The prostate is a gland that is found only in men. Its purpose is to secrete the major component of ejaculatory fluid. The prostate, which continues to grow throughout life, sits directly below the bladder and surrounds the urethra as it exists the bladder.
As a man ages, the prostate enlarges and begins to press on and narrow the opening of the bladder neck and urethra. This occurs gradually over several years. Initially symptoms may be extremely subtle and well tolerated such as urinating frequently, decrease force of urinary stream, and urinating more than twice at night. As the condition progresses the bladder has to work harder to expel urine. This causes the bladder muscle to become thick (hypertrophic). This results in a diminished bladder capacity and decreased elasticity of the bladder wall, causing problems with urinary function.
The symptoms which were tolerable previously advance to greater frequency (more than every 2 hours, difficulty initiating a stream, urgency to urinate, incontinence, retention of urine and complete inability to void the bladder). In medicine, doctors refer to these symptoms as Lower Urinary Tract Symptoms (LUTS). The common, non-cancerous condition of enlargement of the prostate is called benign prostate hyperplasia or BPH. This condition affects about 40% of men in their 50’s, 60% of men in their 60’s and more than 80% of men in their 80’s. About half of such men develop moderate to severe Low Urinary Tract Symptoms (LUTS), which could interfere with advancing age. When the prostate initially begins to enlarge, the bladder muscle can usually push urine through the constricted urethra. As the narrowing continues, the bladder muscle could become thicker or weaken. This would increase urgency to urinate or strain to empty the bladder.
Men with LUTS and BPH also have been found to be at greater risk for Erectile Dysfunction (ED). The connection between LUTS, BPH and ED is not entirely clear. If you are experiencing LUTS or ED, please contact your health care provider. If left untreated, an enlarged prostate can cause permanent urinary problems. While it may be a natural part of the aging process, that doesn’t mean you have to live with it. There are effective options for treatment.
BPH Symptom Score Index – How severe are your enlarged prostate symptoms?
In assessing your symptoms our office uses the BPH symptom score index also known as the American Urological Association Score. The purpose of the test is to determine how bothersome the enlargement of the prostate is.
Prostate health can affect your lifestyle
Many men affected by an enlarged prostate report lifestyle changes such as avoiding travel, interrupted leisure activities, and embarrassment about using urinals. Frequent nighttime trips to the bathroom can disrupt sleep for both enlarged prostate sufferers and their partners as well.
If you have an enlarged prostate, you may experience these symptoms:
- A frequent urge to urinate, especially at night
- An urgent need to urinate with little warning
- Difficulty beginning urination
- Pain or burning during urination
- Feeling that your bladder never completely empties
- Dribbling or leaking urine
- A weak urine stream
- Intermittent—or on/off—urine flow
- Blood in the urine
How is an enlarged prostate (BPH) diagnosed?
Whether you first notice difficulty with urination or your doctor finds that your prostate is enlarged during a routine exam, a smart first step toward a solution is an appointment with our office—that specializes in urinary tract and male reproductive system health. Several tests help identify the problem and suggest the best course of action. Tests vary from patient to patient, but these are the most common:
- Digital Rectal Exam (DRE)
- Prostate Specific Antigen (PSA) Blood Test
- Rectal Ultrasound
- Urine Flow Study
Non-Surgical BPH Treatment Options
Based on prostate symptoms and test results, doctors may offer a number of treatment options for an enlarged prostate. Non-surgical options include:
If your symptoms are mild, your doctor may recommend simply monitoring the situation before taking action.
Oral therapy has potential for symptom relief. It has the advantage of no surgery. Disadvantages include ongoing medication therapy, risks of side effects, high out of pocket cost, and sometimes over time effectiveness diminishes. Certain men also do not like to take medications.
Alpha Blocker Drugs
This is the most common way to treat BPH. Medicines like Flomax, Cardura, Hytrin and Uroxatral have proven to be effective in the treatment of most cases. Alpha Blockers relieve the obstruction by trying to stop the process by which the construction occurs. They basically relax the smooth muscle cells in the prostate to relieve urinary obstruction. Like most medicines side effects can occur. They are mild in most cases and include dizziness on standing, feeling fatigued, loss of ability to ejaculate with orgasm.
