My Penis Stuff

Examples

Uroxatral, Cardura, Flomax, Hytrin

How It Works

Alpha-blockers help treat benign prostatic hyperplasia (BPH) by relaxing smooth muscle tissue found in the prostate and the bladder neck. This allows urine to flow out of the bladder more easily.

These medicines usually are taken by mouth once or twice a day.

What To Think About

Some evidence suggests that alpha-blockers are more effective than finasteride in relieving symptoms.

Long-acting forms of these medicines can be taken once a day, which may make them more convenient to take than finasteride.

Fewer side effects, especially low blood pressure when standing up suddenly, may occur if the drug is taken at bedtime.

Alpha-blockers are sometimes used to treat high blood pressure, too. But for some people, an alpha-blocker does not help with their high blood pressure or is not a good choice for other reasons. So, even if you are taking an alpha-blocker for your BPH symptoms, you may have to take another medicine to control your high blood pressure.

During transurethral resection of the prostate (TURP), an instrument is inserted up the urethra to remove the section of the prostate that is blocking urine flow.

TURP usually requires hospitalization and is done using a general or spinal anesthetic.

What To Expect After Surgery

The hospital stay after TURP is commonly 1 to 2 days.

Following surgery, a catheter is used to remove blood or blood clots in the bladder that may result from the procedure. When the urine is free of significant bleeding or blood clots, the catheter can be removed and you can go home.

Strenuous activity, constipation, and sexual activity should be avoided for about 6 weeks. Symptoms such as frequent urination will continue for a while because of irritation and inflammation caused by the surgery, but they should ease during the first 6 weeks.

Why It Is Done

Your doctor may recommend TURP if symptoms caused by benign prostatic hyperplasia (BPH) have not improved in response to home treatment and medications.

TURP is now the most common surgery used to remove part of an enlarged prostate. Open prostatectomies (in which an incision is made into the abdomen) generally are needed only when the prostate is very large.

How Well It Works

On the average, men experience an 85% improvement in their American Urological Association (AUA) symptom index scores. For example, if you had a score of 25, after this surgery it might be reduced to about 4. Men who are very bothered by their symptoms are most likely to notice great improvement in their symptoms after TURP; men who are not very bothered by their symptoms are less likely to notice a significant change.

In men who have moderate to severe symptoms of prostate enlargement, TURP is more effective than watchful waiting in relieving urinary symptoms. Studies have found that:²

• 90% of men who had TURP had reduced symptoms compared with 39% of those who used watchful waiting.
• After 5 years, 10% of those who had TURP had a “treatment failure,” mainly an inability to urinate, urine left in the bladder, and an increase in the severity of symptoms. This compares with 21% of men using watchful waiting during the same period who had an increase in symptom severity or complications.

TURP and transurethral incision of the prostate (TUIP) had equal effectiveness.

Compared with visual laser ablation, TURP was more effective at relieving symptoms but required a longer hospital stay. Another laser treatment method, contact laser vaporization, is as effective at reducing symptoms as TURP.

Risks

The risks of transurethral resection of the prostate (TURP) include problems with sexual performance, incontinence, and problems from surgery.

Problems with sexual performance

• Erection problems may develop in men who did not have problems before the procedure. The risk of this may depend on how sexual performance is defined and measured, how sexually active the man was before the surgery, and how old he is. Many men in the age group who are likely to have BPH also have some problems with getting an erection. Subsequent erection problems are reported by about 3 to 34 men out of 100. Viagra (sildenafil) is effective in helping most men achieve an erection after they have had TURP.
• A study comparing TURP with watchful waiting and laser surgery indicated that men who had TURP were no more likely to have erection problems, pain on ejaculation, or a perception of an inferior sex life than men who either had laser therapy or practiced watchful waiting.
• Some older studies that reported high rates of erection problems in men after TURP may have failed to assess the sexual function of the men before surgery and may have had differing definitions of what an erection problem is, so they may have overestimated the numbers of men who had an erection problem as a side effect of TURP.
• Ejaculation backward into the bladder (retrograde ejaculation) is very common, occurring in about 25 to 99 men out of 100. This does not affect sexual function.

Loss of ability to control urine flow (incontinence)

• A small number of men (about 1%) say they are completely unable to hold back their urine after the surgery.
• Some men find that they can still hold in their urine after the surgery, but they tend to leak or dribble.

Problems related to having surgery

• About 4 out of 100 men require a blood transfusion during or after surgery.
• TURP syndrome occurs in about 2 out of 100 men who have TURP. This syndrome occurs when the body absorbs too much of the fluid used to wash the area around the prostate while prostate tissue is being removed. The symptoms of TURP syndrome include mental confusion, nausea, vomiting, high blood pressure, slowed heartbeat, and visual disturbances. TURP syndrome is temporary (usually lasting only the first 6 hours after surgery) and is treated with medication that removes excess water from the body (diuretic).
• About 5 out of every 100 men need the operation again after 5 years.
• Repeat surgery because of a complication of the surgery is needed less than 10% of the time.

