Enlarged Prostate (BPH)

Most men as they age will develop an enlarged prostate, a condition called benign prostatic hyperplasia (BPH). In fact, BPH occurs in half of all men by age 50 and more than 75 percent of men by age 80.

Although BPH is unrelated to prostate cancer, it can lead to urinary problems that affect your quality of life. In about half of all cases, medical intervention is needed.

Our fellowship-trained UCI Health urology specialists can help. We offer the latest and safest treatments for BPH, including an innovative outpatient procedure using the UroLift^® device. Learn more about the minimally invasive UroLift procedure ›

Our men’s health specialists at the UCI Health Center for Urological Care can provide a thorough diagnosis and discuss the full range of treatment options available to you. For more information or to schedule a consultation, please call 714-456-7005.

Prostate basics

The prostate is a male reproductive gland, normally about the size of a walnut, that produces semen, the fluid that carries sperm. It is located directly under the bladder and it surrounds the urethra, the tube that carries urine from your bladder out of your body. For many men, the prostate begins to enlarge to approximately apricot or even lemon size as one reaches middle age, which reduces both the flow of urine and the bladder’s ability to hold it.

BPH symptoms

As your prostate enlarges, it compresses the urethra. This causes these annoying urinary symptoms:

• Frequent need to urinate both day and night
• Weak or slow urinary stream
• A feeling that you cannot completely empty your bladder
• Difficulty or delay in starting urination
• Urgent feeling of needing to urinate
• A urinary stream that stops and starts

Though common, BPH symptoms need not be endured as an inevitable part of aging and, in fact, they should not be ignored. Left untreated, symptoms can worsen with age and sometimes lead to infections of the urinary tract, blood in the urine, kidney issues or even complete urinary retention.

Diagnosis

If you display symptoms of BPH, your physician can make a diagnosis by using one or more of the following tools:

• Urinalysis: Checks for infections or other causes of your symptoms
• Urine flow study: Measures urine flow parameters
• Transrectal ultrasound: Views size of prostate and can check for cancer
• Cytoscopy: Measures size of prostate and degree of obstruction

Treatment options

Your BPH treatment plan depends on the severity of your symptoms and your personal preferences.

Watchful waiting

If your BPH symptoms are mild, your physician may first recommend monitoring your condition. You may be asked to track your symptoms and perhaps make simple lifestyle changes, such as limiting liquids consumed in the evening and avoiding certain medications, such as decongestants or antihistamines.

Medications

BPH symptoms can often be managed by medications. Alpha blockers such as alfuzosin, doxazosin or tamsulosin (Flomax^®) may be prescribed to relax the muscles around the neck of your bladder, making it easier to urinate. Alpha reductase inhibitors such as finasteride or dutasteride may be used to actually shrink the prostate.

While medications often relieve symptoms, they must be taken long-term. Side effects such as dizziness, headaches or sexual dysfunction are also possible. A 2016 study showed that 16 percent of men discontinue their BPH medications due to side effects or inadequate symptom relief.

UroLift^® prostatic urethral lift

Approved by the U.S. Food & Drug Administration in 2013, this minimally invasive procedure uses an innovative tool known as the UroLift device. The device delivers tiny implants that lift and hold the enlarged prostate out of the way of the urethra, without any cutting, heating or removal of prostate tissue. Clinical data has shown that this quick, in-office procedure is safe and effective at relieving BPH symptoms and has no impact on sexual function. Read more about the UroLift prostatic urethral lift for BPH ›

TURP surgery

Transurethral resection of the prostate (TURP) is the most common surgical approach to BPH. During this procedure, the patient undergoes general anesthesia while some prostate tissue is removed. TURP is often considered the gold standard for long-term results.

Symptom relief may not happen immediately. As with any surgery, the body requires time to heal. The remaining prostate tissue may actually swell and become inflamed before the desired shrinking effect occurs. Patients require a catheter inserted into their bladder to carry the urine into a bag for several days after the procedure.

There can also be long-term side effects after TURP, such as dry orgasm (retrograde ejaculation), erectile dysfunction or incontinence (leaking of urine).

Laser TURP

TURP also may be performed with a laser in procedures called photoselective vaporization of the prostate (PVP) or holmium laser enucleation (HOLEP). Laser therapy lessens the bleeding risks of traditional TURP. However, since prostate tissue is still removed, there can be tissue swelling and an uncomfortable healing time. Typically, a catheter has to be inserted into the bladder after the procedure.

Thermotherapies

Thermotherapies, which are less invasive than TURP or laser resection, use heat energy such as microwave, radiofrequency or vapor therapy to destroy prostate tissue. The procedure is generally safe and can be performed in about an hour under local anesthesia. It provides moderate symptom relief for some patients.

The downsides of these interventions are tissue swelling and uncomfortable urinary symptoms which may last a few weeks during the healing period. Symptom relief does not occur immediately, and patients often need to have a catheter inserted into their bladder during the recovery period.