Ask the Experts: Fall 2023

Is BPH treatment a "one size fits all" approach with minimally invasive procedures? 

Minimally invasive procedures are a great option to treat symptoms associated with an enlarged prostate, especially when medications aren’t working. There are many great choices available, but they should be tailored to each person. Your doctor will take into account the size of the prostate, variations in anatomy, and other factors when helping you consider your options.  

Surgery or other procedures might help with BPH symptoms if you: 

• Don't get enough relief from medications
• Experience side effects from medications
• Prefer not to try medications
• Aren't able to pass urine
• Have kidney problems
• Keep getting bladder stones, blood in the urine or UTIs

Your doctor will talk with you about the options, possible side effects and how soon you will see a relief of symptoms. Many treatments have very little down time and help to either shrink the prostate or remove prostate tissue to increase the flow of urine. Treatments may include laser therapy, robotic waterjet treatment, water vapor thermal therapy and prostate implants. Talk with your doctor about which approach is best for you.  

Dr. Brian Jordan, urologist and Assistant Professor of Urology at the University of Washington, specializes in prostate health and male voiding dysfunction, including minimally invasive and robotic surgeries for BPH. 

What is the standard of treatment for BPH?

Benign prostatic hyperplasia (BPH), also known as an enlarged prostate, is common for men as they age. In fact, about half of all men between ages 51 and 60 have BPH. Up to 90 percent of men over age 80 have it. BPH itself may not need any treatment, but if it starts to cause problems, treatment may help. Here are the treatments that you may want to talk about with your doctor if you have BPH.

Behavior Changes is an option when your BPH consists of mild symptoms. This usually consists of lifestyle changes such as restricting fluid intake or passing urine on a schedule. BPH symptoms are routinely monitored in case symptoms worsen and drugs or other treatment become necessary.

Prescription Drugs may relax the muscles of the prostate and bladder to reduce BPH symptoms. Some drugs work to shrink the prostate to also help urine flow.

Less Invasive Surgery can often be done in the urologist’s office or as an outpatient procedure, often without a stay in the hospital. This includes implants which lift and compress the enlarged prostate so that it no longer blocks the urethra. Other treatments use water vapor (steam) thermal therapy to destroy prostate cells squeezing the urethra, or a temporary device implanted in the prostate via a catheter.

More Invasive Surgery may be needed in severe cases of BPH or when other choices don’t work as well. Many options include incisions into the prostate, high-pressure water jets, lasers, or electric current to destroy excess prostate tissue.  When no other form of treatment works, a “simple” prostatectomy gets rid of the obstructing prostate gland by open, laparoscopic or robotic-assisted surgery.

Download the Benign Prostatic Hyperplasia (BPH) Treatment Fact Sheet to learn more.

Dr. Jaspreet S. Sandhu, an attending urologist at Memorial Sloan Kettering Cancer Center, directs the Center for Functional and Reconstructive Urology, focusing on urinary tract and pelvic floor reconstruction in men and women along with voiding dysfunction particularly as related to cancer and its treatments.

Should I worry about urinary incontinence and erectile dysfunction after my BPH treatment?

Benign prostatic hyperplasia (BPH) is a health condition in men where the prostate becomes enlarged. It becomes more common with age. An enlarged prostate can cause symptoms that may bother you, like blocking the flow of urine out of the bladder. It also can cause bladder, urinary tract or kidney problems. There are many types of drugs, surgeries and other procedures that can help treat an enlarged prostate. The best treatment choice for you depends on: 

• The size and shape of your prostate
• Your age
• Your overall health and drugs you take
• How serious your symptoms are
• Whether or not you wish to preserve fertility

All the treatment options work to help improve symptoms. The treatments work to shrink or alter the anatomy of the prostate to open the flow of urine. Because of the number of treatment options available, men have choices and rarely only one approach is possible. The options available vary as regards the degree of tissue that is affected and as such, some treatments have lower risks for urinary incontinence and/or erectile dysfunction than others. But, regardless of the treatment, permanent problems with incontinence or erections are low.

Erectile dysfunction can occur with some therapies, but this is not always the case. Some patients report their erectile dysfunction improves after BPH treatments. This could be linked to the prostate becoming smaller or stopping drugs, just to name a few. Retrograde or anejaculation, however, is not an uncommon side effect with resection techniques.

If fertility is a concern, you should talk about options with your doctor, as there are many choices for treatment. Incontinence right after post procedure can occur as the bladder heals from the obstruction it has suffered. There are two types of incontinence that people with prostates may have – urge incontinence (the loss of urine with strong urge or leakage without warning) and stress incontinence (leakage with physical activity). But, long term incontinence is not very likely.

Dr. Lori Lerner, a urologist and Associate Professor of Urology at Boston University School of Medicine, specializes in male voiding dysfunction, BPH, surgical energies (particularly laser) and urinary tract infections.