BPH (BENIGN PROSTATIC HYPERTROPHY)

What are the symptoms of Enlarged Prostate (BPH)?

Most BPH symptoms include problems with urination. Not every man has the same symptoms, nor do they have them to the same degree. But if you are having symptoms most of the time, they will get worse if you don't treat the problem. The prostate surrounds a portion of the urethra (the tube that carries urine from the bladder through the penis). As your prostate grows, it presses against the urethra restricting or obstructing normal urine flow. Urination becomes more difficult. Your bladder may not be able to empty completely. This can cause irritation. If left untreated, BPH can lead to more serious problems such as damage to the bladder and kidneys.

Common enlarged prostate (BPH) symptoms include:

  • Weak urine stream
  • Interrupted or hesitant urine stream (starting and stopping)
  • Nightime urination (having to get up several times per night to urinate)
  • Frequent or urgent urination
  • Sensation of incomplete bladder emptying
  • Painful or burning urination
  • Leaking or dribbling urine
  • Small amount of blood in the urine

How is Enlarged Prostate (BPH) Diagnosed?

Here are some of the more common tests for determining whether you may have an enlarged prostate.

Rectal Examination: The digital rectal exam (DRE) is usually the first test we will perform. We will insert a gloved finger into your rectum and feel the part of the prostate next to the rectum. This exam gives us an idea to the size and condition of your prostate gland.

The American Urological Association's Symptom Index: This quiz gives a "score" to your symptoms. By answerin the questions in this quiz, you help us discover if you have an enlarged prostate.

Prostate Specific Antigen (PSA) Blood Test: To rule out cancer as a cause of urinary symptoms, we will recommend a PSA blood test. In fact, annual PSA tests are recommended for all men and men with a family history of prostate cancer beginning at age 40. PSA, a protein produced by prostate cells, is present at elevated levels in the blood of men who have prostate cancer. However, much remains unknown about the interpretation of PSA levels, the test's ability to discriminate cancer from benign prostate conditions, and the best course of action following a finding of elevated PSA. Therefore, a high PSA level does not automatically mean you have cancer. We will likely perform multiple tests to determine the exact cause of your symptoms.

Ultrasound: We may recommend a rectal ultrasound during which a probe (a long, thing tube) is inserted in the rectum. The probe directs sound waves at your prostate. The sound waves form an image of the prostate gland on a display screen. This image helps us evaluate the size of your prostate and any prostate obstruction or blockage.

Urine Flow Study: If you require this test, you urinate into a specific device. This device measures how quickly your urine is flowing. A reduced or slow flow often suggests BPH because your prostate may be blocking the urethra (the tube that carries urine from the bladder through your penis).
Intravenous Pyelogram (IVP): IVP is an xray of your urinary tract. In this test, dye is injected into a vein. The dye makes urine visible on an x-ray. Then, the x-ray can show if an enlarged prostate has had any effect on your kidneys.

Cystoscopy: After numbing the area, we will insert a small tibe through the opening of the urethra in your penis. The tube, called a cystoscope, contains a lens and a lilght system. This will help us to see inside of your urethra and bladder. This tests allows us to determine the size of your prostate. It also helps show the location and degree of any possible obstruction.

CT Scan: This procedure takes x-ray slices of your kidneys, bladder and prostate to determine the size of the prostate and extent of damage, if any, to the kidneys or bladder.

An Enlarged Prostate - What Everyone Should Know About It

Half of all men in their 60's experience the symptoms of an enlarged prostate or benign prostatic hyperplaisa (BPH). Eventually, 80% of all men will be affected by this condition. Understanding what is normal for your prostate, are the first steps to finding a solution.

One of the more important things you should know is that enlarged prostate is not prostate cancer and does not cause prostate cancer. Having BPH does not increase your chances of developing prostate cancer. However, because the symptoms can be similar and it is possible for the two conditions to exist together in the same person, you should always see a doctor to rule out prostate cancer and other possible conditions.

What is a Prostate?

The prostate is a gland located just below your bladder, and it surrounds your urethra (where urine leaves the bladder.) Normally your prostate is about the size of a walnut. One of its functions is to make fluid that becomes part of semen. Semen is the white fluid that also contains sperms.

What is Enlarged Prostate (BPH)?

