Benign prostatic hypertrophy (BPH) is growth of the prostate with normal aging and causes symptoms, because the prostate blocks the flow of urine through the prostate as the urine exits the bladder. The name BPH indicates enlargement of the prostate, but men may suffer symptoms even with smaller prostates as they age. Other terms that describe the same process include: lower urinary tract symptoms (LUTS), bladder outlet obstruction (BOO) and benign prostatic enlargement (BPE).

Diagnosis and Treatment of Benign Prostatic Hypertrophy

As men age and the prostate continues to enlarge, symptoms typically slowly progress, and men can develop retention of urine, bleeding, urinary infections, stones in the bladder and even kidney problems. Evaluation and management of these symptoms begin with an assessment of the urinary symptoms and quality of life. In the past treatment was often based on relieving serious problems, such as kidney failure, inability to urinate (retention), bleeding, recurrent infections and bladder stones. These are still indications for aggressive treatment but are less frequently encountered. In modern practice the level of bother from the symptoms most often drives treatment decision-making.

Medications

Medical therapy relies on three different types of medications used alone or in combination. Alpha blockers are medications that relax the prostate and bladder opening so the urine can flow more freely. These are typically well tolerated and offer quick improvement in symptoms. Five alpha reductase inhibitors shrink the prostate and work slowly over a four to six month period. These work best for patients with large prostates. Anticholinergic medications help treat bladder over activity and the frequency and urgency that many patients experience with prostate enlargement. These are often used when symptoms of frequency and urgency do not improve after other medical or surgical management and when PVR is reasonably low.

Recently, the phosphdiesterase inhibiting drugs have been shown to improve symptom scores in men being treated for both erectile dysfunction and BPH. Exactly how these drugs improve LUTS is not currently known; but for patients with both problems, this is a new option for medical management.

Surgical Management

Surgical management relies on opening the urethra where it runs through the prostate. This can be done with a variety of different procedures including:

  • TUIP (transurethral incision of the prostate). Relaxing incisions are made in the prostate using a small scope; typically used for small prostates
  • TUMT (transurethral microwave therapy). Destroys prostate tissue with heat delivered by a catheter
  • Vaporization of the prostate. Using either laser energy or electrical energy to destroy tissue using a small scope under direct vision
  • TURP (transurethral resection of the prostate). Removal of prostatic tissue using electrical energy through a small scope
  • HoLEP (holmium laser enucleation of the prostate). Using a laser to carve out the prostate in larger portions and then remove them from the bladder with a morcellating device
  • Simple prostatectomy. Removing prostate tissue through an incision in the lower abdomen; typically used for very large prostates

The risks, benefits and indications for each of these procedures are slightly different, and your surgeon will discuss which is best for you. Often, surgeon experience with one technique will also help select the procedure with the lowest risk of complication and best outcome.

In general risks for surgery for BPH include bleeding, urinary tract infection, abnormal healing with scar tissue formation in the urethra and bladder opening, erectile dysfunction, retrograde ejaculation (where semen flows backward into the bladder with orgasm) and incontinence (leaking urine without control). Complications are not common and most surgeries work very well to increase the strength of men’s urinary flow and relieve the symptoms of frequency and urgency of urination. Surgery is a very good option for men that do not tolerate medicines because of side effects or men for whom the medicines are not strong enough to relieve the symptoms of the problem.

Christopher B. Dechet, MD

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Christopher Dechet, MD, FACS is an associate professor in the Division of Urology, Department of Surgery at the University of Utah. He currently serves as the Co-director of the Multidisciplinary Urologic Oncology Group at the Huntsman Cancer Institute. Dr. Dechet specializes in the surgical care of patients with urologic cancers at the Huntsman Ca... Read More

Specialties:

Adrenal Cancer, Bladder Cancer, Kidney Cancer, Laparoscopy, Prostate Cancer, Robotic Cystectomy and Diversion, Robotic Kidney Surgery, Robotic Prostatectomy, Testicular Cancer, Urologic Oncology, Urology

Locations:

A location has not yet been added by this physician.

