Benign Prostatic Hyperplasia (enlarged prostate)

Benign prostatic hyperplasia refers to the non-cancerous enlargement of the prostate gland, the gland which surrounds the urethra and produces the fluid that carries sperm during ejaculation. Almost all men experience prostate enlargement as they age; however the exact cause is unknown.

Prostate enlargement happens to almost all men as they get older. Prostate enlargement is typically accompanied by symptoms such as: frequent or urgent urination, nighttime urination, weak urinary stream, and difficulty starting urinary stream.

Treatments may include:

Medical Therapy (Medications)
Medications are often the first line of treatment for patients suffering from moderate to severe urination problems caused by benign prostatic hyperplasia (BPH), a condition that leads to age-associated prostate gland enlargement. Some of the most common medications used for this condition include alpha-blockers, 5-alpha reductase inhibitors, phosphodiesterase-5 (PDE-5) inhibitors, or a combination of these drugs. Alpha-blockers, such as terazosin (Hytrin), doxazosin (Cardura), tamsulosin (Flomax), alfuzosin (Uroxatral), and silodosin (Rapaflo), help relieve symptoms associated with an enlarged prostate, but they do not stop the enlargement process. As a result, additional medications are used to help reduce the size of a patient’s enlarged prostate. 

5-alpha reductase inhibitors are a class of drugs that help stop the prostate enlargement process in a matter of 6 months or longer. 5-alpha reductase inhibitors include finasteride (Proscar, Propecia) and dutasteride (Avodart), and using them in conjunction with alpha-blockers can help provide long-term from BPH symptoms. Lastly, phosphodiesterase-5 (PDE-5) inhibitors like tadalafil (Cilais) can help decrease urinary issues caused by BPH. This medication is often used for patients suffering from erectile dysfunction, but it can also be taken by patients with an enlarged prostate who may or may not also have erection problems.

GreenLight Laser PVP (Photoselective Vaporization of the Prostate)
GreenLight laser PVP is a minimally invasive procedure that treats benign prostatic hyperplasia (BPH) using high-powered lasers to vaporize overgrown prostate cells. This treatment may be used as an alternative to transurethral resection of the prostate (TURP), a surgical procedure that removes a portion of an enlarged prostate. During GreenLight laser PVP, a urologist administers an intravenous sedation and anesthesia before inserting a cystoscope into the urethra. The thin, flexible device is run through the urethra into the prostate gland where the urologist will identify areas of overgrowth. The GreenLight laser is then inserted into the cystoscope to begin the treatment.

When the laser is in place, the urologist will turn on a generator to produce pulses of light that radiate from the end of the fiber toward the overgrown prostate cells. This light begins to heat and vaporize nearby tissues. The laser will continue to obliterate tissue until all of the tissue that is restricting the urethra is completely destroyed. After the procedure, patients are sent to a separate room to recover for a few hours before being discharged that same day. There are many benefits to GreenLight laser PVP over other BPH procedures. For example, the laser seals off blood vessels, causing less bleeding than other BPH treatment options. Patients are also able to resume normal activity levels within three to five days after the procedure, with a full recovery occurring in four to six weeks.

Robotic Simple Prostatectomy
A robotic simple prostatectomy is a minimally invasive procedure that removes the inner core of the prostate gland. This surgery is usually performed on patients with prostate glands that are more than three times the normal size. Other factors that may lead to a robotic simple prostatectomy include extremely slow urination, frequent bleeding from the prostate, bladder stones, kidney damage, and frequent urinary tract infections (UTIs). A robotic simple prostatectomy is not a treatment option for prostate cancer, so patients should talk to their urologist about alternative procedures if they suffer from prostate cancer. A number of techniques and approaches may be considered during a robotic simple prostatectomy to ensure the precise removal of the prostate gland. 

For most patients undergoing a robotic simple prostatectomy, the following procedural steps are experienced. A urologist begins the procedure by making several small incisions in the abdomen before using robotic instruments to perform the rest of the surgery. The robotic devices allow for more precise movements to help successfully remove the adenoma, which is the enlarged portion of the prostate. Once the adenoma is carefully resected, the urologist will sew up the remaining parts and tissues together to create a normal prostate capsule. Recovery from robotic surgery is usually well tolerated and results in less pain, minimal blood loss, and less down time. Patients will need to use a catheter for several days after the procedure to help encourage safe urination.

Transurethral Microwave Therapy (TUMT) (Prolieve)
Transurethral microwave therapy (TUMT) is an outpatient procedure that relieves urinary problems caused by benign prostatic hyperplasia (BPH). Prolieve is a TUMT technology system used by the physicians at Affiliated Urologists to perform this treatment. During the procedure, a urologist inserts a unique urinary catheter through the urethra and into the bladder. A small microwave antenna is then fed through the catheter until it reaches the part of the urethra that is closest to the prostate. Using the small, portable TUMT device, the antenna begins to emit microwave energy to eventually heat and destroy tissue that is blocking the urethra. This procedure helps remove excess prostate tissue while restoring the patient’s urine flow. TUMT is usually performed on patients who have not experienced relief from their symptoms while taking BPH medications.