What To Think About

Surgery usually is not required to treat BPH, although some men may choose it because their symptoms bother them so much. Choosing surgery depends largely on your preferences and comfort with the idea of having surgery. Things to consider include your expectation of the results of the surgery, the severity of your symptoms, and the possibility of developing complications from the surgery.

Men who have severe symptoms often have great improvement in quality of life following surgery. Men whose symptoms are mild may find that surgery does not greatly improve quality of life. Men with only mild symptoms may want to think carefully before deciding to have surgery to treat BPH.

For men who have clear indications for surgery, TURP may be less effective than open prostatectomy in relieving the symptoms of BPH. (See the Surgery section of the topic Benign Prostatic Hyperplasia [BPH].)

About 10% of men who have TURP or open prostatectomy are found to have previously undetected early-stage prostate cancer. Cancer discovered this way generally is slow-growing, often requires no additional treatment, and will not be the eventual cause of death in most men. For more information on prostate cancer, see the topic Prostate Cancer.

In transurethral microwave therapy (TUMT), an instrument (called an antenna) that sends out microwave energy is inserted through the urethra to a location inside the prostate. Microwave energy is then used to heat the inside of the prostate. Cooling fluid is circulated around the microwave antenna to prevent heat from damaging the wall of the urethra. To prevent the temperature from getting too high outside the prostate, a temperature sensor is inserted into the man’s rectum during the procedure. If the temperature in the rectum increases too much, the treatment is turned off automatically until the temperature goes back down.

The temperature becomes high enough inside the prostate to kill some of the tissue. As this part of the prostate heals, it shrinks, reducing the blockage of urine flow.

This treatment is done in a single session. It usually does not require an overnight stay in the hospital. A general or spinal anesthetic is needed during the procedure.

Microwave therapy is also known as cooled thermal therapy or by the name of the equipment (Targis or Prostatron).

What To Expect After Surgery

You are generally able to go home after surgery. You may not be able to urinate and may require catheterization to drain your bladder. For most men, this lasts for a week or less. You may also have to take antibiotics or anti-inflammatory medications.

You can generally return to work 1 to 2 days after treatment. Sexual activity can be resumed 1 to 2 weeks after surgery.

Why It Is Done

TUMT is done to help relieve the symptoms of benign prostatic hyperplasia (BPH). It is an option for men who want more than medications for treatment of their symptoms.

How Well It Works

Studies note that TUMT is more effective than treatment with the alpha-blocker terazosin when checked 18 months later.

In one study, transurethral resection of the prostate (TURP) improved symptoms better than TUMT. But in two other studies, there was no major difference in how well the two treatments worked.

Risks

The main complication of TUMT is the inability to urinate (urinary retention) for more than a week. This condition is treated by inserting a tube directly through the abdominal wall into the bladder to drain urine (suprapubic catheter). Erection problems and retrograde ejaculation (ejaculation backward into the bladder) appear to be less common after TUMT than after TURP.

Other complications include persistent irritation of the urethra and blood in the urine.

Recent reports have warned that the procedure has in a small number of cases caused serious injuries and complications, including damage to the penis and urethra. Injuries have required colostomies, partial amputation of the penis, and other procedures. In December 2000, the U.S. Food and Drug Administration (FDA) issued a warning about these injuries.

What To Think About

Most trials using TUMT have been limited by a small number of participants, a short length of time of study, and limited follow-up of the participants after the trial ended.

This procedure is not recommended for men with prostate cancer, men who are suspected of having prostate cancer, or men with prosthetic hip joints or pacemakers.

Transurethral incision of the prostate (TUIP) may be done to treat benign prostatic hyperplasia (BPH). The surgeon uses an instrument inserted into the urethra that generates an electric current or laser beam to make incisions in the prostate where the prostate meets the bladder. Cutting muscle in this area relaxes the opening to the bladder, decreasing resistance to the flow of urine out of the bladder. No tissue is removed. It is done under either general or spinal anesthetic.

The procedure usually requires an overnight stay in the hospital.

What To Expect After Surgery

TUIP is a much less invasive procedure than transurethral resection of the prostate (TURP). TUIP usually requires an overnight stay in the hospital. A catheter is left in the bladder for 1 to 3 days after surgery.

Why It Is Done

TUIP may be a good option for men with only slightly enlarged prostates.

TUIP may be chosen instead of TURP in men who:

• Are at higher risk for complications from surgery and anesthetic, including men with serious health problems. TUIP involves less blood loss and can be done more quickly than TURP.
• Want to avoid the risk of developing retrograde ejaculation, a condition in which semen flows backward into the bladder. This side effect is more common with TURP than with TUIP.

How Well It Works

Symptoms improve after TUIP in about 80% of cases. Generally, men notice about a 73% improvement in their American Urological Association (AUA) symptom index scores. For example, if you have a score of 25 (indicating severe symptoms), it could be reduced to about 6 (indicating mild symptoms).

