Prostate Enlargement (BPH)

The large majority of men (approximately 90%) develop some degree of prostate enlargement as they age. The process begins microscopically when men are in their 40's but significant enlargement generally does not occur until men are over the age of 50. When the prostate enlarges, it can cause partial, and at times complete, obstruction of the bladder leading to difficulty urinating. Most men develop urinary symptoms when the bladder outlet obstruction becomes significant. The most common symptoms are frequent urination, night time urination, incomplete bladder emptying, a weak urinary stream, difficulty starting the stream, an intermittent or dribbling stream, difficulty controlling/holding the urine and, if the obstruction becomes severe, urinary retention or inability to urinate.

The majority of men with mild urinary symptoms do not require active treatment and can be evaluated annually with prostate examination and blood testing. However, in men with more severe or bothersome urinary symptoms, treatment is often necessary.

Treatment options

Treatment options for BPH include:

• Medications

• Minimally Invasive treatment options such as:

  • Transurethral needle ablation (TUNA)””a highly effective non-surgical treatment, the TUNA device delivers low level radio frequency energy directly into the prostate. This energy shrinks and destroys the prostate tissue. It then relieves the constriction on the urethra and improves the symptoms of BPH.
    

  • Transurethral microwave therapy (TUMT), works on the same principle as the TUNA procedure but the heat is delivered by a different mechanism. With TUMT, a microwave antenna that sends out microwave energy is inserted into the prostatic urethra. Microwave energy is then used to heat the obstructing prostate tissue. Cooling fluid is circulated around the microwave antenna to prevent heat from damaging the wall of the urethra.
    
  • Interstitial Laser””a third option to heat the prostate. With this device, a laser fiber is introduced into the prostate and energy from the laser is delivered to the tissue to heat it.

• Surgical treatment options including:
  

  • Laser prostatectomy (laser vaporization) Laser prostatectomy is a surgical procedure used to treat obstruction of the bladder due to enlargement of the prostate. It is similar to (TURP) -but instead of using a wire loop to remove the excess prostate tissue, a holmium laser is used to vaporize the tissue. Laser prostatectomy has the advantage of less bleeding and a lower risk of impotence than TURP.

  • Transurethral resection of the prostate (TURP)””the most common surgical procedure to treat BPH. Under anesthesia, a resectoscope is inserted into the urethra and a cutting wire loop on the end removes the inner part of the prostate which is obstructing the urethra and bladder.
    

  • Transuretheral incision of the prostate (TUIP) is used in men with symptoms from an elevated bladder neck or a bladder neck stricture.

The above mentioned treatment options are all available at the Maryland Prostate Center. For an individual patient, one option may be better than the others. Urologists at the Maryland Prostate Center recommend treatment option(s) which are most likely to benefit the individual patient while minimizing risks and side effects.

For More Information

This page was last updated: June 17, 2013