Managing Benign Prostatic Hyperplasia: Your BPH Treatment Options
Managing Benign Prostatic Hyperplasia: Your BPH Treatment Options
As men get older, it’s common to notice changes when going to the bathroom. If you feel like you can’t fully empty your bladder, you have a weak urine stream, or you’re waking up often at night to use the restroom, you might be dealing with benign prostatic hyperplasia (BPH).
What Is BPH?
BPH is a common condition that affects about 50% of men by age 60 and 90% of men who reach age 85. As a man ages, the prostate grows, and a BPH diagnosis occurs when prostate enlargement has progressed enough to cause noticeable symptoms and disrupt everyday life.
How Is BPH Treated?
If you’ve received a BPH diagnosis, work with a urologist to create a treatment plan tailored specifically to you. Many men start with a combination of lifestyle changes and medications to help manage symptoms.
Common Medications
- Alpha blockers: Helps the muscles around the prostate and bladder to relax, making it easier for the urine stream to start.
- 5-alpha reductase inhibitors: Blocks testosterone and can help the prostate shrink.
At University of Utah Health, urologists perform a physical exam to determine if alpha blockers are enough to treat symptoms or if the 5-alpha reductase inhibitors are also needed.
“In the case of the 5-alpha reductase inhibitors, we’re trying to shrink the prostate,” explains John Evan Thomas, PA-C, a physician assistant in urology at University of Utah Health. “A physical exam is important because that’s how we can tell if the prostate is large enough for us to employ that medication.”
Lifestyle Changes
Your care team may suggest lifestyle modifications, since the following risk factors can contribute to BPH development:
- A sedentary lifestyle
- Obesity
- Eating foods high in sugar or unhealthy fats
- Smoking or excessive use of alcohol
- Other unmanaged comorbidities, such as diabetes or heart disease
When Is Surgery Needed?
If medications and lifestyle changes aren’t effective, surgery may be the next step. U of U Health offers several options, including a minimally invasive procedure called HoLEP.
What Is HoLEP?
Holmium laser enucleation of the prostate (HoLEP) is a no-incision surgery that uses a laser to remove extra prostate tissue through the urethra.
“Through that scope, we’re able to enucleate—or carve out—tissue from the prostate as if we’re peeling an orange from the inside,” Thomas explains. “Then that glandular tissue is pushed into the bladder, leaving behind the capsule of the prostate, which is the part of male anatomy that contains a lot of the nerves for continence control and erectile function.”
The surgery helps relieve pressure and clear blockages so that urine can flow easier.
HoLEP has one of the lowest retreatment rates of BPH surgeries and a high long-term success rate. The tissue removed during the procedure can then be used for diagnostics if necessary.
U of U Health is currently the only medical facility in Utah that offers this type of surgery. Kelli Gross, MD, a urologist at U of U Health, is one of only a handful of surgeons in the Mountain West who offers it.
Other surgical options include:
- Simple prostatectomy: A small incision is made in the lower abdomen to remove excess prostate tissue. This is an option when the prostate is very large.
- Transurethral incision of the prostate (TUIP): Using a scope inserted through the urethra, small incisions are made in the bladder neck so urine can flow better. This minimally invasive procedure is often recommended for younger men or those with smaller prostates.
- Transurethral resection of the prostate (TURP): A minimally invasive procedure where a scope is inserted into the urethra and electrical currents are used to cut away extra tissue that may be blocking urine and contributing to significant urinary issues.
- GreenLight™ laser therapy: A tube with a camera is inserted into the urethra, and a laser is used to vaporize excess prostate tissue. This minimally invasive procedure is appropriate for prostates that are moderately enlarged.
- Rezum® water vapor therapy: This minimally invasive procedure utilizes a catheter inserted into the urethra. The sterile water vapor heats and destroys excess prostate tissues.
- UroLift®: Small implants that pin the prostate out of the way of urine flow are inserted through the urethra.
“As a PA, I collaborate with some of the best surgeons and people who are working at the top of their craft,” Thomas says. “I think that’s one of the advantages that we have at the U—we’re a higher education institution in medicine, so we’re at the top of our game when it comes to research and experience.”
If you have BPH, the urology team University of Utah Health has the expertise, precision, and skill to offer the best comprehensive care for you.
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