Benign prostatic hyperplasia (BPH) is the medical term for an enlarged prostate. It is common for the prostate gland to become enlarged as a man ages and it will affect just about all men to some degree. And, if left untreated, it can lead to more serious conditions including damage to the bladder and kidneys. When the prostate becomes enlarged, it can press against the bladder and urethra (the tube that carries urine from the bladder through the penis). This causes uncomfortable symptoms.

Why is my Prostate Enlarged?

The prostate goes through the main periods of growth. The first occurs early in puberty. At this time the prostate doubles in size. Then, at around age 25, the gland begins to grow again. It is this second growth phase that can, years later, cause uncomfortable symptoms.

As the prostate enlarges, the surrounding tissue stops it from expanding, causing the gland to press against the urethra like a clamp on a garden hose. The bladder wall becomes thicker and irritable. The bladder begins to contract even when it contains small amount of urine, causing more frequent urination. Eventually, the bladder weakens and looses the ability to empty itself. Urine remains in the bladder. The narrowing of the urethra and partial emptying of the bladder cause many of the problems associated with BPH.

For centuries, it has been know that BPH occurs mainly in older men and it doesn't develop in men whose testes were removed before puberty. For this reason, some researchers believe that factors related to aging and the testes may spur the development of BPH. Some studies also suggests that the balance of the hormones testosterone and estrogen play a roll in causing BPH or that dihydrotestosterone (DHT), a substance derieved from testosterone in the prostate may help control the glands' growth. And still other researchers suggest that BPH may develop as a result of "instructions" given to cells early in life. One thing is certain - the cause of BPH is not yet well understood.

The medical term for an enlarged prostate is Benign Prostatic Hyperplasia, or BPH. Benign means non-cancerous. Prostatic means the condition involves the prostate. And hyperplasia mean to grow or enlarge. BPH rarely causes the symptoms before the age of 40. However, more than half of men in their 60's and up to 80% in their 80's have some symptoms of BPH.

First-Line Therapy for Enarlged Prostate

First-line therapy often includes these two main types of treatment options:

  • Medication therapy for BPH
  • Minimally invasive BPH treatment options

Medication therapy for BPH treatment:

It is typical for us to recomend drug therapy to treat mild and moderate enlarged prostate (BPH). There are several medicines that relieve BPH symptoms, atleast initially. And taking medication can help some men avoid surgery for mild to moderate symptoms. You may be fimiliar with these medications or you may have seen the brand names advertised in various publications or media outlets.

  • Five alpha reductase inhibitors: Proscar (finasteride) and Avodart (dutasteride) interfere with the production of a hormone involved with BPH. This can help make the prostate smaller and improve symptoms.
  • Alpha blockers: Hytrin (terazosin), Cardura (doxazosin), Flomax (tamsulosin) and Uroxatrol (alfuzosin) all help relax the smooth muscle of the prostate and bladder neck. This helps improve urine flow and reduce the blockage of the bladder.

For some men, these medications cause undesirable side effects, such as dizziness, low blood pressure, or impotence (the inability to get an erection). And these medications can only treat the symptoms, they can't cure the problem.

Drug therapy means a lifelong commitment to taking medication everyday. Some men find this difficult to follow. It can also be quite expensive. Others have found that effectiveness decreases over time and symptoms return. So for many men, minimally invasive treatment option is there first choice, or a choice they make if they are not satisfied with their drug therapy.

Minimally Invasive BPH Treatment Options:

We are always looking for ways to give patients long-term relief with fewer side effects. Medical science has developed and refined other enlarged prsotate (BPH) treatments in recent years. These advanced treatments use various forms of heat to reduce the size of the prostate without actually cutting it. There are three main categories of minimally invasive options:

  • Laser Energy with Indigo Laser
  • Laser Treatment with Greenlight or 980 Laser
  • Microwave Energy
  • Radio Frequency

These minimally invasive procedures are less invasive to you as a patient, and they don't require traditional surgery. They are also typically performed in our office or hospital outpatient setting, meaning you don't have to stay overnight in the hospital. If you don't want to take medications forever, or your enlarged prostate medication stops working, you might consider these procedures. We can help determine if a minimaly invasive option is right for you.

Indigo Laser Treatment

One of the most advanced minimally invasive treatments is the Indigo Laser Treatment System. We use the Indigo System to destroy the enlarged prostate tissue causing obstruction. In this treatment, we will insert a small device called a fiber optic through the urethra and into the prostate. A specifically designed tip uses laser energy to destroy a precise area of the oversized prostate. Over time, as your body absorbs the tissue, symptoms of BPH decrease.

