrink the prostate gland. Common side effects include erectile dysfunction, decreased libido, and reduced semen during ejaculation
  • A combination of the two

INVASIVE SURGERY

Surgical treatment becomes a viable option when symptoms have not responded to medication and are bothersome enough to diminish quality of life. In addition, surgery is generally required in the following situations

  • Kidney damage due to inadequate bladder emptying
  • Complete inability to urinate after treatment of acute urinary retention
  • Incontinence due to overfilling or increased bladder sensitivity
  • Recurrent blood in the urine despite treatment with medication

Transurethral Resection of the Prostate (TURP)
Though there are a number of invasive options, the surgical mainstay for BPH treatment is called transurethral resection of the prostate (TURP). This surgical procedure has demonstrated long-lasting symptom relief, which is significantly better than what can be achieved with medication. However, there are always risks associated with surgery, and there are documented prolonged side effects, including retrograde ejaculation, erection problems, painful urination, recurring UTI, bladder neck narrowing, excessive bleeding, and blood in the urine. Also, TURP requires a 2- to 3-day hospital stay, and most patients must wear a catheter for approximately 2 days after the procedure.

MINIMALLY INVASIVE SURGICAL ALTERNATIVES

Despite the clinical successes of TURP, the degree and severity of complications have driven the development of alternative, minimally invasive surgical tools for BPH. Most urologists position these therapies somewhere between medical treatment and surgical treatment.
Although numerous medical and surgical treatment options exist, there is a continuous drive to develop less-invasive, efficacious, and cost-effective treatment options. This has led to an influx of minimally invasive surgical alternatives that relieve lower urinary tract symptoms without hospitalization and with fewer side effects, like the following:

  • Transurethral needle ablation (TUNA) uses radio frequency needles placed directly into the prostate to generate heat and cause coagulation. Side effects can include blood in the urine, discomfort, and urinary tract infection
  • Transurethral water-induced thermotherapy (WIT) uses heated water circulated through a catheter system and pressure from a balloon to destroy the excess prostatic tissue. A common side effect is blood in the urine

While these treatments produce an initial level of symptomatic relief, it is important to note that the long-term effectiveness of these procedures still remains unclear.

Laser Therapies
With documented case studies, laser therapies have become a viable alternative to TURP. Laser options remove enlarged prostate tissue through the use of high-energy lasers. Currently, there are two front-running laser therapies: holmium laser enucleation (HoLEP) and photoselective vaporization (PVP) of the prostate.
  • HoLEP is a complicated procedure with a steep learning curve that involves a resectoscope inserted through the penis into the urethra. The prostate tissue is vaporized by the holmium laser. Typically, the patient has a catheter removed the next day and stays 1 night in the hospital
  • PVP, also referred to as the GreenLight™ Laser Procedure, is associated with treatment outcomes similar to TURP with a more favorable risk profile. It consists of a high-powered laser inserted through the urethra, which immediately vaporizes and precisely removes enlarged prostate tissue. Most patients return home a few hours after the procedure, usually without the need for a catheter, and can return to normal, non-strenuous activities within days

PROSTATIC STENTS

This option is reserved for those patients who are severely obstructed and otherwise unable to undergo surgery.

The choice of a treatment is based on the severity of your symptoms, the extent to which they affect your daily life, and the presence of any other medical conditions. The treatment recommendation should be made by your physician.

Is GreenLight™ Right for You?

When symptoms begin to interfere with your lifestyle, it’s time to consider treatment choices. Especially if medication isn’t working and surgery seems scary.

Understanding your options will help you make the right choice for your desired outcome and lifestyle needs. Discuss this information with your urologist.

Use the guide below to help you determine the treatment that best suits your needs. Discuss the expected outcomes and risks for each treatment with your doctor.

