Benign Prostate Hyperplasia

Benign prostatic hyperplasia ( BPH) is a condition which affects millions of men from the age of 30. This condition causes the prostate to enlarge in a noncancerous way. When the prostate creates pressure of the urethra (the tube that you pass urine through) it can cause bothersome urinary symptoms.

The following symptoms may occur:

• Frequent need to urinate during the day or night
• A weak urinary stream
• A feeling of incomplete bladder emptying
• Hesitancy or difficulty starting urination
• An urgent feeling of needing to urinate and difficulty postponing urination
• A stop start urinary stream

Treatment options

Up to 25% of men with BPH will need to seek treatment because of significant symptoms which are impacting on their quality of life.

Medications

As a first step, patients may be prescribed medication such as Prazosin or Tamsulosin to relax the smooth muscle at the bladder neck and within the prostate. Some men cannot tolerate these medications because of the side-effects which include dizziness, headaches, and sexual dysfunction. Over time symptoms may return and medications may prove ineffective.

Another type of medication, five alpha reductase inhibitors, will gradually shrink the prostate over time. This may help some patients to avoid surgery or the complications of BPH such as urinary retention. The side-effects of these medications can include breast swelling and sexual dysfunction.  Concerns have been raised about an association with an increased risk of diagnosis of high grade prostate cancer over time in patients on five alpha reductase inhibitors but this is not widely agreed upon. 

Surgical treatment

• Urolift™ is a minimally invasive therapy for BPH where the enlarged prostate is not removed, but held open with a tiny implantable traction device. 
• Transurethral resection of the prostate (TURP) TURP is considered the gold standard surgical treatment for BPH. Tissue is removed with a heated loop and bleeding is controlled with cauterization. The tissue is then removed and sent away for microscopic analysis. This procedure is usually done under a spinal or general anaesthetic and a catheter is inserted into the bladder for 1 to 2 days afterwards.

  Once the catheter is removed there is a period of a few weeks with there will be discomfort passing urine and occasional blood is seen. This procedure produces a good channel through the prostate which allows for relief of obstruction. Some bleeding is common after the procedure as is ‘retrograde ejaculation’ or dry orgasms. Problems postoperatively are rare but may include incontinence, impotence, and urethral scarring.

• Laser Prostatectomy Lasers can be used to vaporise or enucleate prostate tissue.

• Greenlight laser prostatectomy This type of procedure uses a specific laser wavelength that vaporises prostate tissue to create a cavity within the prostate. It is generally associated with less bleeding that TURP but no tissue is collected for tissue analysis
• HoLEP Holmium laser prostatectomy uses the laser to cut out (enucleate) and remove whole prostate lobes which are then chopped up (‘morcellated’) within the bladder and extracted to be sent for tissue analysis. This is also associated with less bleeding than TURP, less catheterisation time and shorter hospital stay. There is no risk of significant fluid absorption.  Click this link for more information about HoLEP.

• Water Vapor Therapy is a minimally invasive procedure that uses the natural energy stored in a few drops of water to treat the excess prostate tissue causing BPH symptoms. Click this link for more information about Water Vapor Therapy.

Detailed patient information can be found here.