Short-term improvement in BPH symptoms is about the same for TUIP as for TURP. Studies comparing the two types of surgery suggest that the outcomes are similar. However, men who have had TUIP generally are less likely to develop retrograde ejaculation than men who have TURP.

Risks

The possible risks of transurethral incision of the prostate (TUIP) include the following:

• Retrograde ejaculation, in which semen flows backward into the bladder, occurs in about 6 to 55 men out of 100. Retrograde ejaculation is not harmful.
• Erection problems in men who did not have one of these problems before the surgery are reported in about 4 to 25 men out of 100.
• Incontinence occurs in about 1 man out of 100.
• The need for a blood transfusion during surgery is rare.
• A second operation because of a complication of the surgery is needed in about 1 to 3 men out of 100.

What To Think About

Surgery usually is not required to treat BPH, but it may be a reasonable choice for some men. Choosing surgery depends largely on your preferences and comfort with the idea of having surgery. Things to consider include your expectations, the severity of your symptoms, and the possibility of developing complications.

Usually, no tissue is removed in TUIP; therefore, no tissue is available for prostate cancer testing.

Men who have severe symptoms often have great improvement in quality of life following surgery. Men whose symptoms are mild may find that surgery does not greatly improve quality of life. Men with only mild symptoms may want to think carefully before having surgery to treat BPH.

What is rye grass pollen extract?

Rye grass pollen extract comes from the pollen of rye grass (Secale cereale).

Rye grass pollen extract may affect the male hormone testosterone, relax the muscles of the tube through which urine flows (urethra), and improve how well the bladder can force urine out. All of these may reduce symptoms of an enlarged prostate, such as dribbling after urinating or having to get up several times at night to urinate.

What is rye grass pollen extract used for?

People use rye grass pollen extract to relieve the symptoms of noncancerous enlarged prostate (benign prostatic hyperplasia, or BPH). Some research reports that men who use rye grass pollen extracts say their symptoms have improved and that they get up fewer times at night to urinate. But there is very little research on this.

Is rye grass pollen extract safe?

Researchers have not evaluated rye grass pollen extract for long-term effectiveness, safety, or its ability to prevent complications of BPH.

Men who have problems urinating should see a doctor to rule out prostate cancer. Prostate cancer is treatable, but treatment may be more successful when you find and treat the cancer as early as possible.

The U.S. Food and Drug Administration (FDA) does not regulate dietary supplements in the same way it regulates medication. A dietary supplement can be sold with limited or no research on how well it works.

Always tell your doctor if you are using a dietary supplement or if you are thinking about combining a dietary supplement with your conventional medical treatment. It may not be safe to forgo your conventional medical treatment and rely only on a dietary supplement. This is especially important for women who are pregnant or breast-feeding.

When using dietary supplements, keep in mind the following:

• Like conventional medicines, dietary supplements may cause side effects, trigger allergic reactions, or interact with prescription and nonprescription medicines or other supplements you might be taking. A side effect or interaction with another medicine or supplement may make other health conditions worse.
• Dietary supplements may not be standardized in their manufacturing. This means that how well they work or any side effects they cause may differ among brands or even within different lots of the same brand. The form you buy in health food or grocery stores may not be the same as the form used in research.
• The long-term effects of most dietary supplements, other than vitamins and minerals, are not known. Many dietary supplements are not used long-term.

• Most men do not need treatment for benign prostatic hyperplasia (BPH), an enlarged prostate gland. It is not cancer, and it occurs in almost all men as they age.
• BPH can cause mild to moderate problems urinating. These may not bother you, or you may be able to control them with home treatment.
• Your doctor may want to see you regularly to check on your symptoms and make sure other problems haven’t come up.
• Medicine can reduce the symptoms of BPH, but it rarely gets rid of them. If you stop taking medicine, symptoms return. The side effects of medicine, including decreased sex drive, fatigue, dizziness, and headaches, may be worse than the symptoms of BPH.
• Sometimes the symptoms of BPH are more serious, or there may be other problems such as bladder infections or bladder stones. In these cases, BPH may be treated with surgery. Few men have problems severe enough to need surgery.

What is benign prostatic hyperplasia (BPH)?

Benign prostatic hyperplasia (BPH) is an enlarged prostate gland. The prostate gland surrounds the urethra, the tube that carries urine from the bladder out of the body. As the prostate gets bigger, it may squeeze or partly block the urethra. This often causes problems urinating.

BPH occurs in almost all men as they age. BPH is not cancer. An enlarged prostate can be a nuisance, but it is usually not a serious problem. About half of all men older than 50 have some symptoms.

Benign prostatic hyperplasia is also known as benign prostatic hypertrophy.

What causes BPH?

Benign prostatic hyperplasia is probably a normal part of the aging process in men, caused by changes in hormone balance and in cell growth.

