Enlarged Prostate Symptoms / BPH
As men age, the prostate gradually enlarges and can place pressure on the urethra, causing difficulty with urination. This condition, which is known as benign prostatic hyperplasia or BPH, is very common and affects more than half of all men >50 years of age. BPH is a benign condition, which means it is not cancer. It does not cause or lead to cancer. However, BPH and cancer can happen at the same time.
Symptoms of BPH include the following:
- Feeling that the bladder is full, even right after urinating
- Feeling that urinating "can't wait"
- A weak flow of urine
- Needing to stop and start urinating several times
- Trouble starting to urinate
- Needing to push or strain to urinate
Severe long-standing BPH can lead to bladder damage, loss of the ability to urinate (known as retention), infection, the formation of bladder stones, and infection.
The first line of treatment for BPH is medical therapy using a class of medications known as alpha-blocks. Alpha-blockers work to relax the muscles of the prostate and bladder. They improve urine flow and reduce blockage of the urethra. They do not reduce the size of the prostate. Alpha-blocking drugs include alfuzosin (Uroxatral), terazosin (Hytrin), doxazosin (Cardura), and tamsulosin (Flomax). One benefit of alpha-blockers is they start to work right away. Side effects may include dizziness, lightheadedness, fatigue, and trouble ejaculating.
Men not achieving adequate symptoms control with an alpha-blocker typically require a surgical intervention. Some patients, however, may first wish to try combination therapy with a 5-alpha reductase inhibitor (e.g. finasteride/Proscar or dutasteride/Avodart). The 5-alpha reductase inhibitors work by slowing the growth of the prostate and are best suited for men with large prostates (>60 grams). Side effects of 5-alpha reductase inhibitors include erectile dysfunction and reduced libido (sex drive). These medications typically take 6 months to achieve their full effect.
In select patients, the class of medications known as antimuscarinics (e.g. oxybutynin/Ditropan, darifenacin/Enablex, or tolerodine/Detrol) can be combined with alpha-blockers. These medications work best in men with symptoms of urinary urgency and frequency. Side effects of antimuscarinics include dry mouth, blurred vision, hot and flushed skin, constipation, and confusion.
Surgery for BPH
Dr. Gorin offers a full range of minimally invasive surgical treatment options for men with BPH, including UroLift, bipolar endoscopic enucleation of the prostate (BipolEP), holmium laser enucleation of the prostate (HoLEP), and robotic simple prostatectomy. Choosing the right type of surgery for you depends on the size and shape of your prostate, how healthy you are, and your personal preferences.
UroLift -- UroLift involves placing tiny implants in the prostate to hold the lobes of the enlarged prostate apart so that they no longer block the urethra. UroLift may be done with either local or general anesthesia. The UroLift procedure takes less than 30 minutes to complete and patients go home the same day. Most men see symptom improvement within about 2 weeks. The reduction of symptoms and improvement in urinary flow may be less than with the other more invasive procedures described below.
Following the UroLift procedure, some men may experience urinary urgency or have pain or burning with urination. These side effects usually go away within two to four weeks. A major benefit of the UroLift procedure is that men experience little if any sexual side effects from this procedure. You can learn more about UroLift at the device manufacturer’s website.
Enucleation of the Prostate -- The bipoLEP and HoLEP procedures are more invasive than UroLift and are intended for men with more severe symptoms and/or prostate volumes of >60 grams. Prostate enucleation is performed under general anesthesia and uses either bipolar electrocautery (BipolEP) or holmium laser (HoLEP) to excise obstructing prostate tissue from the urethra. Following this procedure, men typically spend 1 night in the hospital and require a urinary catheter during that time. Full recovery from prostate enucleation can take 6 to 8 weeks. It is normal to experience urinary urgency, frequency, and pain with urination during the recovery period. Long-term side effects of prostate enucleation include retrograde ejaculation, erectile dysfunction, and urinary incontinence.
Curious how enucleation compares to the historic TURP or "roto-rooter" procedure? Check out this article published in the British Medical Journal.
Robotic Simple Prostatectomy -- Simple prostatectomy is similar in concept to the enucleation procedure, in that the goal is to remove obstructing prostate tissue from the urethra. This procedure, however, is more invasive and so is reserved form men with very large prostates (>100 grams). Simple prostatectomy requires general anesthesia. During this procedure, small laparoscopic instruments that are controlled by a surgeon using a robot are placed inside the abdomen. The instruments are used to open the bladder to gain access to the prostate. Once the prostate is accessed, its inner portion is surgically removed, greatly widening the urethra. At the end of the procedure, the bladder is repaired and the patient is left with a urinary catheter. Because of the need to make a hole in the bladder, the catheter must stay in place for 10 to 14 days. Following this procedure men typically spend 1 to 2 nights in the hospital. Full recovery after this procedure can take 8 to 12 weeks. It is normal to experience urinary urgency, frequency, and pain with urination during the recovery period. Long-term side effects of simple prostatectomy are similar to enucleation and include retrograde ejaculation, erectile dysfunction, and urinary incontinence.