Benign prostatic hyperplasia, or BPH, is a condition marked by an increase in the size of the prostate gland that can naturally occur as a man ages. It is believed that approximately 8 percent of males under the age of 40 may already have prostate issues, but by the time these patients reach the age of 80, over 86 percent of males will suffer from an enlarged prostate.
Non-invasive procedures for benign prostatic hyperplasia
Traditionally, some of the first-line treatment options for any signs of an enlarged prostate are generally conservative once cancer has been ruled out. Some of the first lines of treatment for benign prostatic hyperplasia include the “wait and see” approach and the subsequent introduction of medications.
In the traditional "wait and see approach, a doctor is able to successfully make a diagnosis of benign prostatic hyperplasia but symptoms for a patient are not bothersome enough to require the use of medications. If this management approach is chosen, a patient will learn to cope with some of the challenges associated with benign prostatic hyperplasia.
In order to limit the number of trips to the bathroom at night, patients are encouraged to follow lifestyle modifications such as reducing the amount of fluids they drink before bed, restrict alcohol use, and try to limit caffeine intake. In some cases, these lifestyle changes will be enough to limit the adverse effects of benign prostatic hyperplasia, but more than 80 percent of these patients will still need to begin medications to help treat BPH.
Medications represent a step-wise increase in terms of benign prostatic hyperplasia management. Numerous medications are available to help relax muscles around the bladder to help facilitate proper urination. About 25 percent of patients with benign prostatic hyperplasia will be successfully managed with medications for their BPH but there are significant side effects to these medications that patients must live with. In these cases, patients will likely experience erectile dysfunction or impotence. This can become bothersome enough and approximately 33 percent of patients prescribed these medications will discontinue their treatment.
Invasive procedures for benign prostatic hyperplasia
Once more conservative efforts have been tried and exhausted, the next step to try to manage a patient with benign prostatic hyperplasia would be to elevate the therapy to a more decisive and invasive procedure. This will require a surgery where a urologist will remove some or all of the prostate in order to help alleviate urinary symptoms.
The most common type of surgery performed for benign prostatic hyperplasia is known as transurethral resection of the prostate, or TURP. Simply put, this procedure involves inserting a camera into the urethra until it reaches the prostate and then using microscopic lasers or knives. Tissue from the prostate will be removed with the hope of removing the impingement along the urethra so patients are able to urinate more naturally and easily.
Although this procedure is more effective than medications, there are more significant side effects that a patient must be aware of. Like with any surgery, there is a risk of inflammation so patients actually may have a harder time urinating right after the procedure. There is also the potential to damage surrounding tissue unintentionally. In some cases, nerve endings that help propagate erections could be damaged permanently and patients will develop severe erectile dysfunction. There is also a possibility of dry organisms due to these nerve bundles being damaged.
Symptoms may gradually improve, but patients who undergo this type of procedure for benign prostatic hyperplasia may also suffer through heavy bleeding episodes. Many patients may require a catheter afterwards for a few weeks and patients may not report a significant reduction of symptoms until a few months even after the procedure has been completed.
This is a definitive treatment, however, and the majority of patients are satisfied with the final outcomes.
Why UroLift may be right for you if you have benign prostatic hyperplasia
In the last decade, a newer procedure has become more popular in the treatment of benign prostatic hyperplasia. Known as the UroLift, this is a type of surgery that is much less invasive compared to the TURP method and side effects are much more manageable for patients to cope with.
This procedure can be performed in an outpatient setting and if a patient qualifies for the UroLift procedure, results can be observed even in the first few hours following the procedure. During the UroLift procedure, a urologist will insert a stent-like device that can be adjusted to help “lift-up” the prostate in order to remove the blockage along the urethra.
Some of the most significant benefits of the UroLift procedure compared to traditional TURP surgery would be the virtual removal of risk of erectile dysfunction and ejaculation issues. Because these stents are only inserted and anchored along the urethra, sensitive nerve bundles will not be involved and sexual intercourse can proceed without any discomfort in these male patients. Patients would also be able to have these procedures done at a sooner time when prostate glands are still only slightly enlarged so the quality of life for these patients can improve significantly in a short period of time.
Even if there are obvious benefits to the UroLift procedure, not every patient will automatically qualify for this procedure. Patients who have an enlarged prostate measured to be over 100 millimeters, those who have an enlarged median lobe of the prostate and those who have a history of urinary retention are disqualified.
Since UroLift is also a newer treatment, the cost of this intervention is considered to be much higher than a TURP treatment. It is likely that a patient who undergoes an UroLift procedure will also eventually need to have a re-operation to help open up the urethra once again when the prostate grows too large for the stents to effectively keep the urethra open. Because UroLift is so new, data is also limited to potential long-term complications that must still be investigated.