What are the symptoms?

BPH causes urinary problems such as:

• Trouble getting a urine stream started and completely stopped (dribbling).
• Often feeling like you need to urinate. This feeling may even wake you up at night.
• A weak urine stream.
• A sense that your bladder is not completely empty after you urinate.

In a small number of cases, BPH may cause the bladder to be blocked, making it impossible or extremely hard to urinate. This problem may cause backed-up urine (urinary retention), leading to bladder infections or stones or kidney damage.

BPH does not cause prostate cancer and does not affect a man’s ability to father children. It does not cause erection problems.

How is BPH diagnosed?

Your doctor can diagnose BPH by asking questions about your symptoms and past health and by doing a physical exam. Tests may include a digital rectal exam, which lets your doctor feel the size of your prostate, and a urine test (urinalysis). In some cases, a prostate-specific antigen (PSA) test is done to help rule out prostate cancer. (Prostate cancer and BPH are not related, but they can cause some of the same symptoms.)

Your doctor may ask you how often you have symptoms of BPH, how severe they are, and how much they affect your life. If your symptoms are mild to moderate and do not bother you much, home treatment may be all that you need to help keep them under control. Your doctor may want to see you regularly to check on your symptoms and make sure other problems haven’t come up.

How is it treated? As a rule, you don’t need treatment for BPH unless the symptoms bother you or you have other problems such as backed-up urine, bladder infections, or bladder stones.

Although home treatment cannot stop your prostate from getting larger, it can help reduce or control your symptoms. Here are some things you can do that may help reduce your symptoms:

• Practice double voiding. Urinate as much as you can, relax for a few moments, and then urinate again.
• Avoid caffeine and alcohol. They make your body try to get rid of water and can make you urinate more often.
• If possible, avoid medicines that can make urination difficult, such as over-the-counter antihistamines, decongestants, nasal sprays, and allergy pills. Check with your doctor or pharmacist about any medicines you take.

If home treatment does not help, BPH can be treated with medicine. Medicine can reduce the symptoms, but it rarely gets rid of them. If you stop taking medicine, symptoms return. The side effects of medicine, which include decreased sex drive, fatigue, dizziness, and headaches, may be worse than the symptoms of BPH.

If your symptoms are severe, your doctor may suggest surgery to remove part of your prostate. But few men have symptoms or other problems severe enough to need surgery.

Can BPH be prevented?

You cannot prevent BPH or the urination problems it may cause. Some people believe that regular ejaculations will help prevent prostate enlargement. But there is no scientific proof that ejaculation helps.

When is surgical treatment suggested as a form of treatment?

When medical therapy fails, surgery is required to remove the obstructing tissue. Surgery is almost always recommended for men who are unable to urinate, have kidney damage, frequent urinary tract infections, significant urethral bleeding or stones in the bladder.

What are the different surgical treatments available?

Removal of the prostate can be accomplished in several different ways. The location of the enlargement within the prostate and the patient’s general health will help the urologist determine which of the three following procedures to use.

Transurethral resection of the prostate (TURP): Transurethral resection is the most common surgery for BPH. In the United States, approximately 200,000 people have TURPs performed each year. After the patient receives anesthesia, the surgeon inserts an instrument called a resectoscope through the tip of the penis into the urethra. The resectoscope contains a light, valves for controlling irrigating fluid and an electrical loop that cuts tissue and seals blood vessels. With this instrument, obstructive prostate tissue is removed one piece at a time. The removed tissue pieces are carried by the irrigating fluid into the bladder and then flushed out and sent to a pathologist for examination under a microscope. At the end of the procedure, a catheter is placed in the bladder through the penis. The bladder is continuously irrigated with fluid through the catheter in order to monitor bleeding and prevent blood from clotting and obstructing the catheter. Since there are no surgical incisions with this procedure, patients normally stay in the hospital only one to two days. Depending on surgeon preference, the catheter may be removed while the patient is still in the hospital or the patient may be sent home with the catheter in place, attached to a leg bag for convenience and removed several days later as an outpatient procedure.

Transurethral incision of the prostate (TUIP): Transurethral incision is used for men with smaller prostate glands who suffer from significant obstructive symptoms. Instead of cutting and removing tissue to relieve the obstructed bladder, this procedure widens the urethra by making several small cuts in the bladder neck where the urethra joins the bladder and in the prostate itself. This reduces the pressure of the prostate on the urethra and makes urination easier. Patients normally stay in the hospital one to three days. A catheter is left in the bladder for one to three days after surgery.

Open prostatectomy: When a transurethral procedure cannot be done, open surgery may be required. Open prostatectomy for BPH is also performed for a prostate that is too large to remove through the penis. Other reasons for choosing an open prostatectomy include patients with large bladder diverticula, with large bladder stones and who cannot physically tolerate having their legs placed in stirrups for TURP/TUIP surgery.

