Bothersome urinary symptoms including an urgency to urinate, weak urine stream or waking during the night to urinate are common among men, especially after age 50. These problems are usually caused by benign prostatic hyperplasia (BPH), also called “enlarged prostate.” While BPH is common and experienced by millions of men, it should not be considered normal or part of getting older.
Today’s minimally invasive treatment options are far superior to older surgical procedures and are very successful in relieving symptoms with minimal side effects or complications. BPH treatment has greatly advanced over the last decade and procedures, including Aquablation®, are now performed on an outpatient basis, allowing men to live life more fully, without urinary symptoms.
Specialists affiliated with Memorial Hermann can identify the most appropriate treatment procedure for each man's specific needs and anatomy. With a combination of leading-edge technology and experience with a wide range of procedures, our affiliated urologists perform innovative procedures to preserve sexual function and eliminate the need for medication.
Benign prostatic hyperplasia (BPH) is noncancerous condition where the prostate gland increases in size. The prostate gland is located beneath the bladder. The urethra, which carries urine from the bladder to be emptied through the end of the penis, runs through the prostate. If the prostate is enlarged, it can put pressure on the bladder and slow or block the flow of urine.
As men get older, their prostate grows larger. Around age 50, approximately half of men have experience BPH. Among men in their mid-80s and older, about 90 percent have symptoms.
Having an enlarged prostate is usually not a harmful condition, but it has symptoms that are similar to other urological problems, including prostate cancer. Having an evaluation by a urologist is important to determine the cause of the symptoms and to rule out a serious medical problem.
The symptoms of BPH can vary between individuals and may become more severe as men get older.
In the early stages of BPH, when symptoms are mild, some men choose prescription medication to address urinary difficulties. However, this is not a permanent solution. Treating BPH with medication may lessen the severity of symptoms in the short term, but it is not a long-term fix. An enlarged prostate is a mechanical problem that needs a mechanical solution. Addressing the condition with a minimally invasive procedure that targets the problematic areas of the anatomy may bring lasting relief.
Aquablation® is a robotic assisted, minimally invasive treatment for BPH that uses ultrasound imaging and waterjet technology to reduce the size of the prostate. Unlike previous BPH procedures, Aquablation® does not use heat-based technology and does not cut any tissue from the prostate.
An ultrasound probe is inserted into the rectum and guided to the prostate. Sophisticated imaging software allows the urologist to view the prostate and create a map of the areas of tissue that need to be removed, while avoiding areas that do not need removal.
Once the mapping process is complete, another probe is inserted through the tip of the penis. High-pressure water is delivered through the probe and destroys the targeted tissue. Because the water is directed specifically at the identified prostate tissue, the area around the ejaculatory duct is untouched which minimizes the risk of sexual side effects.
Most men go home the same day as the procedure, but some may need to stay overnight in the hospital for monitoring. A catheter will remain in place to drain urine until it is safe to remove, and medication may be given to reduce any mild pain or discomfort.
After the excess prostate tissue is removed, urine can flow normally, and urinary symptoms are usually resolved. Research indicated that about 99 percent of men maintain sexual friction and normal urination after the procedure.
Most men who experience urinary symptoms from BPH are candidates. However, men with smaller prostates or who are taking blood thinners should not have this procedure. In these cases, a urologist can recommend an alternative treatment option to achieve symptom relief.
This procedure is minimally invasive and has fewer risks and side effects than older surgical procedures. However, as with all procedures, there are some risks including unresolved urinary symptoms.
Some patients may experience temporary side effects after the procedure that should improve with time:
BPH treatment is not one-size-fits-all because each man has unique anatomy. A procedure that is a good option for one man might not be a good solution for another. The urologist will evaluate each patient's specific needs and health status and, if Aquablation® is not a good option, may recommend an alternate procedure.
Minimally invasive option that uses laser energy to heat and destroy prostate tissue. A small scope with a camera is guided to the prostate, and then laser technology delivers heat to targeted areas. GreenLight laser therapy is suitable for men who are taking blood thinners.
Minimally invasive procedure that uses medical-grade clip devices to “hold back” the prostate tissue away from the urethra. The UroLift implant device is inserted into the penis and through the urethra. When the device reaches the prostate, the urologist secures the prostate tissue with small clips to keep it from obstructing the urethra. This creates an open channel for urine to flow more freely.
The HoLEP minimally invasive procedure has been performed for more than 20 years with consistently positive results. A small, state-of-the-art camera is inserted through the urethra and guided to the prostate. Light-beam technology peels back and destroys the excess prostate tissue that is obstructing bladder function.
This minimally invasive surgical procedure is often a good option for men with extremely large prostates. Using robot-assisted technology, the surgeon makes small, precise incisions in the abdomen to reach the prostate and remove excess tissue to relieve urinary symptoms.
TURP is a surgical procedure that has been used for decades. The urologist inserts a small scope into the tip of the penis and guides it through the urethra to the prostate. Prostate tissue is surgically removed to improve urine flow.
Preserving bladder health is important in all stages of life. Urinary symptoms caused by BPH is a common frustration among millions of men, and some may try to accept these challenges as unavoidable as they get older. However, untreated BPH can lead to other medical conditions that cause significant problems which may be irreversible. Experts agree that men should be proactive in dealing with enlarged-prostate symptoms to not only improve their quality-of-life but also to prevent serious and permanent urinary problems in the future.
The bladder is a muscle and, like all muscles, can be damaged if overworked. When urinary challenges are ignored and left untreated, the bladder suffers ongoing stress and damage that may become too advanced for treatment. If the bladder becomes significantly damaged, men are left unable to urinate on their own and must rely on catheterization. When this happens, men require emergency medical treatment that may or may not be able to restore bladder function.
Prolonged symptoms from an enlarged prostate can lead to a blockage in the urethra and may cause complications including:
If BPH symptoms are interfering with normal urination, it's time to see a urologist about the best path forward. For many men, a minimally invasive procedure can solve the problem quickly and safely. Unfortunately, some men put off these simple procedures until it is too late when they are no longer candidates due to advanced age or other health conditions, or because their bladder has deteriorated to a point where intervention may be less successful. Seeing a health care provider on a regular basis for routine checkups, including discussion and examination of bladder function, is the best way to stay ahead of future urinary concerns and live with the best quality of life possible.
To learn more about surgical options for BPH, visit Find a Doctor to schedule an appointment.