Treatment Result

GreenLightTM

TURP

Rapid symptom relief1
Very low risk of sexual dysfunction2
Dramatic urine flow improvement1
Typically less than 24-hour need for catheter3
Minimal risk of blood transfusion3
Outpatient procedure4
Able to treat patients on anticoagulants5

On the Day of Your GreenLightTMProcedure

On the day of your procedure, you will come to the treatment center. You should have someone drive you home since this is an outpatient procedure. Keep in mind that different patients may require a different treatment regimen. Here is a general description of the procedure and what to expect:

  1. Before treatment, your physician may give you medication to help you relax during the procedure. You may also receive medication to help you avoid infections.
  2. You may be asked to empty your bladder.
  3. You will be brought into the procedure room and moved into the treatment bed where you will lie on your back. You will be provided anesthesia that will allow you to sleep through the entire procedure. Depending on the treatment center, other types of anesthesia may be used, including spinal block or a nerve block.
  4. Once you are asleep or the anesthesia block takes effect, your physician will insert a cystoscope through your urethra.
  5. The laser fiber is introduced through the cystoscope and advanced into the urethra at the location of the prostate.
  6. The physician systematically vaporizes the enlarged prostate tissue until the obstruction is removed.
  7. At the end of the procedure, the physician may insert a temporary catheter to let urine drain from your bladder.

You may experience mild discomfort, such as slight burning during urination, and trace amounts of blood in your urine for a week or so. Also, depending on the condition of your bladder, you may experience a greater urination frequency and urge to urinate. This will resolve over time as your bladder adjusts to removal of the obstruction in your urethra.

Following the GreenLightTM procedure, you will likely experience immediate improvement in flow and symptoms, but will possibly have mild short-term urgency and frequency or mild pain during urination. Blood in the urine occurs less frequently; however, retrograde or diminished ejaculate volume is common. You may require a catheter for a short time, which is dependent on the physician’s discretion.

After Your GreenLightTMProcedure

Because this is an outpatient procedure, you will typically go home within a few hours of treatment. You should have someone drive you home after the procedure.

If a catheter was placed in your bladder at the end of the procedure, it will typically be removed within 24 hours. However, patients with compromised bladder function or those who require prolonged catheterization as a result of severe urinary symptoms may require a catheter for a longer period of time.

Most patients experience very rapid relief of symptoms and a dramatic improvement in urine flow. This typically occurs within 24 hours of the procedure. However, medical history, health condition, and other factors can influence treatment recovery.

  • You may experience mild discomfort, such as slight burning during urination, and small amounts of blood in your urine for a week or so. Also, depending on the condition of your bladder, you may experience greater frequency and urge to urinate. This will resolve over time as your bladder adjusts to removal of the obstruction in your urethra
  • You may be given an antibiotic to help you avoid infection. For discomfort, nonsteroidal anti-inflammatory drugs are options
  • Typically, you may return to normal activities 2 to 3 days after the procedure
  • You should not engage in sexual activities for about 2 weeks following the procedure1
  • Activities that may lead to blood in the urine, such as strenuous exercise (including heavy lifting, bike riding, or running on a treadmill) and working with vibrating equipment (sitting on lawnmowers or snow tractors), must also be avoided for at least 2 weeks2
  • Mild episodes of blood in urine are possible 1 to 2 weeks after the procedure, for which anti-inflammatory medication may be prescribed.

Now there’s a simple, proven solution for BPH. Ask for it by name: GreenLight™

Actual GreenLight Laser prostatectomy by Dr. McHugh 

You’ve already changed your life—sacrificing your personal freedom—to accommodate urinary problems. And ignoring an enlarged prostate won’t make it go away; rather, it may cause even bigger problems.

But choosing a treatment option is such a big decision. Isn’t there a simple solution?

The good news is that there is a simpler solution—an alternative to traditional surgery with quicker recovery and fewer side effects1 that can restore your natural urine flow and have you back to normal activities in a matter of days.

It’s called GreenLight™ Laser Therapy.

GreenLight™ Laser Therapy:

  • Is a minimally invasive alternative to surgery
  • Is an outpatient procedure
  • Provides immediate relief of lower urinary tract symptoms (LUTS)
  • Is a virtually bloodless procedure
  • May be suitable for patients who cannot undergo traditional surgery
  • Has well-documented safety and success data since 1997
  • Has treated more than 500,000 patients worldwide

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