An incision is made in the abdominal wall from below the belly button to the pubic bone. The prostate gland can then be removed in its entirety through either an incision in the fibrous capsule surrounding the prostate (retropubic prostatectomy) or through an incision made in the bladder (suprapubic prostatectomy). Postoperative pain is mild to moderate. Patients usually stay in the hospital for several days and go home with a urinary catheter. In some cases a second catheter draining the bladder through the lower abdominal wall is used.

What can be expected after treatment?

Postoperatively, patients typically experience significant improvement in their symptoms (table 1). As with any operative procedure, complications do exist. Some occur in the early postoperative period (table 2) while others may occur many years later (table 3).

Table 1: Overall improvement in patient symptoms

Table 2: Immediate post-operative complications

Table 3: Late post-operative complications

Will surgery for BPH affect my ability to enjoy sex?

Most urologists say that even though it takes a while for sexual function to return fully, most men are able to enjoy sex again. Most experts agree that if you were able to maintain an erection shortly before surgery, you will probably be able to do so after surgery. Most men find little or no difference in the sensation of orgasm although they may find themselves suffering from retrograde ejaculation.

Is BPH a rare condition?

No, it is very common. It will affect approximately 50 percent of men between the ages of 51 and 60 and up to 90 percent of men over the age of 80.

Does BPH lead to prostate cancer?

No, BPH is not cancer and cannot lead to cancer, although both conditions can exist together. There are usually no symptoms during the early stages of prostate cancer, so yearly physical examinations and PSA testing are highly recommended.

Throughout a man’s life, his prostate may grow and start to cause problems as he ages. For many years, a prostatectomy was the only treatment for this very common problem. Although effective, such major surgery requires patients to spend significant time in the hospital and at home in recovery. It also is associated with more side effects. Fortunately, today’s technological advances now provide urologists with an array of minimally invasive techniques to treat BPH. What are some of these new treatments available? The following should help answer that question as well as others.

What is the prostate?

The prostate, a part of the male reproductive system, is about the same size and shape as a walnut and weighs about an ounce. It is located below the bladder and in front of the rectum and surrounds the urethra, the tube-like structure that carries urine from the bladder out through the penis. The main function of the prostate is to produce ejaculatory fluid.

What is BPH?

Benign prostatic hyperplasia (BPH), previously referred to as prostatism, is a common urological condition caused by the non-cancerous enlargement of the prostate gland in aging men.

What are some of the risk factors for BPH?

Risk factors for developing BPH include increasing age and a family history of BPH.

What are some of the symptoms associated with BPH?

Since the prostate surrounds the urethra just below the bladder, its enlargement can result in symptoms that irritate or obstruct the bladder. A common symptom is the need to frequently empty the bladder, especially at night. Other symptoms include difficulty in starting the urine flow or dribbling after urination ends. Also, size and strength of the urine stream may decrease.

How is BPH diagnosed?

In order to help assess the severity of such symptoms, the American Urological Association (AUA) BPH Symptom Score Index was developed. The AUA diagnostic system includes a series of questions that target the frequency of the urinary systems identified above, and as a result, helps identify the severity of the BPH—ranging from mild to severe.

There are a number of diagnostic test procedures that can be used to confirm BPH. The tests vary from patient to patient, but the following are the most common: digital rectal examination (DRE), PSA test, transrectal ultrasound, urine flow study, bladder scan for residual urine, and cystoscopy.

What are some of the treatments available for BPH?

Watchful waiting: Is recommended as an important option for men who have mild symptoms and do not find them particularly bothersome. It is the least invasive treatment and avoids the risks, inconvenience and costs of medical and surgical treatments. In some men, symptoms improve over time as long as there are no high-risk symptoms like urinary retention, recurrent urinary tract infection, recurrent blood in the urine, bladder stones, kidney failure or bladder diverticula.

Medical therapy: Today’s most common method for controlling moderate symptoms of BPH. Several medications are available to control moderate symptoms of BPH.

Alpha blockers: These drugs, originally used to treat high blood pressure, work by relaxing the smooth muscle of the prostate and bladder neck to improve urine flow and reduce bladder outlet obstruction. Although alpha blockers may relieve the symptoms of BPH, they do not reduce the size of the prostate. They are taken orally, once or twice a day and work almost immediately. Commonly prescribed alpha blockers include: Uroxatral (alfuzosin), Hytrin (terazosin), Cardura (doxazosin) and Flomax (tamsulosin). Side effects can include headaches, dizziness, light-headiness, fatigue and ejaculatory dysfunction.

5-Alpha-Reductase Inhibitors: There are two medications available in this class, dutasteride and finasteride, that work completely different than alpha blockers. In some men, Proscar (finasteride) and Avodart (dutasteride) can relieve BPH symptoms, increase urinary flow rate and actually shrink the prostate. Like all medical therapy, these drugs must be used indefinitely to prevent recurrence of symptoms. This class of medications is best suited for men with relatively large prostate glands. It may take as long as six months to a year, however, to achieve maximum benefits from this drug. Side effects can include impotence, decreased libido and reduced semen release during ejaculation.