The Indigo Laser Treatment System offers some important benefits:

  • Actually makes the growing prostate smaller instead of just treating BPH symptoms, as most medications do
  • Usually eliminates the need for BPH medications and the related costs, inconvenience, possible side effects, and potential interactions with other medications, such as medications for erectile dysfunction (ED)
  • Has a much lower incidence of side effects, such as incontinence and ejaculation problems, than TURP and other traditional surgeries
  • Is very precise and controllable, which can mean fewer complications and less damage to surrounding tissue
  • Can be performed in 30 minutes or less in our office typically using local anesthesia
  • Can be directed to much more precise areas of the prostate and, unlike some of the other minimally invasive options, can be used on patients with hip implants, implants in the pelvic region and caridac pacemakers

Transurethral Microwave Thermotherapy (TUMT):

This BPH treatment uses microwave energy to heat and destroy excess prostate tissue. A special instrument, which we insert through the urethra, heats the prostate. Depending on the type of TUMT used, a rectal temperature probe may also be required during the procedure which takes about an hour to complete.

Transurethral Needle Ablation (TUNA):

This procedure uses radio frequency energy to destroy excess prostate tissue. During this procedure, a device is inserted through the urethra to the prostate and then two needles are advanced into the prostate. The radio frequency energy is then applied. We may choose to place the needles in several difficult locations within the prostate in order to complete the treatment. Overall, TUNA usually takes less than an hour to complete.

Comparing the Indigo Laser Treatment with Medication Therapy

Indigo Laser

The Indigo Laser Treatment System - An Advanced BPH Treatment Option

Laser treatment with the Indigo Laser Treatment System is one of the most advanced enlarged prostate (BPH) treatment options available. Unlike medications that you must take for the rest of your life, this BPH treatment is more permanent. It can help you avoid the cost, inconvenience, side effects and hassle that lifelong medications may require. Enlarged prostate treatment with the Indigo Laser Treatment System is a minimally invasive procedure. There is no cutting or incision.

Is Indigo for me?

Am I a candidate for Indigo Laser BPH Treatment?

Enlarged prostate treatment with the Indigo Laser Treatment System is appropriate for a wide variety of patients. To determine if treatment using the Indigo Laser System is right for your, ask yourself these questions:

  • Are enlarged prostate (BPH) symptoms disrupting my life?
  • Have I tried medical management (drugs) for my BPH? If so:
  • Have I found medications to be a less-than-effective way to control my symptoms?
  • Have I experienced and unpleasant side effects with my medication?
  • Have I had to limit my ability to take medication for erectile dysfunction (impotence)?
  • Is my medication not working as well as it used to?
  • Am I comfortable with taking medication for the rest of my life?
  • Am I concerned about the cost of lifelong medications for BPH?

If you answered YES to any of these questions, a more perrmanent solution to enlarged prostate (BPH) - such as treatment with the Indigo Laser System - may be a good choice for you.

The Indigo Procedure (An Advanced Type of Laser):

The Indigo Laser Treatment System enables us to perform a procedure called Interstitial laser Thermotherapy (ILTT). This is not the same procedure as a "Laser TURP" or "Laser surgery of the prostate" which are not minimally invasive procedures. In a laser TURP, we actually remove tissue from the prostate during a surgical procedure in a hospital setting. In an ILTT procedure, there is no incision or cutting of the tissue. Instead, using the Indigo Laser Treatment System, we apply heat within the prostate, causing excess tissue to shrink over time and be absorbed by your body.

After enlarged prostate treatment with the Indigo Laser System:

  • Your body gradually absorbs the destroyed enlarged prostate tissue
  • Your prostate becomes smaller
  • Your urethra returns to a more normal shape and size
  • Your urine flows more freely again
  • Your symptoms improve

Tradiational Surgery

Traditional Enlarged Prostate Surgery

The most traditional, long-term BPH treatment is surgery. Often times, especially for those with severe symptoms, surgery is necessary over other treatment options, which now may include minimally invasive procedures. Traditional surgeries often require a 1-3 day hospital stay. Surgery can provide long-term relief. It can also produce long-term side effects, such as incontinence, difficulty attaining erections, and retrograde ejaculation (when, at the point of orgasm, semen goes backwards into the bladder instead of coming out of the penis).

Here are some of the most common surgical procedures doctors perform to treat enlarged prostate.

