The prostate is a walnut-sized gland surrounding the male urethra just below the bladder. Its function is to store and nurture the sperm that has been produced by the testicles. After the age of 20, the prostate gland starts growing and continues to grow more or less for the rest of one’s life. In some people it will grow faster than others, which is likely related to genetics and diet. The enlarged prostate gland will pinch the urethra and may cause obstruction of the urine flow. A large prostate does not necessarily need treatment. WHile some men will develop bothersome symptoms, others will have no problems at all. The exact reason for this phenomenon is still unknown, and is likely multifactorial.
Common symptoms of an enlarged prostate include:
- Weak, variable, or dribbling stream
- Need to strain or push to urinate
- Difficulty beginning urination
- Sudden need to urinate (urgency)
- Urinary frequency
- Interrupted sleep due to need to urinate at night
- Pain or burning during urination
These symptoms may also be caused by other urinary problems such as an overactive bladder, prostate cancer, or a urinary tract infection. A urologist should be able to help you find out what causes these symptoms.
Once it has been determined that the symptoms are caused by an enlarged prostate (BPH), there are multiple ways to manage the symptoms:
Surveillance: If the symptoms are not too bothersome and in the absence of complications such as urinary tract infections, bladder stones, renal failure, one may elect to monitor the symptoms and intervene only if the situation worsens
Medication: There are multiple medications available, but they fall in two basic groups: alpha blockers (such as tamsulosin aka Flomax and alfuzosin aka Uroxatral, doxazosin, and terazosin), and 5-alpha reductase inhibitors (finasteride aka Proscar, and dutasteride aka Avordart). Sometimes a medication from each group are used together as they do different things and the combination of both works better than either one alone.
Surgery: The traditional golden standard surgery is the TURP, also commonly known as transurethral resection of the prostate or roto-rooter operation. The obstructing prostate tissue is scraped out through a scope. This procedure was associated with bleeding and necessitated hospitalization, and also could cause erectile dysfunction. An alternative to the TURP is the Greenlight Laser Prostatectomy, or PVP. During this procedure, a high-powered laser burns off the obstructing prostate tissue via the scope, and at the same time the laser tends to coagulate the blood vessels so that there is usually very little or no blood loss during the procedure. The procedure is done outpatient, and sometimes patients can be sent home without a catheter (tube to drain the bladder). It does not affect erectile function, and other complications are reduced while the effectiveness and durability of the procedure is more or less the same as the TURP.
There are procedures that are done in the office, but they have fallen out of favor due to poor long-term success rates (TUMT-microwave, TUNA, Indigo). Newer outpatient procedures are available, but insurance coverage is still spotty and hopefully will soon be improved. Urolift where a small implant is inserted that lifts the obstructing prostate tissue out of the way, and Prostate Vapor Injection, which causes the prostate tissue to shrink over time. Short-term results of these procedures are encouraging, no long-term results are available at this time.
Dr. Lotenfoe has performed hundreds of the Greenlight Laser procedures successfully and has taught other urologists the procedure. He is a staunch advocate for this very elegant procedure as it is effective with fewer side effects and decreased hospital stay.