Conditions & Treatments
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 or enlarged prostate is common in men over the age of 50, but usually does not cause any major problems. However, in some patients, this enlargement can cause significant urinary problems, which might lead to bladder and kidney damage. Thus, evaluation by a urologist is recommended when the urinary symptoms of BPH become bothersome.
Typical symptoms of enlarged prostate or BPH include:
- Frequent urination (called frequency)
- Trips to the bathroom at night (nocturia)
- Diminished force of the stream
- Difficulty holding back urination (urgency)
- Delay in starting the stream (hesitancy)
- Interruption of the stream (intermittency), or sense of incomplete emptying.
Patients with minor problems are usually treated by modifying fluid intake and cutting back on coffee, tea or alcohol, particularly in the evening.
Transurethral resection of the prostate (TURP) is the most common form of BPH surgery. After administering anesthesia, the prostate is shaved from inside the urethra using a scope that has an electric loop at its end. The chips of tissue are vacuumed out and this procedure opens the channel for a more forceful urinary stream. The patient must wear a urethral catheter for removing any blood for a day or so until the urine clears. The TURP procedure removes the obstructing prostate tissue and improved urination is occurs rapidly. Patients are typically hospitalized overnight after undergoing transurethral resection.
Transurethral incision of the prostate (TUIP) is a more limited BPH procedure that cuts 1 or 2 deep grooves through the prostate rather than shaving or vaporizing prostate tissue. This procedure is quicker than the TURP, and is used on smaller prostates. A catheter is needed for a day or two while some of the edema (swelling) subsides. TUIP is usually performed as ambulatory surgery.
A more major surgical option for enlarged prostate is also available, "simple" prostatectomy. This is the removal of large prostates (over 100 cc), and it requires a skin incision below the belly button. The hospital stay after the procedure is 3-5 days, and recuperation takes about 1 month.
Non-Surgical Treatments for Enlarged Prostate
Some patients with troubling symptoms may benefit from saw palmetto, an over-the-counter herbal medication. 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.
Patients with moderate to severe urinary symptoms may be treated by medications called alpha-blockers, like tamsulosin (Flomax), alfusozin (Uroxatral), silodosin (Rapaflo), doxazosin (Cardura), or terazosin (Hytrin), which relax smooth muscle within the prostate gland and allow urine to flow more freely. Alternately or at the same time, patients may be treated with 5-alpha reductase inhibitor medicines, including finasteride (Proscar) or dutasteride (Avodart), which might shrink a very enlarged prostate (over 40 cc size) over 6-12 months of treatment. 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.
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 catheterization may be required until surgery or a minimally invasive treatment is performed.
Minimally Invasive BPH Treatments
Minimally invasive treatments are procedures that have minimal bleeding risk, and they are performed under local anesthesia or intravenous sedation.
Minimally invasive therapies involve slow heating of the prostate tissue. These techniques are particularly useful for high-risk patients, such as those patients where anesthesia or any bleeding problems might be complicated. Patients may require a Foley catheter for a few days to several weeks, and the symptoms will not begin to improve until the damaged tissue is absorbed over several weeks, so maximum improvement may take 3-4 months to achieve. Often, theseprocedures are performed in the office setting.
Transurethral needle ablation (TUNA) uses a fine needle, which is inserted through the urethra and then into several sites in the prostate to deliver the slow heat energy using radiofrequency waves. Treatment takes about 30 minutes. The newest version of TUNA is called Prostiva.
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