Enlarged Prostate

The prostate is a walnut-size gland that sits below the bladder. The urethra runs through the middle of it, down to the end of the penis, allowing urine to flow. The prostate has a role in reproduction, producing fluid that makes up a portion of semen volume, and protecting sperm.

In many men, starting around age 40-50, the prostate can grow. BPH is a common, benign (non-cancerous) condition. However, this growth may block the urethra and the flow of urine out of the body.

As you age, your prostate can enlarge, often beginning around the age of 40-50. Enlargement of the prostate is known as benign prostatic hyperplasia, or BPH. BPH is a benign (non-cancerous) condition that is very common in males. However, this enlargement tends to block the urethra and urine flow out of the body.

Symptoms of BPH can include:

• Difficulty starting to urinate
• Sudden, recurrent urge to urinate
• Interrupted, slow, or weak urine stream
• Frequent urination, especially at night
• Painful pushing or straining to urinate
• Inability to empty the bladder completely
• Urine leakage

Diagnosing BPH early is important because, if left untreated, it can lead to urinary tract infections (UTIs), bladder or kidney damage, kidney stones, and incontinence. Distinguishing BPH from more serious diseases like prostate cancer is important.

To diagnose BPH we generally use a combination of tests, starting with an office visit and then escalating as your situation warrants.

Visit with your Urologist

• Exam – Your urologist will do a physical exam, which will most likely include a digital rectal exam (DRE) to feel for size of the prostate and for lumps or nodules that may be a concern.
• Blood test – A blood test called a PSA (prostate-specific antigen) test is often completed to help determine your risk for prostate cancer. A higher number can indicate an enlarged prostate, infection or cancer.
• Urine test – A urinalysis and/or urine culture can tell us if you have blood or infection in your urine.

Bladder Function Tests

• Urodynamics test – A test to measure the bladder’s ability to fill and empty with the use of a catheter.
• Urocuff test – An easy, in-office test to measure urine flow with the use of a small cuff around the penis.

Advanced Testing

• Cystoscopy – A small scope, sometimes with a camera, is used to look inside the urethra, prostate and bladder. This will help determine if the prostate is enlarged and blocking the urethra, slowing urine from leaving the bladder. It may also find problems with the bladder such as stones or tumors.
• Transrectal ultrasound – A probe is inserted into the rectum to check the prostate the prostate’s size and for abnormal areas.
• Prostate needle biopsy – A needle is used to take a small sample of prostate tissue to check for cancer. This is only done if your PSA blood test is found to be abnormal or if your prostate exam during the DRE is abnormal. It is not typically done for just an enlarged prostate without any other concerns.

Together, these tests can help your urologist determine the cause of your issues and help create a customized treatment plan.

Here are some common treatments for BPH:

• Lifestyle modifications: As physicians, we believe the most conservative course of action is best to try first, unless circumstances warrant a more aggressive approach. There are some simple steps you can take without medication or procedures that may improve your urinary symptoms, including changing bathroom habits, monitoring medications and examining your diet.
• Medication: Medicine is one of the most common ways to treat men with mild to moderate BPH.
  • Some medicines ease BPH symptoms by calming the muscles in the bladder and prostate to improve urine flow. These are called alpha blockers, and they are the most common medication to treat BPH.
  • 5-Alpha Reductase Inhibitors (5-ARI) may also be used. These medicines work by shrinking your prostate over many months. It may take up to 6-12 months to notice improvement in your symptoms.
• Surgical treatments:
  • UroLift® System: The physician places small, permanent implants into the prostate to lift and hold enlarged tissue out of the way. This relieves pressure on the urethra and allows urine to flow. In a way, the implants act like curtain ties, lifting the tissue out of the way. This minimally invasive procedure involves no cutting, heating or removal of prostate tissue. Your urologist will perform this outpatient procedure at one of our hospital affiliates.
  • Transurethral resection of the prostate (TURP): TURP is the traditional, “gold standard” treatment and has been around for decades. It is a surgery where a combined visual and surgical instrument (resectoscope) is inserted through the tip of your penis and into your urethra, the tube that carries urine from your bladder. Using the resectoscope, your doctor trims away excess prostate tissue that’s blocking urine flow. TURP is generally considered an option for men with moderate to severe urinary problems who haven’t responded to medication.
  • GreenLight™ Laser Therapy: During this procedure, the tissue blocking your prostate is rapidly heated and vaporized. The urologist inserts a small scope into your urethra, allowing him/her to see the inner surfaces of the urethra, prostate and bladder. Your urologist will then vaporize the prostate tissue that is obstructing urine flow. Most patients experience rapid symptom relief and dramatic improvement in urine flow within 24 hours.
  • Holmium Laser Enucleation of the Prostate (HoLEP): This procedure also uses laser technology but in a different method. The laser is used to enucleate, or core-out, the prostate in one piece. A separate instrument is then used to cut the prostate tissue into smaller fragments that are easily removed.
  • Robotic “Simple” Prostatectomy: This surgery removes the inside of the prostate. It is similar to a HoLEP but requires cutting of the skin. For men with very large prostates, this is a good option to remove a larger portion of the prostate.
  • Aquablation Therapy: This minimally-invasive treatment for BPH uses the power of water to remove prostate tissue. The prostate is accessed through your urethra; no abdominal incision is needed.