Alpha Reductase Inhibitors
Avodart and Proscar are drugs that work by bringing about hormonal changes that actually shrink the prostate. These however must only be used by men who exhibit clear signs of prostate enlargement, not just LUTS. Side effects include excess hair growth, decrease volume of ejaculation and decreased sexual desire.
Minimally-Invasive BPH Treatment Procedures
These generally tend to be far more effective that the oral medicines but some can carry greater risks. They include:
In Thermotherapy, heat is applied to the prostate to destroy the prostate tissue. Heat can be applied using several different sources, including microwave energy as with Thermatrx Dose Optimize Thermotherapy (DOT). The heat causes changes in the prostate tissue and results in improvement of symptoms. There is no cutting or incision. Oral drugs are given to help you relax and the procedure is well tolerated. Most patients have only minor discomfort. You may have a urine drainage catheter 2-5 days after treatment. The Thermatrx system continues to measure the prostate temperature to ensure you are given the optimal “dose of heat”. The procedure is done in the doctor’s office and takes about 90 minutes. No hospital stay is required. No sexual side affects have been reported. Your doctor will perform tests to see if it is the right treatment option for you. Medicare and most private insurance plans cover Thermatrx.
Advantages of Thermatrx include long lasting symptom relief, and it is an alternative to cost, side effects and inconvenience of other therapies. In clinical trials, patients did not report incontinence or retrograde ejaculation as a result of the treatment. It had minor short term side effects only which usually went away on their own and id does not effect one’s ability to take ED medications. It is FDA approved as safe and effective.
Dr. Eid specializes in Thermatrx Dose Optimized Thermotherapy.
Urethral stent is a mesh tube that holds the urethra open at the point of obstruction. It immediately improves the flow of urine. The stent is placed through the procedure in an out-patient procedure. It has been clinically proven to maintain these results over the long term. No catheter is required after most procedures. It is fully incorporated within the body. This procedure is easy and safe and can be done under local anesthesia but is usually reserved for cases of recurrent stricture of the bladder opening.
Transurethral Microwave Therapy (TUMT)
In Transurethral Microwave Therapy, an instrument called an antenna, that send out microwave energy is inserted though the urethra to a location inside the prostate. The temperature becomes high enough inside the prostate to kill the extra tissue. As this part of the prostate heals, it shrinks, reducing the blockage of urine flow. This is an out patient procedure done under general or spinal anesthesia. The main complication of TUMP is the inability to urinate for more than a week but can be treated by inserting a catheter.
The Urolift® Prostate Urethral Lift
The prostate urethral lift is a novel approach to relieve urinary symptoms such as frequency and difficulty of urination caused by an enlarged prostate. The Urolift® System treatment is a minimally invasive approach that lifts the enlarged prostate out of the way so it no longer blocks urine flow. Small implants are installed without surgery or cutting through the penis to hold open the prostate lobes. Read more about this innovative treatment here.
Surgical BPH Treatment Options
Surgical removal of the prostate (Prostatectomy)
If your BPH symptoms are severe and all other treatment options have not been successful, surgery (prostatectomy) may be recommended. These surgeries remove large amounts of prostate tissue. They have to be performed in the hospital, require general anesthesia and carry risks of side effects. (ED and Incontinence being some of them).
Transuretheral resection of the prostate (TURP)
This is one of the most common surgeries performed. With TURP, the inner portion of the prostate is cut out through the urethra using a cystoscope. It is effective in most cases and can provide long-term relief. It requires a hospital stay. Side effects can include bleeding, loss of ejaculation and in rare instances, incontinence and erectile dysfunction.
GreenLight Laser Surgery
This is essentially very similar to the TURP. Where as in the TURP the electric current is used to cut the prostate, here a laser beam is used instead. Laser surgery is a relatively newer treatment and its advantage is that bleeding is markedly reduced and patients can be discharged much sooner. With over 200,000 procedures performed worldwide, the GreenLight procedure is creating a new standard of care.
Comparing a TURP to GreenLight