While TUMT can produce optimal results in patients with BPH, it is considered less effective than other surgical methods, such as transurethral resection of the prostate (TURP) and a robotic simple prostatectomy. Nevertheless, there are many advantages to undergoing TUMT over other minimally invasive procedures. For example, the treatment is usually performed on an outpatient basis, so patients can return home the same day. Furthermore, TUMT does not require general or spinal anesthesia; it is less likely to cause heavy bleeding after the procedure, and it has a lower chance of producing sexual side effects such as erectile dysfunction. 

Transurethral Resection of the Prostate (TURP) and Plasma Button
Transurethral resection of the prostate (TURP) is a minimally invasive procedure that treats moderate to severe cases of benign prostatic hyperplasia. For many years, this procedure was considered the most effective treatment option for patients suffering from an enlarged prostate. While there are a number of newer therapies on the market today, TURP continues to be a popular treatment technique for patients with BPH. During the procedure, general or spinal anesthesia is administered before a resectoscope is inserted through the tip of the penis (urethra) and into the prostate area. This procedure is advantageous for patients not wanting to undergo an extensive surgical procedure because TURP requires no incisions be made outside the body. 

Once the resectoscope is in place, the urologist will begin cutting small pieces of tissue from the prostate gland. As the tissue is being cut, the urethra will start to expand and free up space, making it easier for patients to urinate. After all of the necessary tissue has been resected, the urologist will remove the excess tissue and place a urinary catheter into the urethra. This catheter is usually kept in the urethra for up to 48 hours to help patients urinate on their own after the procedure. During the healing process, patients may experience painful urination, blood in urine, or a frequent need to urinate. These symptoms should subside as the patient heals.

UroLift System
The UroLift System is a minimally invasive procedure that treats patients suffering from an enlarged prostate. This treatment technique is incredibly unique because it does not require cutting, heating, or the removal of prostate tissue. Instead, the UroLift system utilizes tiny implants to hold the prostate lobes apart, increasing the opening of the urethra. Patients are not put under general anesthesia during the procedure, nor are they sent home with a urinary catheter to help them urinate. This treatment option is usually considered for patients who have not found success from medications for their BPH, who want a less invasive approach (compared to surgery) to treat their urinary symptoms.

During the procedure, a urologist places the UroLift Delivery Device through the urethra and into the prostate gland. Once the device is in place, the urologist pushes one side of enlarged prostate gland out of the way to create a larger opening for the urethra. Shortly thereafter, the permanent implant is installed to help hold the lifted prostate tissue. This process is repeated on the other side of the enlarged prostate to create a wide and clear pathway for the urethra. As soon as the implants are in place, the urologist removes the delivery device and sends the patient to a separate room to recover. As mentioned previously, a catheter is not typically placed in the urethra after the procedure. Many patients report complete symptom relief in as little as two weeks.

Rezūm:
Rezūm is a unique treatment using steam to treat an enlarged prostate (BPH). Performed in both clinic and out-patient settings, Rezūm is FDA approved and uses thermal energy to treat the excess prostate tissue that causes symptoms such as frequent and urgent need to urinate, weak stream, irregular flow, and straining.

The Rezūm treatment is performed by applying radiofrequency energy to drops of water inside a handheld device in order to create steam. The steam is applied to prostate tissue that is impeding urine flow from the bladder, and quickly turns back into water while releasing thermal energy into the membrane of the tissue cells. These cells are rapidly damaged, and over time, the body begins to absorb the affected tissue.

Benefits of Rezūm include a noticeable improvement of symptoms an as little as two weeks, no need for general anesthesia, preservation of urinary and sexual function, and ability for patients to return to regular activities in just a few days.

Dr. Lipson is now performing the Rezūm procedure. Please schedule an appointment to see if Rezūm is an option for you.

HoLEP:
HoLEP, which stands for Holmium Laser Enucleation of the prostate, is a minimally invasive procedure to treat an enlarged prostate, or benign prostatic hyperplasia (BPH). The procedure removes excess tissue with a laser, eliminating blockages and allowing urine to flow through the prostate. The affected tissue is then cut into smaller fragments and removed. The HoLEP procedure requires a brief hospitalization and an anesthetic. A catheter may be needed for 1-2 days after the procedure until the urine clears. 

HoLEP offers several advantages to traditional prostate surgery, including no limit to prostate size before treatment, less bleeding, quicker discharge and recovery, and a lower chance of recurrence needing additional surgery. 

Schedule an appointment to find out if HoLEP may be an option for you. 

 

 

 

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