Enlarged Prostate

How to Manage Benign Prostatic Hyperplasia

As men get older, the likelihood of developing a condition called benign prostatic hyperplasia (BPH), also known as benign prostatic hypertrophy, increases. In fact, the majority of men will experience one or more of the symptoms of prostate enlargement (BPH) at some point in their 60s and older. Benign prostatic hyperplasia refers to the gradual enlargement of the prostate gland, which can eventually compress the urethra (urine channel) and lead to a variety of uncomfortable symptoms, such as urinary hesitancy or slow urine flow. While it is possible for most men to manage the symptoms with conservative methods, such as medication, some men may require a form of surgical treatment for this condition.

If you or a loved one has been experiencing the symptoms of BPH, it is crucial to seek an accurate diagnosis as soon as possible in order to not only receive effective treatment and improve the quality of life, but to also rule out the possibility of prostate cancer. The skilled urologists at Comprehensive Urology are renowned leaders when it comes to benign prostatic hyperplasia treatment. Please contact us at (310) 499-2756 today to schedule an appointment today.

BPH Symptoms

Fortunately, many men with BPH do not have noticeable symptoms regardless of the extent of their prostate enlargement. Some men may experience the symptoms more often during cold weather or when stressed, and others may suffer severe symptoms from only the slightest enlargement. It is important to seek a diagnosis from a board-certified urologist if you or a loved one has one or more of the following BPH symptoms:

  •  Weak urine flow

  • Straining to urinate

  • Difficulty starting urination

  • Painful urination

  • Dribbling after urinating

  • Feeling that the bladder does not empty completely

  • Frequent need to urinate, especially at night

  • Urinary urgency

  • Leakage of urine

  • Blood in urine

  • Erectile dysfunction

If left untreated, BPH can lead to more serious urinary issues, such as recurrent urinary tract infections, obstruction of the kidneys, and kidney failure. Contact Comprehensive Urology for a thorough diagnosis. Urinary issues do not automatically indicate BPH and a board-certified BPH specialist can help determine the best course of action based on each patient's unique health and circumstances.

Benign Prostatic Hyperplasia Treatments

In many cases, benign prostatic hyperplasia is characterized by bladder dysfunction, such as difficulty urinating or storing urine. Depending on the symptoms and the patient's health, Dr. Kia Michel and his Comprehensive Urology team can create a personalized treatment plan for each patient depending on the symptoms as well as the patient's age and overall health.

Many patients respond well to the following conservative methods:

Medication – Different groups of medications are available: Alpha Blockers, 5 Alpha Reductase Inhibitors, and recently daily PDE5 Inhibitors. These medications can mitigate, reduce or block prostate enlargement in order to relieve urinary symptoms, with relatively low side effect profiles.

Pelvic Floor Rehabilitation – Strengthening the pelvic floor muscles with physical therapy as well as electrostimulation can help alleviate urinary issues caused by BPH.

In the event that benign prostatic hyperplasia medications or other conservative treatments are ineffective, the following surgical options may be recommended.

Trans-urethral Microwave Therapy (TUMT) – This non-surgical treatment uses microwave energy to shrink the prostate, allowing the urethra to open to its original size within eight to 12 weeks after the procedure.

The UroLift System – This revolutionary treatment is minimally invasive and provides permanent results. Small implants are placed around the prostate and stitched in to place to hold open the urethra for normal urinary function. The procedure is highly effective and patients can return to their everyday activities in a matter of days.

The REZUM system ®– This cutting-edge treatment is the newest weapon in our arsenal for treating BPH. This is a minimally invasive procedure which can be done in the office. You urologist will perform this through the urethra (no incisions) and use direct injection of water vapor (steam) into the enlarged, obstructing parts of the gland, allowing cell death by convective heat energy and natural absorption by your body. Please refer to our dedicated REZUM system page for further details.

Transurethral Resection of the Prostate (TURP) - This surgical procedure is recommended when medication and conservative treatments have failed. TURP involves removing all or part of the enlarged prostate gland with a resectoscope, which is inserted through the urethra (no external cuts or incisions). The middle portion of the prostate is typically removed to help widen the urethra channel and allow for normal urine function. TURP may be used to treat BPH and sometimes prostate cancer.

Photoselective Vaporization of the Prostate (PVP) - This is also known as the Green Light Laser ® therapy and is recommended when medications have failed. In this procedure which is done through the urethra (similar to TURP), a powerful green laser beam is used to vaporize the excess BPH tissue. The enlarged parts of the gland are targeted and vaporized by the surgeon, thus creating an open channel for the urine to flow easily. PVP has the advantage of minimal bleeding and can be done for patients who are taking blood thinners.

Robotic Simple Prostatectomy – Often recommended for patients with very large prostates, a robotic simple prostatectomy involves removing the entire prostate. The procedure is conducted with the da Vinci surgical robotic system, which requires much smaller incisions than traditional open prostatectomy, reducing the risks of bleeding and infections, as well as greatly improving recovery times.

The best treatment for enlarged prostate issues will depend largely on the patient, however, it is crucial to have a skilled urologist and medical team on your side to diagnose BPH and provide the most comprehensive care and treatment available.

Our own Dr. Arash Akhavein is a board certified urologist and fellowship-trained endourologist who sub-specializes in all of the cutting edge treatments for this issue. Please contact his office and schedule an appointment if you or a loved one are suffering from BPH.

In a nutshell: BPH and its treatments

  • BPH: benign enlargement of the prostate gland which can cause many urination problems

  • Symptoms: weak urine stream, dribbling, need to push too much to urinate, need to urinate too often and urgency to do so, waking up multiple times at night to urinate, etc.

  • Evaluation: visit your urologist and discuss your symptoms, how they affect your life, and have simple office tests done (e.g. Uroflow to measure your stream, Ultrasound to assess bladder emptying, Urine analysis, etc)

  • Treatment: many options are available based on your goals and condition. Non-invasive (life style tips, medication), minimally invasive (TUMT, Urolift, REZUM, TURP, PVP), and other surgical treatments are all offered by Comprehensive Urology.

Written by: Dr. Arash Akhavein

Sydney Sharon