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Enlarged Prostate

Benign Prostate Hyperplasia (BPH)

One of the most common “plumbing” problems in men as they age, it’s important to know that BPH is not cancer and does not cause cancer. But symptoms can get worse over time, so don’t wait to talk to a doctor.

Understanding Benign Prostate Hyperplasia

Benign prostate hyperplasia (BPH) is the enlargement of the prostate, a gland that sits right below the bladder and surrounds the urethra. It is important to understand is that BPH is not cancer and does not cause cancer.

BPH develops in most men as they age because of changing levels in sex hormones. In fact, by the time they reach the age of 60, about half of all men will have some signs of BPH. Ethnicity also plays a role, with BPH being more common in Caucasian and Australian men.

Symptoms of BPH tend to gradually increase over time and can include:

Early symptoms of BPH:

  • Weak or intermittent urine stream
  • Need to urinate more frequently or more suddenly
  • Difficulty starting to urinate and straining during urination

Later symptoms, if the condition goes untreated, include:

  • Bladder stones or bladder infection
  • Blood in your urine
  • Sudden blockage of the urethra, making urination difficult

BPH often affects men starting at the age of 50. By age 60, about half of all men will have some signs of BPH.

What can cause BPH?

BPH is a condition caused by an enlarged prostate (the gland that sits right below the bladder), and is a normal part of aging. As the prostate expands, it can block the urethra and make it harder to urinate. It can also start to press up against the bladder, making you feel like you have to urinate more often.

Other symptoms can include straining when you urinate, a weak urine stream, and the feeling that your bladder does not empty completely.

There are some lifestyle changes that can help control the symptoms of BPH and keep the condition from getting worse.

Tips to control BPH

Avoid too much caffeine or alcohol as they can increase the amount of urine you produce

Don’t drink anything an hour or two before you go to bed

Don’t wait too long to urinate – this can cause the bladder muscles to stretch

Practice “timed voiding” – follow a schedule of drinking fluids and urinating at set times during the day to help train yourself to control frequency and urgency

Practice “double voiding” – urinate as much as you can, relax briefly, then urinate again

Medication is an option to help reduce the symptoms of BPH, but there are other things that can help.

What to expect

Your urologist will review your medical history and perform a medical exam. Tests such as a blood test, urinalysis, and possibly a neurological exam (to find out if there is a problem with the nerves in your bladder) may also be recommended.  The doctor may perform a cystoscopy, procedure in which he looks in the bladder with a small flexible scope.

Non-surgical treatment options

If a diagnosis confirms mild or moderate benign prostate hyperplasia, it is likely that your urologist will recommend medication. Options include:

  • Alpha blockers: These medications help relax the prostate and bladder muscles. They work quickly to relieve symptoms, but do not reduce the size of the prostate.
  • 5-alpha reductase inhibitors: These medications prevent the hormonal changes that cause prostate growth. They would be recommended if your prostate is very large, because they help to shrink the size of the prostate. It can take several weeks or even months before symptoms improve.

If your symptoms are severe and medication doesn’t work for you, your urologist may recommend surgery.

Surgical treatment options

Surgery can help to reduce the size of the prostate and open the urethra:

Minimally invasive surgeries:

Convective radiofrequency water vapor thermal therapy

This procedure releases thermal energy directly to the prostate gland to treat BPH by using water vapor (steam). When the steam contacts the prostate tissue, it converts to its liquid state and releases the thermal energy it had stored up. This thermal energy kills the cell membranes immediately, freeing up the blockage caused by BPH. This is a minimally invasive procedure performed in an outpatient clinic with no incisions, allowing for a quicker recovery.

How is convective radiofrequency water vapor thermal treatment done?

The procedure is done in an outpatient setting under local anesthesia, with or without the use of nitrous oxide, or laughing gas. The entire procedure takes just a few minutes to perform. During the procedure, a narrow sheath is inserted through the urethra. Once inserted, a thin needle is deployed from the sheath and into the prostate gland. Water vapor (steam) is then rapidly delivered to the prostate gland, typically within 8-10 seconds, causing the offensive cells to die.

Over time, the patient’s body will absorb the treated tissue through its natural healing process. As this process takes place, the symptoms of BPH are relieved. Typically, patients begin experiencing relief in as little as two weeks, with the maximum benefit occurring in one to three months.

What to expect after treatment

After treatment, patients will need a temporary catheter for drainage. Patients are given thorough instructions on how to remove the catheter at home. Patients can return to pre-procedural activity levels within a week of undergoing the procedure.

Since it is a minimally invasive procedure, patients who undergo convective radiofrequency water vapor thermal treatment experience fewer side effects compared with those seen in invasive surgical procedures. However, as with any procedure, side effects may occur.

The most common side effects are:

  • Mild pelvic discomfort
  • A small amount of blood in semen and urine
  • Mild urgency of and burning urination

These side effects typically subside on their own within three weeks of the procedure. Discomfort during the short-term healing process can be relieved through a mild pain medication such as Tylenol, or a warm bath or heating pad.

Benefits and considerations of BPH treatment

Convective radiofrequency water vapor thermal treatment also provides the following benefits:

  • Preserves sexual and urinary function
  • Alternative to BPH medications
  • Relieves symptoms quickly (typically within two weeks)
  • Does not require general anesthesia
  • Allows patients to return to regular activities within a few days

Laser therapies: There are different types of lasers that work by removing prostate tissue around the urethra, allowing urine to flow more freely. With this minimally invasive technique, patients recover more quickly than they would from traditional surgery. However, for some men, laser treatments are not as effective over the long term.

Transurethral microwave therapy (TUMT): This treatment is generally only used on small prostates and is usually performed in your doctor’s office. It uses thermal energy (i.e. microwave, radiofrequency) to reduce the number of prostate cells. Over time, it can be effective in shrinking the prostate. However re-treatment is sometimes necessary.

Other surgical techniques:

Transurethral resection of the prostate (TURP): This procedure has been used for many years and generally relieves symptoms quickly. Your urologist inserts a scope into your urethra and removes part of the inner prostate to relieve pressure on the urethra and make it easier for urine to flow out of the bladder.

Transurethral incision of the prostate (TUIP or TIP): This procedure is similar to the TURP procedure described above, but prostate tissue is not removed. Instead, small incisions are made in the prostate gland to open up the urethra and improve the flow of urine.

Transurethral needle ablation (TUNA): This minimally invasive thermal therapy passes radio waves into your prostate gland to apply heat and destroy the extra prostate tissue that blocks the flow of urine.

As with any surgery, it’s important to discuss possible risks and side effects with your doctor.

Need a referral?

It helps to have a urologist from John Muir Health who knows your health history and can help you get the treatment that’s right for you more quickly.

For more information about our urology services, please call (925) 937-7740.