Enlarged Prostate | Benign Prostatic Hyperplasia

As men get older, the prostate can begin to swell and grow in size. This condition is non-cancerous and called benign prostatic hyperplasia (BPH), often referred to as “enlarged prostate.” Having an enlarged prostate is incredibly common, especially among men over 50. While BPH does not increase an individual’s risk of prostate cancer, it can cause uncomfortable urinary symptoms. Fortunately, there are many treatment options that can help provide symptom relief and improve your quality of life.

Why choose us

At MedStar Health, our urologists have more experience in diagnosing and treating BPH than anyone else in the Washington, D.C., metropolitan area. There is no one-size-fits-all treatment, and we consider each patient’s anatomy, symptoms, and goals when determining the right approach for each individual. By offering the full range of medical and surgical BPH treatment options, including the latest minimally invasive procedures, we can help slow the progression of BPH, reduce symptoms, and minimize the impact of BPH on your daily life.

What is an enlarged prostate?

The prostate is part of a man’s reproductive system. It is a walnut-sized gland that lies at the base of the bladder and surrounds the urethra (a tube that takes urine from the bladder, along the penis, and out of the body). The main function of the prostate is to produce the fluid that provides nutrition to the sperm. When the prostate grows as you age, it can put pressure on the urethra (the tube through which urine passes) and cause irritating urinary symptoms.

Benign Prostate Hyperplasia (BPH)

A common symptom of BPH is a noticeable change in urination, resulting from obstruction of the urethra, and the loss of bladder function. Left untreated, BPH can lead to urinary tract infections, bladder or kidney damage, bladder stones, or incontinence.

Enlarged prostate symptoms

Many men with an enlarged prostate don’t experience symptoms. However, as you age and the condition progresses, it can cause urinary problems. BPH symptoms are categorized into two groups:

Obstructive symptoms caused by blockages to the urethra may include:

Delayed start of the urinary stream (urinary hesitancy)
Straining to urinate
Weak urine stream
Dribbling

Changes to the bladder over time as a result of BPH may cause:

Incomplete emptying of the bladder
Having to urinate often (urinary frequency)
Sudden and intense urge to urinate
Needing to urinate frequently at night

An enlarged prostate can also lead to complications like urinary retention (inability to urinate), hematuria (blood in urine), urinary tract infections, bladder stones, incontinence, or in rare cases, bladder or kidney damage.

Treatments for enlarged prostate

Not everyone who develops an enlarged prostate will need treatment. Only patients who have complications from prostate enlargement and who are bothered by their urinary symptoms require treatment. Your MedStar Health urologist will develop an individualized, comprehensive treatment and prevention plan tailored to your unique needs. This may include “watchful waiting,” lifestyle changes, BPH medication, minimally invasive treatments, or surgery.

BPH medications

The first-line treatment is often medical therapy. Medications for an enlarged prostate may involve one or more of the following:

Alpha-blockers:These BPH drugs, such as tamsulosin and alfuzosin, relax the muscle in the prostate and bladder neck, and open the urethra so urine can flow more easily.
5-alpha reductase inhibitors (5-ARIs): This class of enlarged prostate medicines includes finasteride, among others, to shrink the prostate over time, and prevent future complications from enlarged prostate.
Phosphodiesterase inhibitors: These drugs, such as tadalafil, relax the muscles in the prostate, urethra, and bladder neck. They may also be used to treat erectile dysfunction.
Anticholinergics and beta 3 agonists: These agents relax the bladder and may be used to relieve urinary symptoms, such as urinary frequency or urgency.

In some patients, combination therapy may be utilized. Medical therapy is half as effective as minimally invasive therapy and 25% as effective as surgical therapy.

Minimally invasive procedures and surgeries for BPH

Your urologist may recommend a minimally invasive procedure or surgery to treat BPH if you:

Don’t experience relief with medication
Have complications, such as retention, bleeding, or kidney failure
Keep getting UTIs or bladder stones

The type of intervention that will be best for you depends on your prostate size, prostate anatomy, and other factors. Your urologist may perform additional studies, like cystoscopy, transrectal prostate ultrasound, and urodynamic study, to decide which procedure may offer you the most benefit.

Below are some of the available enlarged prostate treatment options.

UroLift^TMSystem

The UroLift^TM System is an FDA-approved, minimally invasive, ten-minute procedure to treat BPH. It involves inserting four to six implants in the prostate to lift and secure it so that it no longer blocks the urethra. There is no cutting or heating, so there is minimal bleeding and pain after the procedure. In addition, there are no sexual side effects and patients experience symptom relief for up to five years following treatment. At MedStar Health, our urologists were the first to use the Urolift system to treat an enlarged prostate in Washington, D.C., making us the most experienced in the metropolitan region.

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Aquablation

Aquablation therapy is a robotic procedure that utilizes a robotically controlled, heat-free waterjet to remove prostate tissue. The treatment is performed in a hospital and is done under anesthesia. The minimally invasive procedure typically takes less than an hour and generally involves an overnight stay. Aquablation therapy has a very low rate of irreversible complications. In clinical studies, Aquablation therapy has been shown to provide long-term relief at five years.
Transurethral Resection of Prostate (TURP)

Considered the “gold standard” for BPH treatment, TURP is a surgical procedure that involves removing the inner part of the prostate using electrical currents. The procedure is performed using a special instrument that is passed through the urethra into the bladder. It can be done utilizing monopolar or bipolar electrocautery. Most patients require overnight catheterization and hospitalization.
Holmium Laser Enucleation of Prostate (HoLEP)

Holmium laser prostate surgery, or HoLEP, is a minimally invasive surgical option that involves removing prostate tissue obstructing the urethra with a high-powered laser inserted through a scope in the urethra. The removed tissue is extracted through the scope and sent to a lab to be evaluated for prostate cancer or other health concerns. Most patients require overnight catheterization and it can be performed in an outpatient setting.
Green Light Vaporization of Prostate (PVP)

PVP is a bloodless procedure that involves vaporizing the inner part of the prostate using a green light laser, providing immediate symptom relief. Like other BPH procedures, it’s performed through a scope inserted through the urethra. However, unlike HoLEP, no tissue is obtained for pathologic examination. Most patients require overnight catheterization and it can be performed in an outpatient setting.
Simple Prostatectomy (open or robotic)

Simple prostatectomy is surgical removal of the inner part of the prostate. This can be performed using an incision (open surgery) in the lower stomach or using laparoscopic or robotic-assisted techniques. Most patients will need a catheter and hospital stay for several days following surgery.

Frequently asked questions

What does BPH stand for?

BPH is an acronym for benign prostatic hyperplasia, which occurs when the prostate swells over time. It is also commonly known as “enlarged prostate.”
What causes an enlarged prostate?

We don’t know exactly what causes the prostate to swell. However, the cause of prostate enlargement may be linked to changes in testosterone as men age.
What are the potential complications of enlarged prostate treatment?

The possible complications of an enlarged prostate procedure include bleeding, urinary tract infection, retrograde ejaculation, urinary incontinence, urinary frequency, need for postoperative catheterization, and need for reoperation. Your urologist will closely monitor how you respond to treatment and work to proactively minimize any potential side effects of treatment.