Benign Prostatic Hyperplasia (BPH) is a common, benign (not cancerous) condition in older men in which the prostate gland enlarges. The prostate is a walnut-sized gland that produces semen, the fluid that transports sperm. Located below the bladder and surrounding the urethra (the tube carrying urine out of the body), the growing prostate can squeeze the urethra and cause difficulty with urination.
Carolina Urology Partners in North and South Carolina is the 9th largest urology practice in the country. Our physicians provide the most sophisticated care for patients with BPH or enlarged prostate in the Carolinas.
Causes
Benign Prostatic Hyperplasia (BPH) is believed to be related to the aging process and the presence of the male hormone testosterone. More than half of men age 50 and older and 90 percent of men age 80 and older have BPH.
Symptoms
An enlarged prostate can cause a variety of urinary symptoms including:
- Recurring, sudden need to urinate
- Increasingly frequent urination, especially at night
- Weak or interrupted urine stream
- Difficulty starting urination
- Urine leakage
- Inability to completely empty the bladder
- Blood in the urine (hematuria)
Caffeine, alcohol, spicy or acidic foods, certain cold medications, and constipation can make symptoms worse. Left untreated, symptoms may worsen over time and can cause complications that may include inability to urinate (urinary retention), bladder or kidney damage, bladder stones or urinary infections. See your doctor for a thorough evaluation.
Diagnosis
Our doctors and enlarged prostate specialists will take a medical history and do a physical exam. A digital rectal exam (DRE) will be performed. Your doctor may order a prostate specific antigen (PSA) test. Elevated levels of PSA can indicate BPH, prostatitis (prostate inflammation) or prostate cancer. Additional tests may include a symptom score sheet, a urine flow study, ultrasound, CT scan and a cystoscopy.
Treatment
Treatment for BPH / enlarged prostate will depend on the severity of your symptoms and how much they interfere with your lifestyle. Men with minimal symptoms may only need to make lifestyle changes; those with more pronounced symptoms or complications may require medication or a procedure. Your doctor can help you determine which treatment is most appropriate for you.
Lifestyle Changes
- Avoid caffeine, acidic drinks such as colas, tomato and orange juice, and alcohol. Cold medications containing antihistamines or pseudoephedrin, and constipation can make it more difficult to urinate.
- Limit evening beverages and urinate when you first feel the urge.
- Increase your physical activity level.
Medications
Recent studies indicate that using combinations of medications which work by different pathways may be more effective than a single medication to treat BPH.
Medications may include:
- Alpha blockers to relax the smooth muscle tissue in the bladder and prostate, increasing urinary flow
- Enzyme (5 alpha reductase) inhibitors to shrink the prostate by preventing the conversion of testosterone to dihydrotestosterone, a key ingredient in prostate enlargement
- Anti-cholinergics to reduce frequency and urgency
- Herbal products such as saw palmetto, derived from a plant in the Southeastern U.S., may reduce mild to moderate symptoms
Minimally Invasive Therapy
These procedures seek to open a passage through the prostate to allow urine to flow with less effort. Many are called “transurethral” because instruments are passed through the opening at the tip of the penis and into the urethra. Your urologist will perform the most advanced treatment using the least invasive technique appropriate to resolve your problem.
- Transurethral needle ablation (TUNA) - radiowaves heat and destroy obstructing prostate tissue
- Laser vaporization - a laser heats and vaporizes the obstructing prostate tissue
- Transurethral microwave therapy (TUMT) - microwave energy heats and destroys obstructing prostate tissue
- Transurethral incision of the prostate using electrocautery or laser
- Transurethral resection of the prostate (TURP) - obstructing tissue is removed through a cystoscope; more invasive than the preceding techniques, but urologists still use the results from the TURP as the standard by which other transurethral procedures are judged
- Prostatectomy - open procedure to remove the obstructing prostate; a less common option reserved for those with very large prostates
The UroLift® System
What is the UroLift® System?
Treatment with the UroLift® System uses a minimally invasive approach that provides rapid relief and recovery of BPH symptoms. It is an earlier treatment option that can get men off of BPH medications and avoid major surgery. The goal of the UroLift® System treatment is to relieve symptoms so you can get back to your life and resume your daily activities. The UroLift® System treatment has demonstrated a significant improvement in quality of life for patients that is greater than reported for medications. The UroLift® System is the only BPH procedure shown not to cause new and lasting erectile or ejaculatory dysfunction, while being a safe and effective treatment of lower urinary tract symptoms due to BPH.