Blake D. Hamilton, MD

Patient Rating:

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Blake D. Hamilton, M.D.Dr. Hamilton has several areas of interest and expertise.His primary interest is minimally invasive kidney surgery. This began at the Cleveland Clinic in the 1990’s, where he was in the forefront of urologic laparoscopy. From there, he brought to Utah extensive experience in laparoscopic renal and adrenal surgery. He has been... Read More

Specialties:

Endourology, General Urology, Laparoscopy, Stone Disease, Urology, Vasectomy

Locations:

University Hospital
Urology
801-213-2700

A. Jolyn Hill, MD

Dr. Jolyn Hill is a fellowship trained Urogynecologist and women's health provider in the Urogynecology and Pelvic Reconstructive Surgery division. Dr. Hill received her Bachelor of Science from Utah State University in Logan, Utah and her M.D. from Virginia Commonwealth University School of Medicine in Richmond, Virginia. She completed her Obstetr... Read More

William Lowrance, MD, MPH

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William Lowrance, MD, MPH, is an assistant professor in the Division of Urology at the University of Utah School of Medicine and a Huntsman Cancer Institute (HCI) investigator. He specializes in the surgical treatment of urologic malignancies. His practice at the Huntsman Cancer Institute primarily focuses on treating prostate cancer, bladder cance... Read More

Specialties:

Laparoscopy, Prostate Cancer, Urinary Diversion, Urologic Oncology, Urology

Locations:

Huntsman Cancer Hospital
Clinic 2B, GU
801-587-4381

Sean J. Mulvihill, MD

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Sean Mulvihill, MD has specialized expertise in the treatment of diseases of the liver, biliary tract, and pancreas. He is board certified in general surgery. His main clinical focus is in the management of patients with pancreatic tumors, such as pancreatic adenocarcinoma and neuroendocrine tumors. He has integrated a research program funded by th... Read More

Brock O'Neil, MD

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Brock O’Neil, MD is an assistant professor in the Division of Urology at the University of Utah School of Medicine. His clinical practice at the Huntsman Cancer Institute focuses on the surgical treatment of genitourinary malignancies including prostate, bladder, kidney, adrenal, testicular, penile and urethral cancers. He is an experienced robotic... Read More

Specialties:

Adrenal Cancer, Bladder Cancer, Blue Light Cystoscopy With Cysview, Kidney Cancer, Laparoscopy, Penile Cancer, Robotic Cystectomy and Diversion, Robotic Kidney Surgery, Robotic Prostatectomy, Testicular Cancer, Urinary Diversion, Urologic Oncology, Urology

Locations:

Huntsman Cancer Hospital 801-585-0250

Stephen J. Summers, MD, BS

Patient Rating:

4.8

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As a general urologist I see both men and women of all ages with a variety of urologic complaints. Currently I see patients at both the University of Utah main campus, as well as at the new Farmington Health Center. I care for patients with most urologic disorders and have special interests in the management of complex or recurrent kidney stones, p... Read More

Specialties:

Endourology, Erectile Dysfunction, General Urology, Kidney Cancer, Laparoscopy, Male Incontinence, Robotic Kidney Surgery, Robotic Prostatectomy, Robotic Ureteral Reimplant, Stone Disease, Ureteral Stricture, Urethral Stricture, Urologic Oncology, Urology, Vasectomy

Locations:

Farmington Health Center 801-213-3200

Specialties:

Adrenal Cancer, Bladder Augmentation, Bladder Cancer, Complications of Spinal Cord Injury, Complications of Urologic Surgery, Endourology, Erectile Dysfunction, Female Incontinence, General Urology, Kidney Cancer, Laparoscopy, Male Incontinence, Male Infertility, Men's Health, Mesh Erosion, Neurogenic Bladder, Pelvic Fractures and Urethral Injury, Penile Cancer, Peyronie's Disease, Radiation Injuries, Robotic Cystectomy and Diversion, Robotic Kidney Surgery, Robotic Prostatectomy, Robotic Ureteral Reconstruction, Robotic Ureteral Reimplant, Stone Disease, Testicular Cancer, Ureteral Stricture, Urethral Stricture, Urinary Diversion, Urinary Strictures and Fistula, Urologic Oncology, Urology, Vasectomy, Vesicovaginal Fistula

Locations:

A location has not yet been added by this physician.

University of Utah Hospital
3rd Floor, Room 3A100
50 N Medical Drive
Salt Lake City, UT 84132
Map
Appointments
801-213-2700
Farmington Health Center 165 N. University Ave.
Farmington, UT 84025
Map
801-213-2700
South Jordan Health Center 5126 W. Daybreak Parkway
South Jordan, UT 84009
Map
801-213-2700