Enlarged prostate, or benign prostatic hyperplasia (BPH), is the noncancerous enlargement of the prostate gland surrounding the urethral passage between the bladder and penis. BPH is common in men over the age of 50, and while bothersome, often does not cause major health problems. However, in some cases, this enlargement can cause significant issues including infections, need for catheterization, or even bladder and kidney damage. Thus, evaluation by a urologist is recommended when the urinary symptoms of BPH become bothersome.

Typical initial symptoms of enlarged prostate or BPH include:

  • Frequent urination
  • Diminished force of the urine stream
  • Delay in starting the urine stream (hesitancy)
  • Urgent need to urinate
  • Stopping and starting of the urine stream (intermittency)
  • Trips to the bathroom at night (nocturia)
  • Sense of incomplete emptying of the bladder
Patients with minor problems are usually treated by modifying fluid intake and cutting back on coffee, tea or alcohol, particularly in the evening.

Non-Surgical Treatments for Enlarged Prostate

BPH Medication

Patients with moderate to severe urinary symptoms or patients for whom behavioral changes are not sufficient may benefit from medications. The two main categories of BPH medications are alpha-blockers and 5-alpha reductase inhibitors. Alpha-blockers relax smooth muscle within the prostate gland and allow urine to flow more freely. Alternately or used in combination, 5-alpha reductase inhibitors are used in patients with large prostates (over 40cc in size) shrink the gland over 6-12 months of treatment.

Some patients with bothersome symptoms may benefit from saw palmetto, an over-the-counter herbal medication, although research studies are inconclusive. Consult your doctor before taking any over-the-counter or herbal medications. Some herbal medications interfere with prescription drugs that you might be taking for another condition.

When patients cannot urinate (urinary retention) or the bladder does not empty adequately (high post-void residual), then placement of a urethral catheter to drain the bladder or using intermittent self-catheterization may be required until further intervention can be completed.

Surgical Treatments

Patients who fail to improve with medications would then be considered for surgical treatment, which can range from minimally invasive therapy performed in the office setting to traditional surgery under anesthesia in the operating room.

The faculty at Emory Urology offers a full spectrum of minimally invasive, transurethral and robotic BPH surgeries, including the most cutting edge treatments. The type of BPH procedure that is right for you depends on the size of your prostate as well as other medical factors.

Minimally Invasive BPH Procedures

Minimally invasive treatments are procedures that have minimal bleeding risk and are done in the outpatient setting.

REZUM is a water vapor therapy that harnesses the energy in steam to ablate obstructive prostate tissue. The sterile water vapor is instilled during short, nine-second injections delivered through a scope. This minimally invasive procedure can be performed in the office without the need for general anesthesia.

Transurethral BPH Surgeries

These procedures are offered for larger prostates and are done in the operating room under general anesthesia (completely asleep). After passing a scope through the urethra, prostate tissue is excised or ablated, opening the channel for easier passage of urine. Patients typically remain in the hospital overnight for observation and go home the next day. A catheter is usually left in place for 1-2 days after the procedure depending on the size of the patient’s prostate and the condition of their bladder. Once the catheter is removed the improvement in the urine stream is immediately noticeable as the anatomic obstruction has been removed.

Transurethral resection of the prostate (TURP) is the most common and longest standing form of endoscopic BPH surgery. This procedure uses electrocautery passing across a loop to excise tissue from the inside out. The resected pieces of prostate are then suctioned out of the bladder.

Holmium Laser Enucleation of Prostate (HoLEP) is a newly developed transurethral procedure for very large prostate glands (over 80cc) and patients with other complex medical issues. Again through a scope, this procedure uses a laser to resect the prostate along the capsule and remove the maximum amount of obstructive prostate adenoma possible for a transurethral procedure. The prostate tissues is then suctioned out of the bladder. Emory is pleased to be the first urology practice in the state of Georgia to offer this state-of-the-art procedure.

Robotic BPH Surgery

Another surgical option for very large prostates is “simple” prostatectomy, which is now offered using the Da Vinci robotic surgical platform. Robotic simple prostatectomy approaches the prostate through the abdomen from above and is optimal for patients who need other treatments on their bladder (e.g. stones or diverticulum) or have a history of urethral stricture disease. Patients are usually observed in the hospital for 1-2 nights and the catheter remains for up to a week to allow the bladder to completely heal.