Watch: Meet Mike – Exploring BPH Treatment Options
The UroLift® System uses a revolutionary approach to treating BPH that lifts and holds the enlarged prostate tissue so it no longer blocks the urethra. It is the only available BPH treatment performed by a urologist that does not require heating, cutting, or removal of the prostate tissue. The procedure is typically performed using local anesthesia in a physician’s office or ambulatory surgery center. Patients typically return home the same day without a catheter.
Watch: UroLift® System Animation
You may be a good candidate if you are a male, 45 years of age or older, and have symptoms relating to BPH. Speak with your urologist to see if the UroLift® System treatment is right for you. If you have a known allergy to nickel, titanium or stainless steel, talk to your doctor about your allergy before getting a UroLift® System treatment.
What should I expect during the treatment? Is it painful? How long does it take?
If you and your doctor decide that the UroLift® System treatment is right for you, your doctor will provide you with more detailed information relating to the treatment. In general, the UroLift® System is a minimally invasive treatment that entails minimal downtime. Your doctor will use the UroLift® Delivery Device to deploy permanent implants to relieve obstruction caused by the enlarged prostate that is pressing on your urethra. The procedure, which usually takes about an hour, may be performed under local or general anesthesia and you may be given medication to feel comfortable during the treatment. This typically helps minimize discomfort during the procedure, though everyone’s definition for pain and discomfort varies greatly. Typically, no catheter and no overnight stay is required post-treatment.
What happens post-treatment, during the recovery period? Are meds required?
After the treatment, patients typically go home the same day without a catheter. There is minimal downtime post-treatment and many patients experience symptom relief in as early as 2 weeks. Patients may experience some urinary discomfort during the recovery period. Most common side effects are mild to moderate and include pain or burning with urination, blood in the urine, pelvic pain, urgent need to urinate and/or the inability to control the urge. Most symptoms resolved within two to four weeks after the procedure.
Does the treatment affect my sexual function?
Clinical studies have shown the UroLift® System treatment does not cause new, sustained instances of erectile or ejaculatory dysfunction. The same cannot always be said of other BPH therapies such as TURP, laser, and even medication.
Does my insurance cover the treatment?
The UroLift® System treatment is covered by Medicare and all major private insurers. Contact your insurance provider for your specific coverage information.
GreenLight™ Laser Therapy
Surgery is designed to open the prostate channel by ‘removing’ the excess tissue in the area. Traditionally, the excess tissue is removed using a small electrical loop in a procedure known as transurethral resection of the prostate or TURP. While this procedure is considered the gold standard therapy, it does require an overnight hospitalization and has a higher risk of bleeding than the other procedures mentioned.
GreenLight Laser Therapy is a proven treatment that has helped more than 1 million men around the world gain relief from the frustrating and life-changing symptoms of BPH.
What is GreenLight Laser Therapy?
GreenLight Laser Therapy uses a laser to remove excess prostate tissue. The laser treatment is delivered through a thin, flexible fiber, which is inserted into the urethra through an instrument called a cystoscope.
GreenLight Laser Therapy is generally an outpatient procedure. Typically, no overnight stay in the hospital is required, but it will depend on your individual condition.
What are the risks of GreenLight Laser Therapy?
All surgical treatments have inherent and associated risks. The GreenLight Laser System is intended for removal of soft tissue, including vaporization of the prostate for benign prostatic hyperplasia (BPH). Potential risks include irritative symptoms, bleeding, retrograde ejaculation and urinary tract infection.
How long does it take until symptoms are relieved?
Most patients experience relief of symptoms and improvement in urine flow within 24 hours of the procedure. However, medical history, your health conditions and other factors can influence treatment and recovery.1
How soon can I return to work or normal activity?
Most patients can resume normal activities within a couple of days. Strenuous activities can be resumed within a short time.1 Your doctor will discuss any restrictions and your specific condition during your visit following your procedure.
Does the GreenLight procedure affect sexual function?
