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It is common for the prostate gland to become enlarged as a man ages. Doctors call this condition benign prostatic hyperplasia (BPH), or benign prostatic hypertrophy. As a man matures, the prostate goes through two main periods of growth. The first occurs early in puberty, when the prostate doubles in size. At around age 25, the gland begins to grow again. This second growth phase often results, years later, in BPH.

Though the prostate continues to grow during most of a man’s life, the enlargement doesn’t usually cause problems until late in life. BPH rarely causes symptoms before age 40, but more than half of men in their sixties and as many as 90 percent in their seventies and eighties have some symptoms of BPH.

Many people feel uncomfortable talking about the prostate, since the gland plays a role in both sex and urination. Still, prostate enlargement is as common a part of aging as gray hair. As life expectancy rises, so does the occurrence of BPH. In the United States in 2000, there were 4.5 million visits to physicians for BPH.

Dr. Lance Walsh of Advanced Urology Institute at Titus discusses BPH on the Desert Living Show.

Why does BPH occur?

The cause of BPH is not well understood. No definite information on risk factors exists. For centuries, it has been known that BPH occurs mainly in older men and that it doesn’t develop in men whose testes were removed before puberty. For this reason, some researchers believe that factors related to aging and the testes may spur the development of BPH.

Symptoms

Many symptoms of BPH stem from obstruction of the urethra and gradual loss of bladder function, which results in incomplete emptying of the bladder. The symptoms of BPH vary, but the most common ones involve changes or problems with urination, such as

  • a hesitant, interrupted, weak stream
  • urgency and leaking or dribbling
  • more frequent urination, especially at night

Diagnosis

If BPH is suspected, several tests help the doctor identify the problem and decide whether surgery is needed. The tests vary from patient to patient, but the following are the most common.

  • Digital Rectal Examination (DRE)
  • Prostate-Specific Antigen (PSA) Blood Test
  • Rectal Ultrasound and Prostate Biopsy
  • Urine Flow Study
  • Cystoscopy

Treatment

Men who have BPH with symptoms usually need some form of treatment at some time. The following section describes the types of treatment that are most commonly used for BPH.

Drug Therapy

Over the years, researchers have tried to find a way to shrink or at least stop the growth of the prostate without using surgery. The FDA has approved several medications to relieve common symptoms associated with an enlarged prostate.

Minimally Invasive Therapy

Because drug treatment is not effective in all cases, researchers in recent years have developed a number of procedures that relieve BPH symptoms but are less invasive than conventional surgery. These include:

    • UROLIFT treatment – is a minimally invasive approach to treating BPH that lifts and holds the enlarged prostate tissue out of the way so it no longer blocks the urethra. There is no cutting, heating or removal of prostate tissue.
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    • Transurethral microwave procedures – a device sends computer-regulated microwaves through a catheter to selected portions of the prostate. Although microwave therapy does not cure BPH, it reduces urinary frequency, urgency, straining, and intermittent flow. It does not correct the problem of incomplete emptying of the bladder.

    • Transurethral needle ablation – the delivery of low-level radiofrequency energy through twin needles to burn away a well-defined region of the enlarged prostate.

    • Water-induced thermotherapy – uses heated water to destroy excess tissue in the prostate.

    • High-intensity focused ultrasound – uses ultrasound waves to destroy prostate tissue is still undergoing clinical trials in the United States. The FDA has not yet approved high-intensity focused ultrasound.

Surgical Treatment

Most doctors recommend removal of the enlarged part of the prostate as the best long-term solution for patients with BPH. With surgery for BPH, only the enlarged tissue that is pressing against the urethra is removed; the rest of the inside tissue and the outside capsule are left intact. Surgery usually relieves the obstruction and incomplete emptying caused by BPH. The following section describes the types of surgery that are used.

    • HoLEP Surgery – HoLEP is short for holmium laser enucleation of the prostate. Using a holmium laser, Dr. Walsh can perform a minimally invasive treatment for BPH by enucleating most of the excess benign prostate tissue. In other words, Dr. Walsh can remove the enlarged tissue from inside the prostate without cutting into it. The HoLEP procedure lasts an average of 45 minutes to two hours, depending on the size of the prostate.

    • Transurethral Surgery – the surgeon reaches the prostate by inserting an instrument through the urethra No external incision is needed. During the 90-minute operation, the surgeon uses a resectoscope to remove the obstructing tissue one piece at a time. The pieces of tissue are carried by the fluid into the bladder and then flushed out at the end of the operation. Transurethral procedures are less traumatic than open forms of surgery and require a shorter recovery period.

    • Open Surgery – in the few cases when a transurethral procedure cannot be used, open surgery, which requires an external incision, may be used. Open surgery is often done when the gland is greatly enlarged, when there are complicating factors, or when the bladder has been damaged and needs to be repaired. The location of the enlargement within the gland and the patient’s general health help the surgeon decide which of the three open procedures to use.
      Open surgery is often done when the gland is greatly enlarged, when there are complicating factors, or when the bladder has been damaged and needs to be repaired. The location of the enlargement within the gland and the patient’s general health help the surgeon decide which of the three open procedures to use.

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Most doctors recommend removal of the enlarged part of the prostate as the best long-term solution for patients with BPH. With surgery for BPH, only the enlarged tissue that is pressing against the urethra is removed; the rest of the inside tissue and the outside capsule are left intact. Surgery usually relieves the obstruction and incomplete emptying caused by BPH. The following section describes the types of surgery that are used.

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