Benign Prostatic Hyperplasia (BPH) is enlargement of the prostate gland that surrounds the urethra, the tube that carries urine from the bladder out the body. BPH is not cancer, and occurs in nearly all men with increasing age.
Men with BPH can experience any of the following lower urinary tract symptoms (LUTS):
- Difficulty starting or stopping a urinary stream (dribbling)
- Weak stream
- Frequency of urination
- Increased urgency to void
- Feeling of incomplete emptying
- Increased night time voiding (nocturia)
Over time, men with BPH can have worsening of symptoms and in some cases can experience complete urinary obstruction known as urinary retention. Enlarged prostate can also lead to secondary problems including refractory bleeding, bladder stones, recurrent urinary tract infections, bladder diverticulum and chronic bladder dysfunction.
BPH is diagnosed by routine history and physical exam, International Prostate Symptom Score (IPSS) questionnaire, and digital rectal exam. In some cases, your physician may also look into your bladder and evaluate your prostate under direct visualization.
Treatment of BPH is based on the degree of your symptoms and the level of bother your are experiencing. Mild symptoms can be watched over time and even improve with some behavioral modifications. Bothersome moderate and severe symptoms can be treated with oral medications, or with endoscopic or minimally invasive surgery. Medications that improve symptoms will need to be taken long term and symptoms will return once medication is discontinued. Alternatively, there are several procedures that can improve voiding symptoms and avoid need for life-long medications. Surgical treatment options for BPH range from transurethral procedures (Urolift vs TURP) or minimally invasive robotic simple prostatectomy.
The Urolift procedure is the least invasive treatment option where using a camera, few small clips are placed and help push the obstructive prostate lobe away, creating an open channel to urinate through. This is an outpatient procedure with minimal to no blood loss, minimal to no risk of sexual side effects, and there is rare need for a foley catheter post procedure. In appropriately selected patients, there is an excellent response in voiding symptoms. See below video for a demonstration of procedure.
Transurethral resection of Prostate is a procedure in which the obstructive parts of the prostate is resected using a camera. Patients usually stay in hospital overnight with a foley catheter. Patients usually can have foley removed the next day and are discharged home after demonstrating ability to urinate.
Robotic Simple Prostatectomy
Using the Da Vinci Robot, an opening is made into the bladder and the prostate is removed. Patients often stay in the hospital for 1 day and are discharged home with the foley catheter. The foley is removed 1 week after surgery to allow the bladder closure to heal. This surgery is often recommended for patients with very large prostates (>80grams). This surgery is different from prostate cancer surgery and carries a much lower risk of urinary incontinence and erectile dysfunction.
Surgical Treatment Options
Tranurethral Resection of Prostate (TURP)
Robotic Simple Prostatectomy
Open Simple Prostatectomy