In a recent study, 86% of patients reported improved or unchanged sexual satisfaction; 14% worsened. Similar outcomes were seen for erectile function.2
Is GreenLight Laser Therapy covered by insurance?
Medicare and most private insurers cover the GreenLight Laser Therapy procedure. It is the responsibility of the patient to contact their insurance provider for specific coverage information.
How do I know if I am a candidate for GreenLight Laser Therapy?
The GreenLight procedure is generally appropriate for most symptomatic BPH patients. Your provider will assess your symptoms and desired outcomes and determine the best course of treatment for you.
Watch: GreenLight Laser Therapy Patient Education Video
Click here to download the GreenLight patient brochure
Click here to download a quiz to assess your BPH symptoms
For more information on BPH and GreenLight Laser Therapy, please visit www.TreatMyBPH.com.
- Bachmann A, Tubaro A, Barber N, et al.180-W XPS GreenLight Laser Vaporisation Versus Transurethral Resection of the Prostate for the Treatment of Benign Prostatic Obstruction: 6 Month Safety and Efficacy Results of a European Multi-Centre Randomised Trial – The GOLIATH Study. Euro Urol. May 2014; 65(5): 931-942.
- Lukacs B, Loeffler J, Bruyère F, et al. Photoselective vaporization of the prostate with GreenLight 120-W laser compared with monopolar transurethral resection of the prostate: A multicenter randomized controlled trial. Eur Urol. 2012;61(6):1165-73.
Rezūm™ Water Vapor Therapy
Rezūm Water Vapor Therapy is a natural alternative to surgery. It treats the cause of your BPH, so you can get back to your life.
What is Rezūm Water Vapor Therapy?
Rezūm Therapy treats the source of BPH — your enlarged prostate. This short, in-office procedure uses the natural energy stored in a few drops of water to shrink the prostate so urine can flow freely. There are no incisions, no general anesthesia, and most patients return to regular activities within a few days.* And, it preserves sexual function.1,2
How does Rezūm Water Vapor Therapy work?
Rezūm Water Vapor Therapy is a non-surgical treatment that uses the natural energy stored in water vapor, or steam, to remove excess prostate tissue that is pressing on the urethra.
Watch: How does Rezūm Water Vapor Therapy work?
Over time, your body’s natural healing response absorbs the treated tissue, shrinking the prostate. With the extra tissue removed, the urethra opens, reducing BPH symptoms.
Most patients begin to experience symptom relief in as soon as two weeks, and maximum benefit may occur within three months.1,2 Patient responses can and do vary.
Who may benefit from Rezūm Water Vapor Therapy?
Rezūm Therapy may be an option for those who have given up on watchful waiting and lifestyle changes, men who are dissatisfied with, have stopped or don’t want to start taking BPH medications, and men not interested in other minimally invasive or surgical BPH procedures.
For years, the primary options for treating BPH were through medications or invasive surgery. Rezūm Therapy is a natural, in-office therapy option for men who do not want to take medication or are dissatisfied with medication symptom relief and want to avoid invasive surgery or implants to treat their BPH.
Market research indicates that preserving sexual function is a priority for men when it comes to BPH treatments.3 Clinical studies show Rezūm Therapy treats the cause of BPH symptoms while preserving sexual function.1
Where is the Rezūm Water Vapor Therapy procedure performed?
Rezūm Therapy can be performed in a short visit in our office, clinic or another outpatient setting.
Is Rezūm Water Vapor Therapy covered by insurance?
Rezūm Therapy is considered a covered benefit by Medicare and most private insurance. Patients should verify their benefits with their insurance company in advance of the scheduled procedure.
How quickly do patients experience symptom relief?
Clinical studies show that most men experience symptom relief as soon as two weeks after treatment with Rezūm Therapy, and maximum benefit may occur within three months.4 As with any procedure, patient responses can vary.
How soon can patients return to regular activities?
Clinical studies show that following treatment with Rezūm Therapy, most men return to regular activities within a few days.2 Your Carolina Urology Partners provider will make personal recommendations on resuming activity.
Additional Resources:
Click here to view the Rezūm patient brochure
Click here to view the patient education anatomical guide
Click here to download a quiz to assess your BPH symptoms
For more information about BPH and Rezūm Water Vapor Therapy, please visit www.Rezum.com