Benign Prostatic Hyperplasia, or BPH, is a common condition that a lot of men will experience as they age. The prostate, which is involved in male sexual function, sits at the neck of the bladder. I tell my patients that, as it enlarges, it’s like putting your thumb on the end of a water hose. It requires more force to push the urine out effectively. Symptoms can arise as early as our 30’s and perhaps 50% of us will have issues by our 60’s. It causes all sorts of symptoms including slowing of the urinary stream, incomplete bladder emptying, frequent or urgent urination, urinary retention and nocturia. Unfortunately, a large percentage of men will simply ignore these symptoms and just chalk it up to “old age.” Not only can these symptoms be bothersome but, in some cases, it can lead to significant bladder dysfunction, kidney issues, infections, etc.
So what does one do when these issues arise? First is evaluation. This typically involves a simple exam to check the size and consistency of the prostate and blood work to rule out other potential problems such as prostate cancer. In some cases, further work up with imaging and even office endoscopy to evaluate the size and shape of the prostate may be necessary (and yes, the shape, not just the size, is important).
Once this is complete, a discussion between the patient and clinician then turns to treatment.
Option #1: Observation – This might be the best option if symptoms are mild and the exam and other work up is not worrisome. Dietary modifications like limiting caffeine can be helpful. The addition of herbal supplements like saw palmetto can also be considered.
Option #2: Medication – This is a common option for a lot of men and is very effective in many cases. In general, medications are aimed at relaxing the prostate and bladder neck or at shrinking the prostate over time to improve symptoms. Most are tolerated well but sometimes medication side effects, cost, interactions, etc. can cause these to be less desirable.
Option #3: Surgery – Most commonly in this category we think of the TURP (TransUrethral Resection of the Prostate) to open the prostate up and allow for better flow of urine and symptom relief. If the prostate is very large, resection of the inner portion of the prostate is completed from within the abdomen using robotic assisted laparoscopic techniques as well. Again, these are very good options for a lot of men but may carry potential side effects and temporary catheterization that men would like to avoid if possible. Also, as this is a disease that is more common with increasing age, some men may not be very good surgical candidates in some instances.
Now, more options are becoming available to bridge the gap between medications and traditional surgery for men with moderately enlarged prostates.
Rezum is an office-based procedure in which steam is injected through the wall of the prostate from within the urethra. This results in the eventual regression of the obstructing tissue within the prostatic urethra and subsequent improvement in voiding symptoms.
Urology Centers of Alabama is excited to offer another option in this area of disease treatment called Urolift. This procedure can be performed in the office or in an operative setting to simply reposition the obstructing intraurethral prostatic tissue in patients with moderate BPH This is accomplished using small implants into the prostate to hold the lobes of the prostate out of the way. It shows a rapid improvement in symptoms with minimal downtime and often does not require the use of a catheter after the procedure. In most cases only occasional mild bleeding or discomfort is noted in the immediate time after the procedure. It also has the unique advantage of having no effect on erectile dysfunction and ejaculation, as there is no cautery, heat or destruction of native tissue, which could affect the nerves involved in sexual function. This is an ideal option for the patient who wants to avoid the potential side effects of the other options listed above and to have minimal to no catheter time associated with the procedure.
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