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Center for Robotics, Laparoscopy, and Advanced Urology
VOTED AS AMERICA'S TOP UROLOGISTS
A Division of WESTMED Medical Group

Treatment for Enlarged Prostate (BPH)

Overview

Benign prostatic hyperplasia [BPH], the most common benign neoplasm in American men is a chronic condition that is associated with progressive lower urinary tract symptoms and a non-cancerous enlargement of the prostate gland. It affects more than 50 percent of men over the age of 60 and almost 3 of 4 men during the seventh decade of life. As the prostate grows, it presses against and narrows the urethra, causing a urinary obstruction that makes it difficult to urinate. The most common reason for patients to be treated is bothersome symptoms. However, if left untreated and progresses, BPH has the potential to cause permanent damage to the urinary system.

Anatomy and Physiology

The prostate gland is a muscular, walnut-shaped gland in men. It is located right below the bladder and surrounds the urethra (the tube that carries urine out of the body). It is responsible for making the fluids that carry sperm. As a man ages, the prostate begins to slowly enlarge and may begin to squeeze the urethra, causing problems with urination.

The normal adult prostate weighs 18 grams; measures 3cm in length, 4cm in width, and 2cm in depth. The prostate is composed of approximately 70% glandular elements and 30% of fibromuscular stroma. Although anatomically divided into different zones, the prostate is described as having 2 palpable lateral lobes separated by a central sulcus and one nonpalpable median lobe that may project into the bladder in older men.

Signs and Diagnosis

As the prostate enlarges and obstructs the urethra, a patient progressively develops lower urinary tract symptoms [LUTS]. These symptoms are variable and include nocturia, hesitancy, urgency, frequency, and incomplete voiding. Size alone does not diagnose BPH. It is a combination of criteria, including symptom severity, increased prostate size, abnormal uroflow results, and an increased postvoid residual of urine that aids in the diagnosis of BPH.

Typical symptoms of include:

  • Decreased Stream — Decreased size and strength of urine stream; a weak urine flow
  • Hesitancy — Having a hard time "getting started"
  • Intermittence — An "on again, off again" flow of urine
  • Incomplete Urination — The feeling that your bladder is not quite empty after you urinate
  • Urinary Retention — Being completely unable to urinate
  • Frequency — Having to urinate much more often than usual
  • Urgency — An extremely strong desire to urinate as soon as possible
  • Nocturia — The need to get up and urinate in the night
  • Incontinence — Being unable to hold back urine until you reach the bathroom (often accompanied by feelings of urgency)

Treatment Options (All offered at our practice)

Watchful waiting is an acceptable approach in men with mild symptoms of BPH. However, in men who are suffering from LUTS (lower urinary tract symptoms), medical treatment of BPH with the use of alpha blockers and 5 alpha reductase inhibitors is an option as first line of therapy. The downside of medical therapy is that it requires a lifetime of treatment as opposed to the various procedures/surgical options available. Alpha blockers are the initial choice of medical therapy. These drugs act on the dynamic component of bladder outlet obstruction and relax the prostatic smooth muscle. 5 alpha reductase inhibitors act on the static component of bladder outlet obstruction and reduce prostate size by inhibiting the conversion of testosterone to dihydrotestosterone. In the Medical Therapy Of Prostatic Symptoms trial, the combination of the two classes of medications was found useful in men with larger prostates, specifically those greater than 40 grams. When medical therapy is no longer effective, tolerated, or desired by the patient on a long term basis, surgical therapy is the next option. Over the last several years, new minimally invasive surgical techniques have been developed to treat BPH including transurethral microwave therapy and laser therapy. The gold standard of BPH surgery that all the minimally invasive treatments must be compared to is transurethral resection of the prostate. Regardless of what therapy is used, BPH is an important chronic condition that is highly prevalent and requires long term care and evaluation.

Medications

In cases of mild BPH symptoms that require treatment, medications may provide relief for many men. Drugs are costly, must be taken every day for the rest of your life, and may stop working over time. Side effects can include lowered sexual drive, erection problems, dizziness, low blood pressure and nasal congestion.

Minimally Invasive Options

  • Thermotherapy — This state-of-the-art method uses heat to target and destroy the prostate tissue. Heat can be applied to the prostate using several different sources, including microwave energy, as with the TherMatrx® Dose Optimized Thermotherapy™. This procedure is done in our office on an outpatient basis. No general anesthesia is required. (thermatrx link)
    • In office procedure
    • No general anesthesia required
    • Safe and effective
    • Return to normal activity within 24 hours
  • Laser surgery, as with the Evolve Biolitec system, is a procedure that uses a laser to help enucleate (carve out) prostatic tissue. It requires general anesthesia and thus is performed at an ambulatory surgery center. Patients usually go home the same day as the procedure. (view video)

Surgery

Surgery (prostatectomy) may be recommended if your BPH symptoms are severe or other treatment options haven't been successful for you. BPH surgeries remove large amounts of prostate tissue. They are performed in a hospital and require general anesthesia. Although there is a low risk of serious side effects, they do exist and include retrograde ejaculation ("dry climax"), erectile dysfunction (ED), and incontinence (the inability to control your bladder). Transurethral resection of the prostate (TURP) is the most common BPH surgery and can provide long-term relief. It requires a 2-3 day hospital stay.




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Center for Robotics, Laparoscopy, and Advanced Urology
WESTMED Medical Group
210 Westchester Avenue
Department of Urology
White Plains, NY 10604
Tel: 914.682.6470
Fax: 914.681.5264
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1 Theall Road
Rye, NY 10580
Tel: 914.682.6470
Fax: 914.681.5264
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171 Hugenot Street
Department of Urology
New Rochelle, NY 10801
Tel: 914.682.6470
Fax: 914.681.5264
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73 Market Street-Ridge Hill
Yonkers, NY 10710
Tel: 914.682.6470
Fax: 914.681.5264
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3030 Westchester Avenue
Purchase, NY 10577
Tel: 914.682.6470
Fax: 914.681.5264
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Visit WESTMED Medical 's website Group at www.westmedgroup.com




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