What are some of the minimally invasive treatments available for BPH?

Prostatic stent (stenting): Anesthesia is not required for this procedure. The technology involves placing a spring-like contraption inside the prostatic part of the urethra to hold it open. There are many different kinds of stents but their overall use is limited. This is usually best suited for patients who have many medical problems or who are high-risk for surgery. Serious complications include urinary incontinence, dislodgement of stent position, stone formation on the stent with blockage and difficulty removing the stent. Minor complications include urinary frequency and urgency, dribbling of urine, discomfort and light bleeding. Patients with certain conditions are often advised against stent placement including those with strictures (narrowing) in the urethra, urinary infection, bladder stones, weak bladder and cancer, and patients who will be undergoing other procedures performed through the urethra soon after stent placement (e.g., treatment of kidney stones). Generally, prostatic stents are used for the same patients who would otherwise use an indwelling catheter or transurethral microwave thermotherapy (TUMT).

High-intensity focused ultrasound (HIFU): Anesthesia is usually required for this procedure. A special ultrasound probe is placed into the rectum near the prostate. Ultrasound waves heat the prostate up to very high temperatures, which causes destruction to the prostate tissue. The heated prostate tissue is destroyed and initially swells but then shrinks. The need for catheterization due to retention of urine and blood in the urine has been a problem postoperatively.

Holmium laser enucleation of prostate (HoLEP): After the patient receives anesthesia, the surgeon inserts an instrument called a resectoscope through the penis into the urethra. A visual lens and laser are passed through the hollow center of the instrument. The prostate tissue is vaporized using the holium:YAG laser. There is very little bleeding and recovery time is cut significantly. Typically, the patient has a catheter removed the next day and stays overnight in the hospital one day.

Interstitial laser coagulation: Anesthesia is usually required for this procedure, but patients can usually go home the same day. The technology involves placing a “cystoscope” (metal tube through which the visual lens and laser can be passed). A laser is used to pierce through into the prostate and the laser energy burns the tissue. Studies to date have shown limited long term benefits.

Transurethral electroevaporation of the prostate (TUVP): After the patient receives anesthesia, the surgeon inserts an instrument called a resectoscope through the penis into the urethra. An electrode moves across the surface of the prostate and transmits current that vaporizes prostate tissue. The vaporizing effect penetrates below the surface area being treated so underlying blood vessels are coagulated and sealed. Bleeding and fluid absorption are minimal and patients can usually return home without a catheter after an overnight hospital stay.

Transurethral microwave thermotherapy of the prostate (TUMT): This is an office-based procedure performed with topical and oral pain medication and does not require anesthesia. Computer-regulated microwaves are sent through a catheter to heat portions of the prostate. A cooling system is required in some types for better tolerance. Traditionally, the best use of this procedure has been for patients who have too many medical problems for more invasive surgery or for patients who truly wish to avoid any type of anesthesia. Benefits are that there is no need for anesthesia and there is no blood loss or fluid absorption (these would be significant benefits in a person with a weak heart). Patients usually go home the same day. Many urologists have the technology available in their practice and results are pretty reliable regardless of who performs the procedure. The use of TUMT has been expanding to a broader patient population and there are several types of TUMT machines available.

Transurethral radio frequency needle ablation of the prostate (TUNA): The procedure involves anesthesia and medications to make the patient sleepy. The technology involves heating of tissue using radio frequency energy transmitted by needles inserted directly into the prostate. High frequency radiowaves heat the prostate up to very high temperatures. The heated prostate tissue is destroyed and initially swells but then shrinks. Most men require a catheter for a period of time after this procedure. Advantages in the use of TUNA include the limited anesthesia requirement, the ability to perform the procedure in an office setting and avoidance of serious complications sometimes associated with other procedures.

Photoselective vaporization of the prostate (PVP): This is fast becoming a very popular procedure performed either in a well equipped office or as an out-patient at the hospital. It uses a high-powered laser that vaporizes the obstructing prostate tissue with minimal bleeding or side effects. This procedure can serve to get men off of medical therapy. It is effectively replacing more invasive surgical treatment.

Catheterization: Placement of a catheter into the bladder will temporarily drain urine. Catheters can be placed intermittently every six to eight hours—clean intermittent catheterization—or left in place for one to three months at a time (indwelling). Catheters can be placed either through the urethra or by making a small puncture into the bladder above the pubic bone (called a suprapubic tube). Infection is the biggest risk of having a catheter in place for long periods, as bacteria can stick to the surface of the catheter, making it difficult for the body’s immune system or antibiotics to clear the organisms. Another risk is that after a few years there is a higher risk of bladder cancer due probably to the long-term irritation caused by the catheter sitting in the bladder. Catheterization, performed by the individual or a caregiver every six to eight hours, minimizes the risk of infection and cancer compared with an indwelling catheter. Catheters are most useful as a treatment of choice for temporary drainage while waiting for medication to start working, surgery to be scheduled, or clearance of infection. They also might be the most appropriate choice for a patient with multiple medical problems and a short life expectancy, where the risk and discomfort of surgery outweigh the risk of infection or cancer. Catheterization is the treatment of choice over medications or surgery for patients who have neurogenic bladder in addition to prostatic obstruction.

