Benign Prostatic Hyperplasia (BPH)

What is BPH?

Benign prostatic hyperplasia (BPH) is an enlargement of the prostate gland that commonly occurs as men age. It can contribute to bothersome lower urinary tract symptoms (LUTS).

What are the symptoms of BPH?

BPH can cause a variety of bothersome urinary symptoms including slow urinary stream, difficulty getting started (hesitancy), incomplete bladder emptying, urinary frequency, urinary urgency, waking up at night to urinate (nocturia), and occasionally urinary dribbling or incontinence.

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How is BPH diagnosed?

A detailed medical history including surveys such as the American Urological Association (AUA) Symptom Score are the most important diagnostic tool. A digital rectal exam to feel the size and texture of the prostate is also important. In addition, a urinary flow rate and the amount of urine left in the bladder after urinating (post-void residual) can be useful diagnostic tools. A urinalysis to rule out infection or possible bladder tumor as the cause of symptoms is performed and a prostate specific antigen (PSA) will often be checked to screen for prostate cancer. If these tests are non-conclusive or if surgery is planned to treat BPH, urodynamics, cystoscopy, or prostate ultrasound may be utilized.

How is BPH treated?

There are multiple medical treatments for BPH. One class of medications are referred to as alpha-blockers. These medications help to relax the smooth muscle in the prostate and bladder neck to allow the urine to flow better. The most common medication in this class is tamsulosin but others include alfuzosin, terazosin, and silodosin, and doxazosin. The most common side effects of these drugs is occasional lightheadedness and retrograde ejaculation.
Another class of medications for BPH are called 5-alpha-reductase inhibitors and include finasteride and dutasteride. These medications decrease the levels of dihydrotestosterone (DHT) in the prostate which causes the prostate to shrink.

There are multiple surgical options that we offer for the management of BPH. Almost all of the current surgical treatments for BPH are minimally invasive. One of these treatments is called Urolift and is a quick office procedure where small implants are placed into the prostate to open up the prostate obstruction to improve urinary symptoms. Another treatment offered at Associated Urological Specialists is Rezum which is also done in the office. A small scope is placed into the bladder and the device injects steam into the prostate which subsequently leads to prostate shrinkage. Transurethral microwave therapy (TUMT) can also be done in the office and uses a special catheter with a balloon that helps to expand the prostate and then utilizes microwave energy to help shrink the enlarged prostate.

There are also several outpatient surgical options used for the treatment of BPH that are all performed endoscopically with no incisions and minimal blood loss. During all of these procedures, a scope is placed into the urethra and the prostate is visualized directly and a laser is utilized to vaporize the enlarged prostate tissue. Examples of these procedures are photoselective vaporization of the prostate also known as the GreenLight laser, and bipolar transurethral resection of the prostate or TURP in which bipolar energy is used to resect overgrown prostate tissue.

Occasionally, the prostate is too enlarged for these minimally invasive procedures. In these cases, we offer a simple prostatectomy which involves a lower abdominal incision or we offer the laparoscopic daVinci robotic simple prostatectomy as well as Aquablation.

Our urologists have extensive experience with Greenlight laser vaporization of the prostate which is a minimally invasive option for patients with larger prostates.