Men in their middle and later years frequently experience the blockage of urination that occurs when the prostate gland increases in size, otherwise known as benign prostatic hyperplasia (BPH). This is the most common abnormality affecting the prostate gland. It is a completely benign condition and has no relation to prostate cancer. Patients with mild symptoms may not require treatment other than observation. Moderate symptoms can be treated with a variety of medications that relax the smooth muscle of the prostate. Men with more advanced symptoms may require additional treatment. Undiagnosed and untreated, the condition can lead to chronic inflammation of the prostate and even to kidney failure. Occasionally, BPH is associated with unwelcome side effects, such as incontinence and impotence.
By age 50, half of men have some signs of BPH and about half of these men develop symptoms that require treatment. By age 60, up to 80 percent of men have signs of the condition. If the symptoms of BPH are affecting the quality of your life—if you are losing sleep because you need to constantly urinate during the day or night or you have to push and strain to urinate—you should consult a urologist about what is likely an enlarged prostate.
Diagnosis of Benign Prostatic Enlargement
At The Center for Prostate Health and Male Voiding Dysfunction at Columbia University Department of Urology at NewYork-Presbyterian Hospital, we offer every method available for making a painless diagnosis of BPH.
- A history, physical and simple non-invasive urine tests can help us confirm an enlarged prostate.
- We can also measure urine flow and bladder pressure using urodynamic studies to determine the degree of obstruction.
- Using cystoscopy, an examination of the prostate using a small flexible telescope, we can evaluate the size of the prostate, examine the bladder, and help plan potential treatment options in patients where medication alone does not alleviate symptoms.
These advanced tests are performed on an outpatient basis, with little or no discomfort.
Treatment for Benign Prostatic Enlargement
TURP: Transurethral Resection of the Prostate (TURP) has been considered the "gold standard" of surgical care for the last several decades. In this procedure the urologist uses a cystoscope, a telescope with a wire loop, to cut and remove the prostate tissue that is blocking the urine from exiting the bladder. TURP is typically performed under regional or general anesthesia. Patients usually require a one-to-two-day hospital stay. Potential complications include bleeding, fluid absorption, incontinence, and potentially erectile dysfunction.
Novel technologies: Our physicians provide novel technologies to reduce prostate gland size including lasers, microwave treatments, and radiofrequency needle ablation are also provided Our goal is to provide comfortable and effective treatment without the undesirable consequences of traditional invasive treatments. Guided by the extensive experience of the Center's clinicians, patients can help us determine the best treatment for them.
Minimally invasive approaches: Our team of urologic experts offers many minimally invasive treatment options including therapies derived from laser, microwave, and radiofrequency technologies.
Watchful Waiting: For patients with mild symptoms, sometimes behavioral changes alone (fluid modification, caffeine reduction, dietary changes) are enough and we can follow patients with an annual examination and no further treatment.
Medical treatment: Three different classes of medications are effective in BPH--alpha-blockers, 5-alpha-reductase inhibitors, and antimuscarinics. Alpha-blockers relax the smooth muscle of the bladder neck and prostate gland and improve urinary symptoms. 5-alpha reductase inhibitors block the production of dihydrotestosterone (DHT), an enzyme that allows the prostate's growth. When DHT is blocked, the prostate size is reduced by roughly 25 percent. Antimuscarinic agents block receptors on the bladder responsible for unwanted bladder contractions and are useful in patients with excessive frequency, urgency, and nighttime frequency (nocturia).
Photoselective vaporization of the prostate (PVP): This procedure uses the GreenLight XPS Laser that vaporizes prostatic tissue. Patients avoid a hospital stay and recover quickly with excellent relief of their "prostatism" symptoms. PVP is performed on an outpatient basis at both NewYork-Presbyterian/Columbia as well as at NewYork-Presbyterian/The Allen Pavilion.
Minimally invasive surgical therapies (MIST): Our urologists also offer other minimally invasive treatments including transurethral needle ablation (TUNA) and transurethral microwave therapy (TUMT). These outpatient procedures heat the prostate tissue using radiofrequency energy or microwave energy, respectively, to a point where the tissue is denatured. The body subsequently reabsorbs this tissue over a two- to three-month period following prostate surgery.