Is BPH a rare condition?

No, it is very common. It will affect approximately 50 percent of men between the ages of 51 and 60 and up to 90 percent of men over the age of 80.

Does BPH lead to prostate cancer?

No, BPH is not cancer and cannot lead to cancer, although both conditions can exist together. There are usually no symptoms during the early stages of prostate cancer; so yearly physical examinations and PSA testing are highly recommended.

Which type of drugs are the best?

To date, there are not enough research data to predict who will respond to medical therapy or which drug will be better for an individual patient.

How do I know if oral medications are the best treatment for me?

If you are diagnosed with BPH, you should discuss all treatment options with your urologist. Together, you can decide whether medication or surgical treatment is best for you.

If I am 65 and healthy with mild urinary symptoms, which is the best treatment for me?

As long as your symptoms are mild, your quality of life is not very affected and you do not have any compelling reason to have invasive surgical therapy right away, you can start with watchful waiting or the medical therapies. If those options are ineffective or your symptoms worsen over time, then minimally invasive therapy or surgical treatment may be the answer.

I am 77 with severe heart disease. My cardiologist tells me we cannot fix my heart. Meanwhile, although I am taking tamsulosin I am still having very bothersome urinary symptoms all night long. Which procedure is the best for me?

Most people can have a PVP without adverse events, but it is much riskier for someone with your medical history. After discussing your options with your urologist, one of the minimally invasive procedures that does not require anesthesia might be a better choice for you, for example, TUMT. Also, a combination of medical therapies may help.

Throughout a man’s life, the prostate may grow and start to cause problems as a man gets older. For many years, surgery was the only relief for this very common problem. Today, medications are the most common method for controlling urinating symptoms of BPH. What are the causes of these symptoms and what are some of the new treatments? The following should help answer that question as well as others.

What is the prostate?

The prostate, part of the male reproductive system, is about the same size and shape as a walnut and weighs about an ounce. It is located below the bladder and in front of the rectum and surrounds the urethra, the tube-like structure that carries urine from the bladder out through the penis. The main function of the prostate is to produce ejaculatory fluid.

What is BPH?

Benign prostatic hyperplasia (BPH) is a common urological condition caused by the non-cancerous enlargement of the prostate gland in aging men. Urinating symptoms can occur as the prostate enlarges.

What are some of the risk factors for BPH?

Risk factors for developing BPH include increasing age and a family history of this condition.

What are some of the symptoms associated with BPH?

Since the prostate surrounds the urethra just below the bladder, its enlargement can result in symptoms that irritate or obstruct the bladder. A common symptom is the need to frequently empty the bladder, especially at night. Other symptoms include difficulty in starting the urine flow or dribbling after urination ends. Also, size and strength of the urine stream may decrease.

How are the urinating symtoms secondary to BPH diagnosed?

In order to help assess the severity of such symptoms, the American Urological Association (AUA) BPH Symptom Score Index was developed. This diagnostic system includes a series of questions that target the frequency of the urinary systems identified above, and as a result, helps identify the severity of the BPH — ranging from mild to severe.

There are a number of diagnostic test procedures that can be used to confirm BPH. The tests vary from patient to patient, but the following are the most common: digital rectal examination (DRE), PSA test, transrectal ultrasound (this measures the size of the prostate), urine flow study (this measures the speed and strength of the urinary stream), measurement of how much urine is left after urinating (post-void residual urine) and cystoscopy (a fiber-optic instrument inserted into the urethra to examine both the prostate and the urinary bladder).

What are some of the medical treatments available for BPH?

Alpha blockers: These drugs, originally used to treat high blood pressure, work by relaxing the smooth muscle of the prostate and bladder neck to improve urine flow and reduce bladder outlet obstruction. Although alpha blockers may relieve the symptoms of BPH, they usually do not reduce the size of the prostate. They are usually taken orally, once or twice a day and they work almost immediately. Commonly prescribed alpha blockers include: Uroxatral (alfuzosin), Hytrin (terazosin), Cardura (doxazosin) and Flomax (tamsulosin). Side effects can include headaches, dizziness, light-headiness, fatigue and ejaculatory dysfunction.

5-alpha-reductase inhibitors: Finasteride and dutasteride are oral medications that work completely different then alpha blockers. In select men, Proscar (finasteride) and Avodart (dutasteride) can relieve BPH symptoms, increase urinary flow rate and actually shrink the prostate though it must be used indefinitely to prevent recurrence of symptoms. Studies suggest that these medications may be best suited for men with relatively large prostate glands. It may take as long as six months to a year, however, to achieve maximum benefits from this drug. Side effects can include impotence, decreased libido and reduced semen release during ejaculation.

