Minimally Invasive Management
of Enlarged Prostate (BPH)

by Terrence R. Grimm, MD | Commonwealth Urology


Benign prostatic hyperplasia, or BPH, is a urological condition caused by the non-cancerous enlargement of the prostate gland (male reproductive organ that produces ejaculatory fluid). This very common condition affects men as they age and can lead to a number of health concerns. For many years, a prostatectomy (surgical removal of all or part of the prostate) was the only treatment for this condition. Although effective, such major surgery is associated with several side effects and requires patients to spend significant time in the hospital and at home in recovery. Fortunately, today's technological advances now provide urologists with an array of minimally invasive techniques to treat BPH.

What are the risk factors for and symptoms associated with BPH?

Risk factors for developing BPH include increasing age and a family history of BPH. The symptoms of BPH generally include problems with storage or emptying of the bladder and can include:

  • Difficulty starting a urine stream (hesitancy and straining).
  • Decreased strength of the urine stream (weak flow).
  • Dribbling after urination.
  • Feeling that the bladder is not completely empty.
  • An urge to urinate again soon after urinating.
  • Pain during urination (dysuria).
  • Waking at night to urinate (nocturia).
  • Frequent urination.
  • A sudden, uncontrollable urge to urinate.

How is BPH diagnosed?

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

There are a number of diagnostic tests that can be used to confirm BPH. Tests can vary, however, the most common include 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?

For men who have mild symptoms and do not find them particularly bothersome, careful monitoring can be the best initial course of action. It is the least invasive 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.

For men with more severe symptoms, both medical and surgical treatments are available and include:

Medication

  • Alpha blockers
  • 5-Alpha-Reductase Inhibitors

Minimally Invasive Treatments

  • Prostatic stent (stenting)
  • High-intensity focused ultrasound (HIFU)
  • Holmium laser enucleation of prostate (HoLEP)
  • Interstitial laser coagulation Transurethral electroevaporation of the prostate (TUVP)
  • Transurethral microwave thermotherapy of the prostate (TUMT)
  • Transurethral radio frequency needle ablation of the prostate (TUNA)
  • Photoselective vaporization of the prostate (PVP)
  • Catheterization