  • Traditional Resection of the Prostate (TURP)
  • Transurethral Incision of the Prostate (TUIP)
  • Open Prostatectomy (suprapubic prostatectomy/retropubic prostatectomy)

Transurethal Resection of the Prostate (TURP):

The TURP procedure is the most common surgical procedure for enlarged prostate. This type of surgery is transurethral (we reach the prostate by inserting an intrument through the urethra). There is no need for an abdominal incision. With TURP, a surgeon uses an instrument called a resectoscope. The doctor inserts the resectoscope through the penis and removed the blocking tissue one piece at a time. Because TURP occasionally affects some of the nerves involved with the prostate, this surgery has its share of side effects. These include increased risk of impotence, retrograde ejaculation, and incontinence. The TURP procedure can also be performed with laser energy. However, this is not a minimally invasive procedure and is very difficult from the Indigo Laser procedure, which is a minimally invasive option.

Transurethral Incision of the Prostate (TUIP):

While the previously mentioned TURP procedure removed tissue, TUIP works by widening the urethra. We widen the urethra by making a few small cuts in the prostate gland and in the bladder neck (where the urethra joins the bladder). These cuts reduce the pressure on the urethra and ease the pain of urination.

In some cases, TUIP relieves symptoms nearly as effectively as TURP and there is less risk of side effects. However, its advantages and long-term side effects are not fully know, and this procedure is not suitable for very large prostate glands.

Open Prostatectomy (suprapubic prostatectomy/retropubic prostatectomy):

We may use open prostate surgery when a transurethral procedure (such as TURP or TUIP) will not suffice. Open prostatectomy requires an abdominal incision. We usually perform open surgery when the prostate is greatly enlarged, when there are complicting factors, and when the bladder is damaged and must be repaired.

In an open procedure using anethesia, we reach the prostate through the open incision and remove the enlarged prostate tissue. Because it is a major, open surgery, there is a greater risk for complications and additional side effects. And it usually takes longer for a patient to recover from this type of surgery.

Frequently asked Questions?

"I'm currently on medication for enlarged prostate (BPH). Could treatment with the Indigo Laser System be an option for me?"

Many patients who are seeking a more permanent solution to their BPH are appropriate candidates for treatment with the Indigo Lasre System. Sometimes they might find that their medication no longer works as well as it once did. Or perhaps they are bothered by side effects. Some would prefer not to be on lifelong medication. Some are concerned about the cost. If you are seeking an alternative to drug therapy for BPH, contact us. See if enlarged prostate treatment with the Indigo Laser System is right for you.

"I have friends who have had TURP's. How is treatment with the Indigo Laser System different?"

In a TURP, sections of the prostate are actually removed (cut out) surgically. In treatment with the Indigo Laser System, we use a special laser to heat and destroy tissue. Your body will absorb the tissue naturally.

"What are the primary benefits of BPH treatment with the Indigo Laser System?"

Actually makes the growing prostate smaller instead of just treating BPH symptoms, as most medications do

Usually eliminates the need for BPH medications and the related costs, incontinence, possible side effects, and potential interactions with other medications such as erectile dysfunction medications
Has a much lower incidence of side effects, such as incontinence and ejaculation problems, then TURP and other traditional surgeries

Is very precise and controllable, which can mean fewer complications and less damage to surrounding tissue

Can be performed in our office typically using local anesthesia

Can be directed to much more precise areas of the prostate and, unlike other forms of minimally invasive treatments, can be used on patients with hip implants, implants in the pelvic region and cardiac pacemakers

"Am I a candidate for the Indigo Laser?"

All patients are different and we must approach your enlarged prostate (BPH) treatment individually. However, for many patients with enlarged prostate, treatment with the Indigo Laser System is an effective option.

"What sort of anesthesia is used?"

Local anesthesia

"How long will I need a catheter?"

From 3 to 7 days

"Will I experience any side effects?"

Slight bleeding and urinary discomfort

"What follow-up care is necessary?"

You will probably see us 7 to 10 days after the procedure then for regular checkups

"When will I notice relief from my BPH symptoms?"

You should notice symptom improvement within 3-4 weeks. Typically, peak improvement is seen at 6 weeks after the procedure. Symptoms will continue to improve up to 8-12 weeks.

"When can I return to work?"

Within a week

"Is BPH treatment with the Indigo Laser System covered by insurance?"

Most major insurers cover this procedure. Check with your insurance company to be sure of your coverage.

"How can I learn more about treating enlarged prostate (BPH)?"

We can answer many of your questions, regarding BPH and the various treatments. Please call us at (440) 891-6500


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