Is BPH a rare condition?

No, it is very common. It will affect approximately 50 percent of men between the ages of 51 and 60 and up to 90 percent of men over the age of 80.

Does BPH lead to prostate cancer?

No, BPH is not cancer and cannot lead to cancer, although both conditions can exist together. There are usually no symptoms during the early stages of prostate cancer, so yearly physical examinations and PSA tests are highly recommended.

Which type of drugs are the best?

To date, there is not enough research data to predict who will respond to medical therapy or which drug will be better for an individual patient.

How do I know if oral medications are the best treatment for me?

If you are diagnosed with BPH, you should discuss all treatment options with your urologist. Together, you can decide whether medication or surgical treatment is best for you.

Throughout a man’s life, his prostate may become larger and start to cause problems as he ages. But what are some of those problems? How do I know if I have BPH? When should I see a doctor? What kinds of tests will my doctor perform? The following should help answer these questions as well as others.

What is the prostate?

The prostate is part of the male reproductive system, is about the same size and shape as a walnut and weighs about an ounce. It is located below the bladder and in front of the rectum, and surrounds the urethra, the tube-like structure that carries urine from the bladder out through the penis. The main function of the prostate is to produce ejaculatory fluid.

What is BPH?

Benign prostatic hyperplasia (BPH), also known as lower urinary tract symptoms (LUTS), is a common urological condition caused by the non-cancerous enlargement of the prostate gland in aging men. As the prostate enlarges, it can squeeze down on the urethra. This can cause men to have trouble urinating leading to the symptoms of BPH.

What are some of the risk factors for BPH?

Risk factors for developing BPH include increasing age and a family history of BPH.

What are some of the symptoms associated with BPH?

Since the prostate surrounds the urethra just below the bladder, its enlargement can result in symptoms that irritate or obstruct the bladder. A common symptom is the need to frequently empty the bladder, sometimes as often as every one to two hours, especially at night. Other symptoms include the sensation that the bladder is not empty, even after a man is done urinating, or that a man cannot postpone urination once the urge to urinate arises. BPH can cause a weak urinary stream, dribbling of urine, or the need to stop and start urinating several times when the bladder is emptied. BPH can cause trouble in starting to urinate, often requiring a man to push or strain in order to urinate. In extreme cases, a man might not be able to urinate at all, which is an emergency that requires prompt attention.

How is BPH diagnosed?

In order to help assess the severity of such symptoms, the American Urological Association (AUA) BPH Symptom Score Index was developed. This diagnostic system includes a series of questions that ask how often the urinary symptoms identified above occur. This helps measure how severe the BPH is — ranging from mild to severe.

When a doctor evaluates someone for possible BPH, the evaluation will typically consist of a thorough medical history, a physical examination (including a digital rectal exam or DRE), and use of the AUA BPH Symptom Score Index. In addition, the doctor will generally do a urine test called a urinalysis. There are a series of other studies that may or may not be offered to a patient being evaluated for BPH depending on the clinical situation. These include:

1. prostate specific antigen (PSA), a blood test to screen for prostate cancer
2. urinary cytology, a urine test to screen for bladder cancer
3. a measurement of post-void residual volume (PVR), the amount of urine left in the bladder after urinating
4. uroflowmetry, or urine flow study, a measure of how fast urine flows when a man urinates
5. cystoscopy, a direct look in the urethra and/or bladder using a small flexible scope
6. urodynamic pressure-flow study that tests the pressures inside the bladder during urination
7. ultrasound of the kidney or the prostate

When should I see a doctor about BPH?A man should see a doctor if he has any of the symptoms mentioned previously that are bothersome. In addition, he should see a doctor immediately if he has blood in the urine, pain with urination, burning with urination or is unable to urinate.

Is BPH a rare condition?

No, it is very common. It will affect approximately 50 percent of men between the ages of 51 and 60 and up to 90 percent of men over the age of 80.

Does BPH lead to prostate cancer?

No, BPH is not cancer and cannot lead to cancer, although both conditions can exist together. There are usually no symptoms during the early stages of prostate cancer, and so yearly physical examinations and PSA tests are highly recommended to eliminate cancer diagnosis.

Are there risks in not seeking treatment for BPH?

In the majority of men BPH is a progressive disease. It can lead to bladder damage, infection, blood in the urine, and even kidney damage. It is therefore important for men with this condition to continue to be followed.

Which type of drugs are the best?

To date, there is not enough research data to predict who will respond to medical therapy or which drug will be better for an individual patient. There are a variety of drugs available and, in some men, a combination of drugs may work best.

How do I know if oral medications are the best treatment for me?

If you are diagnosed with BPH, you should discuss all treatment options with your urologist. Together, you can decide whether medication, minimally invasive therapy or surgical treatment is best for you.