Benign Conditions – BPH

Symptoms & Diagnosis

Prostate gland enlargement, also known as benign prostatic hyperplasia (BPH), is the most common, benign condition of the prostate that men experience as they age. Over the years, it is normal for the prostate to grow. Enlargement is only considered a problem if symptoms worsen to the point of increasing the patient’s discomfort or causing other medical conditions. Your symptoms may include:

  • Frequent or urgent need to urinate
  • Difficulty starting urination
  • Weak stream
  • Problems stopping and starting urination
  • Dribbling at the end of urination
  • Increased frequency of urination at night
  • Straining while urinating
  • Unable to empty your bladder
  • Urinary tract infection
  • Blood in your urine (hematuria)
  • Stones form in the bladder
  • Impaired kidney function

Diagnosis

The process of diagnosing BPH usually begins with an in-depth interview conducted by your doctor to ascertain your general health. There are a number of medical conditions that can cause symptoms similar to those of BPH, including heart failure, diabetes, infections, bladder or kidney stones, stroke, neurological problems and prostate cancer. Your doctor will want to rule these out.

To specifically diagnose BPH your doctor may:

  • Use the American Urological Association (AUA) Symptom Index for BPH to assess the severity of your symptoms
  • Conduct a digital rectal exam to determine the degree of enlargement of your prostate gland
  • Order a Urine test to rule out an infection
  • Order a Prostate-specific antigen (PSA) blood test to see if levels are elevated
  • Conduct a Urinary Flow Test to measure the strength and amount of your urine flow
  • Conduct a Postvoid residual volume test to measure whether you can empty your bladder completely
  • Order a Transrectal ultrasound test to measure the size and assess the anatomy of your prostate
  • Perform a Prostate biopsy to take and examine tissue samples of the prostate to rule out prostate cancer

Treatment

When BPH is diagnosed, early treatment usually focuses on alleviation of symptoms with suggested lifestyle changes and prescription medications. However, if you experience increasing discomfort and medication is not addressing your symptoms adequately, surgery may be recommended. NJCPC&U specializes in a number of minimally invasive procedures to address BPH and your doctor will determine which is best for your specific condition.

Transurethral Needle Ablation of the Prostate (TUNA)

The TUNA procedure is often recommended for patients who bleed easily or have other complicating health problems. Your NJCPC&U specialist uses a Cystoscope passed through your urethra to place needles into your prostate gland. The needles are used as conductors for radio waves which heat and destroy the targeted prostate tissue that’s obstructing urine flow. Typically, the “scarred” prostate tissue responds by retracting, clearing the way for urine flow. The TUNA procedure is done on an outpatient basis, with a quick recovery and return to routine. It may take some time for patients to experience relief of symptoms and some patients experience only partial relief.

Greenlight™ Laser Therapy

The GreenLight™ Laser Therapy uses laser energy to remove enlarged prostate tissue that is impeding urine flow. It actually makes the channel wider but without much of the side effects of transurethral resection of the prostate. NJCPC&U specialists perform Greenlight on an outpatient basis and most patients experience a quick recovery. Greenlight offers a BPH solution with fewer side effects and less risk of erectile dysfunction (less than 1% of patients have reported cases.) Other benefits include: rapid urine flow improvement; a virtually bloodless procedure; short or no catheterization; and long-lasting relief of BPH symptoms.

Transurethral resection of the prostate (TURP)

For many years, TURP has been the “gold standard” procedure for enlarged prostate. Your NJCPC&U specialist places a resectoscope into your urethra and surgically removes all but the outer part of the prostate (prostate resection). Patients tend to experience quick relief of symptoms, most noticeably a stronger urine flow within just a few days. TURP is more invasive than some of the newer procedures and therefore carries a higher risk of bleeding and infection. After the procedure you will require a catheter to drain your bladder for three to five days. You will need to take it easy until you’ve recovered completely. Patients who qualify for TURP generally have smaller prostates. Even with the advent of newer, minimally invasive surgeries, your doctor may recommend TURP as the best treatment choice depending on the specifics of your health and condition.

Simple Prostatectomy

For extremely large prostates requiring intervention, Greenlight laser therapy and TURP often prove unsuccessful. In these cases, the traditional operation of choice was open simple prostatectomy, in which the bladder is opened through an abdominal incision, and the prostate is virtually “cored” out from the inside. While the outcomes were good, open simple prostatectomies unfortunately carried a much higher morbidity due to a larger surgical incision, higher blood loss, and longer post-operative recovery

With the advent of the daVinci Robotic System, a simple prostatectomy can now be performed laparoscopically (with keyhole incisions), with minimal bloodloss, minimal pain, and a rapid recovery. At NJCPC&U, the robotic prostatectomy has proven successful in prostates ranging from 160g to 540g.