Benign Prostate Hyperplasia (BPH) is known more commonly as an enlarged prostate – and there’s a new treatment option for men who have been given this diagnosis. Hartford HealthCare Tallwood Urology & Kidney Institute urologist Dr. Abram D’Amato has details.
Q: What is an enlarged prostate?
A: An enlarged prostate is often our explanation for lower urinary tract symptoms in a male. As men age the prostate continues to grow. In some cases this can lead to partial or even complete blockage of the urethra leading to increased difficulty voiding. This will manifest in a patient as a slower urinary stream, feelings of incomplete emptying, hesitancy in initiation of urination and can lead to increased urgency and frequency of urination.
Q: There is a new, minimally invasive treatment for BPH called the UroLift. Tell us about it.
A: Generally performed under anesthesia a surgical telescope (cystoscope) is placed though the urethra into the prostate and bladder. Using the Urolift device through that scope, small sutures can be placed that compress the lateral lobes of the prostate to open the urethra. This accomplishes the same thing as a traditional transurethral resection of the prostate (TURP) without having to cut the prostate and with fewer side effects.
Q: Which type of patient would be an ideal candidate for the UroLift procedure?
A: UroLift is limited by the size of a prostate (must be less than 80 g according to FDA) and the internal anatomy. Any patient considering a form of surgical intervention on their prostate to alleviate obstruction and improve voiding will undergo a workup that often includes measurement of the prostate size as well as office cystoscopy to evaluate the internal anatomy of the prostate. Typically in a prostate with a very large median lobe Urolift is less efficacious than other modalities. The largest benefit of Urolift over other options is that antegrade ejaculation is typically preserved and worsened erectile function is extremely rare. Additionally, post-operative catheterization is very short, often less than 24 hours, and no overnight hospital stay is needed. Urolift can be an ideal solution for men who have an adequate response to oral therapy but are unable to tolerate the side effects. It can also be used in men who have not had a sufficient response to medication.
Q: What are some of the other treatments are there for BPH?
Q: Transurethral resection of the prostate (TURP), green light laser vaporization of the prostate and Holmium ablation of the prostate (PVP) are techniques utilizing different heat sources to remove tissue from the center of the prostate. These procedures are all performed in the operating room under anesthesia and sometimes an overnight stay in the hospital is required. A Foley catheter is left in place for several days after surgery. These techniques are highly effective and are currently the most popular surgeries for treating BPH. Initially, patients experience an increase in urinary urgency and frequency along with a significant improvement in force of urinary stream and improved bladder emptying. After the irritation decreases (generally 1-2 months after surgery) urinary frequency will be much improved. Dry ejaculation is expected and permanent and there is low risk of urine leakage (incontinence).
“Simple” prostatectomy has been a longstanding surgical treatment for BPH. It is now reserved for very large glands and can be done through either a single incision or with several small incisions using a robot. This technique removes the obstructing tissue but is more invasive and has higher risks. Typically a 1-3 day stay in the hospital is required and a Foley catheter will be in place for up to 2 weeks. Dry ejaculation is expected and permanent and there is a risk of erectile dysfunction and a low risk of urine leakage.
Prostate artery embolization (PAE) is another new technology. PAE is a procedure performed by interventional radiologists under sedation. The interventional radiologist places a catheter into an artery in the groin and is guided to the blood supply of the prostate. Medication is injected through this catheter to stop the blood flow to the prostate, and over time shrinks the prostate and improves symptoms. Typically reserved for men who are not candidates for other surgeries, it is considered a lower risk procedure with few side effects, although long-term data is lacking.
We are investigating bringing in a promising new technology called Aquablation which is still undergoing testing. Aquablation, performed in the operating room, uses computer and robotically controlled jets of water to remove the central portion of the prostate that is constricting urine flow. Typically there is minimal bleeding but an overnight stay is required. A Foley catheter placed during the procedure and will need to be removed at the doctor’s office 1-4 days after surgery. After the irritation decreases (1-2 months after surgery) frequency will be much improved. Dry ejaculation is rarely reported and there is minimal risk of urine leakage.