What is BPH?
BPH, or benign prostatic hyperplasia, refers to enlargement of the prostate in the absence of cancer. This condition affects millions of men across the country. The problem usually starts when the man is in his fifties.
An enlarged prostate gland can result in blockage of the flow of urine. If the condition is not treated, several complications can occur including urinary tract infections, bladder stones, permanent damage to the bladder, and permanent damage to the kidneys.
It is important to note that BPH is a progressive condition. Symptoms often start gradually and may be subtle at first, but they typically worsen over time. Men may notice changes in their urinary patterns, such as waking multiple times at night to urinate, difficulty initiating urination, or a sensation that the bladder is never fully empty. Recognizing these early signs and seeking medical evaluation can prevent more serious complications from developing.
Symptoms of BPH
The Symptoms of BPH include:
- Weak urine stream
- Frequent urination
- Urgency to urinate
- Urgency incontinence
- Inability to completely empty the bladder
Generally, the larger the prostate, the worse the symptoms. The size of the prostate, however, does not always determine the severity of symptoms. Some men with only a slightly enlarged prostate have more severe symptoms, while other men with very large prostates have only minor issues.
Additionally, BPH can impact overall quality of life. Men with frequent nighttime urination may experience fatigue, irritability, and difficulty concentrating during the day. Persistent symptoms may even affect personal relationships or social activities due to the constant need for bathroom access. Addressing BPH promptly can greatly improve daily comfort and overall wellbeing.
In some cases, a combination of alpha-blockers and 5-alpha-reductase inhibitors is prescribed to maximize symptom relief. Your doctor may also recommend periodic monitoring of prostate size and urinary flow to determine whether adjustments in therapy are necessary.
What Causes BPH?
The most important risk factor for BPH is family history. Diabetes and obesity may also play a role. Ultimately, it is the production of testosterone that causes the male prostate to enlarge.
When the prostate enlarges it starts to block the flow of urine. The prostate is shaped like a donut.
While age and hormonal changes are the primary drivers of BPH, lifestyle factors such as diet, physical activity, and comorbid conditions can influence symptom severity. Maintaining a healthy lifestyle and managing underlying health issues may help slow symptom progression and improve urinary function.
The prostate surrounds the urethra which is a tube that carries the urine from the bladder out the penis. So as the prostate enlarges, the urethra is compressed and the urine becomes blocked.
BPH Treatment
When it comes to BPH, there are a number of treatment options, including medication, TURP, and laser therapy. You should always start with medication before proceeding to surgery.
Medication
The treatment of BPH starts with medication. Flomax, or tamsulosin, is a medication that is classified as an alpha-blocker. It works by relaxing the smooth muscle surrounding the prostate. Flomax does not shrink the prostate. Nevertheless, it is the most effective medication on the market for this condition. The main side effect is postural hypotension, or dizziness when you stand up. If you had a stroke, you should not take Flomax.
Avodart or Proscar are two medications that shrink the size of the prostate. They take several months to work and produce about a 15% to 20% shrinkage of the prostate. They are very safe and are most appropriate for older men who have coexisting medical issues.
Transurethral Incision of the Prostate (TURP)
The Transurethral Resection of the Prostate, or TURP, is a surgical procedure performed in the hospital with the patient under general or spinal anesthesia. The procedure involves placing a fiber-optic telescope into the penis and advancing it to the prostate. An electric current is passed through a wire loop. The loop is advanced out the tip of the telescope and into the prostate. The hot loop cuts away the inside part of the prostate that is blocking the flow of urine. The outside part of the prostate is not affected.
Patients typically experience rapid relief of urinary symptoms following TURP, and most men notice an immediate improvement in urine flow. Postoperative care focuses on preventing infection, managing discomfort, and ensuring proper bladder emptying.
Patients remain in the hospital overnight. The catheter is usually removed in the morning and the patient is then discharged home.
In most patients, the procedure does not affect the erection or the sensation of orgasm. The TURP does, in most cases, cause the patient to ejaculate less fluid. You should not have this procedure if you want to have more children. Significant bleeding or incontinence are rare complications.
Green Light Laser TURP
The green light laser prostatectomy is similar to the TURP, except that it uses laser energy instead of electrical energy. Dr. Lazare inserts a cystoscope, or fiber-optic telescope, into the urethra and advances it to the prostate. He then inserts a laser fiber through the scope and he applies laser energy directly to the prostate. The prostate is then vaporized by the laser.
The advantage of this procedure is that bleeding is minimal. You can even undergo this procedure if you are taking aspirin or blood thinners. You will most likely return home catheter-free in less than 24 hours.
This minimally invasive approach offers many benefits, including shorter recovery time and less postoperative discomfort. Many patients are able to resume normal activities quickly, and the risk of significant bleeding is greatly reduced compared to traditional TURP.
TURP Recovery
Following this procedure, you will remain in the hospital overnight. You will then be discharged home from the hospital the following morning with a catheter attached to a leg bag. Dr. Lazare usually removes the catheter in his office two days later. Recovery is usually rapid and you can often return to work in about a week.
What Are the Risks Of a TURP?
Side effects are usually minimal. The procedure does not cause incontinence or impotence in the vast majority of cases. The TURP will cause you to ejaculate less fluid. You should not have this procedure if you want to have more children.
Rare complications include significant bleeding and the “TUR” syndrome which is caused by absorption of excess water.
Following either procedure, patients are encouraged to maintain regular follow-ups with their urologist. Monitoring helps ensure that the urinary tract is healing properly and that any recurring symptoms are promptly addressed. Patients should also adopt healthy lifestyle habits, including adequate hydration, limiting bladder irritants, and practicing pelvic floor exercises, to maximize long-term outcomes.
What Are the Side Effects of the Laser TURP?
The main side-effect is inflammation caused by laser energy. This inflammation can take 2 to 3 weeks to subside and may result in discomfort upon urination during this period.
Video About Enlarged Prostate
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If you believe that you are dealing with an enlarged prostate you can seek treatment at our Brooklyn, New York office. Give us a call today to schedule your appointment with Dr. Lazare and get started on your journey towards a better quality of life.