Enlarged Prostate

Overview

An enlarged prostate, also called benign prostatic hyperplasia (BPH), is a common condition in older men. The prostate is a walnut sized gland that surrounds the urethra, which starts at the base of the bladder and runs through the middle of the prostate. Over time, an enlarged prostate can stop or slow the flow of urine, causing bladder and kidney problems.

If you are suffering from an enlarged prostate, talk to us. Our team of urologists at City of Hope are experts who use leading-edge methods to diagnose and treat the many urologic conditions that affect millions of men.

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To make an appointment here at City of Hope, request an appointment online or contact us at 800-826-4673 (HOPE). Please visit Making Your First Appointment for more information.

As a founding member of the National Comprehensive Cancer Network, our doctors also help develop and improve evidence-based prostate cancer treatment guidelines for patients throughout the country.
 
The physicians in our Division of Urology and Urologic Oncology are leading experts in treating patients with all types of urologic disorders and cancers. Just as no two patients are alike, an enlarged prostate requires a unique treatment plan tailored to each individual to attain the best possible outcomes.
 

NEWS & BREAKTHROUGHS

What is an enlarged prostate?

As men age, the prostate grows. In some men, the prostate can get bigger without squeezing urethra closed. In other men, the prostate can grow into the urethra, making the opening narrower. When this happens, the bladder has to work harder to get urine out.

Unfortunately, the bladder becomes more irritable when it works harder—meaning it does not tolerate holding urine well. In extreme cases, the prostate may grow into the bladder, creating a ball valve that closes off and completely stops the stream of urine trying to leave the bladder.

There are several symptoms of an enlarged prostate, some of which may indicate an obstruction while others point to bladder irritability.

Signs and symptoms of an enlarged prostate

There are several symptoms of an enlarged prostate, some of which may indicate an obstruction while others point to bladder irritability. If you are experiencing the following symptoms, contact your doctor to assess your needs.
 
Symptoms indicating an obstruction:
  • A weak urine stream
  • An intermittent urine stream
  • Straining to urinate
  • Inability to empty the bladder
Common irritative symptoms: 
  • Frequent urination
  • Urgent need to urinate
  • Waking up at night to urinate (nocturia)
  • Leakage when you have the urge to urinate

 

Who is more likely at risk for benign prostatic hyperplasia?

Men with the following factors are more likely to develop an enlarged prostate:

  • Age 40 years and older
  • Family history of benign prostatic hyperplasia
  • Medical conditions such as obesity, heart and circulatory disease, and type 2 diabetes
  • Lack of physical exercise
  • Erectile dysfunction

How we diagnose an enlarged prostate

At City of Hope, we use several methods to diagnose an enlarged prostate, including:
  • Symptom score sheets:  These forms detail the symptoms patients may be experiencing. They are a valuable resource when diagnosing and directing therapy for patients.
  • Flow rate test: This test assesses a patient’s urine flow rate by measuring the strength of the patient’s stream. A stream of less that 15ml/s is highly indicative of an obstruction. 
  • Postvoid residual measurement:  Also known as a bladder scan, this noninvasive test ensures that you are emptying your bladder completely. The results of this test determine whether or not a patient is at risk of infection as well as if anticholinergic medications may be prescribed. 
  • Cystoscopy: This procedure involves placing a small camera into the urethra and bladder to determine the nature of the prostate anatomy, particularly the length of the prostate, and if the prostate has a median lobe creating a ball valve effect.  
  • Prostate volume measurements: This is an important test which places a small probe into the rectum to measure the prostate. Measuring the prostate’s size is important because it helps doctors determine the best treatment type of surgery to perform. For a smaller prostate, many surgical options are available; for larger prostates, there are only a few options that we recommend that have been shown to be most effective. The ultrasound measurement is the most accurate way to determine size.
  • Prostate specific antigen: Also known as PSA, this blood test detects prostate cancer and is necessary for every man between 45 and 75 years of age. Operating on a prostate with cancer is risky, and it is important to determine if there is any concern for cancer before starting treatment. 
  • Urine culture: This test involves collecting urine in a small cup and testing for infection. Prior to any surgery, we will test your urine to make sure there is no infection. If there is, we will treat it before we operate.

How is prostate enlargement (benign prostatic hyperplasia) treated?

Working together with your urologist, you can determine a personalized treatment plan based on your preferences, prostate size and overall health.

At City of Hope, we offer several effective treatment options for enlarged prostate, including:

Lifestyle changes

Simple lifestyle changes may positively impact an enlarged prostate diagnosis. Some helpful techniques for patients include:

  • Timed voiding: The goal of timed voiding is to empty the bladder on a regular basis, rather than waiting for the urge to urinate. Patients should urinate every two hours, even if there is no urge.
  • Caffeine and alcohol avoidance: Caffeine and alcohol not only act as diuretics (pulling extra water into the bladder to make you urinate more) but they are also a direct irritant to the lining of the bladder.
  • Double void: Often, people do not completely empty their bladder, resulting in the bladder filling more quickly. With this technique, a patient urinates normally, then waits about 10 seconds before attempting to urinate again.
  • Decrease fluids at night:  When we eat and drink, the fluid in the food we consume ultimately gets converted to urine. If you drink fluid at night, they will continue to make urine that will then fill the bladder. When the bladder is full at night, it is harder for our brain to silence the signals that it sends because we are sleeping. This often results in nocturia, or getting up at night to urinate. To help prevent this, it is helpful to cut back on fluids three hours before bedtime.
  • Kegel exercises and urge suppression techniques: To exercise Kegel muscles, squeeze and hold for ten seconds, then relax for ten seconds. Repeat this process ten times once a day. When the urge to urinate comes, the best thing to do is squeeze and hold the muscle until the urge passes.

Medications

Prescription medication can also help ease the symptoms of an enlarged prostate. The medicines we typically use are:

  • Alpha-blockers: Usually a first line medical therapy, these medications work by relaxing the muscles of the prostate to allow urine to pass through more easily. Examples include tamsulosin (Flomax), alphazosin (Uroxatral), silodosin (Rapaflo), doxazosin (Cardura) and terazosin (Hytrin).
  • 5 alpha reductase inhibitors: These medications shrink the prostate over time and prevent future growth. Examples include finasteride (Proscar) and dutasteride (Avodart). They are suitable for patients with prostates measuring 40 grams or more.
  • Anticholinergics: These medications relax the muscles of the bladder and are effective for men experiencing irritative symptoms. Examples include oxybutinin (Ditropan), trospium (Sanctura), fesoterodine (Toviaz), darifenacin (Enablex), solifenacin (Vesicare) and toltoerodine (Detrol).  

Surgery

When performing surgery for an enlarged prostate, the goal is to remove or displace tissues that cause obstructions so that the bladder can empty more easily. After most operations, both obstructing and irritative symptoms will improve, however the degree of improvement is dependent on the severity of symptoms before the surgery.

There are many surgical options for treating an enlarged prostate. At City of Hope, we have expertise in the following procedures used to treat those suffering from an enlarged prostate:

  • UroLIFT surgery: This is a relatively new procedure that inserts small UroLIFT implants to hold the prostate open. While the procedure may not be as effective as other operations, it is less invasive and usually will not cause problems with retrograde ejaculation, or erectile dysfunction.




     
  • Transurethral resection of the prostate: This procedure involves removal of the part of the prostate that is causing a blockage. This is an incredibly effective treatment option and is considered the gold standard.
  • Holmium laser enucleation (HoLEP): This procedure removes all obstructing tissue from the prostate, which is then pushed into the bladder where a device collects and disposes of the tissue. While this is one of the most thorough procedures available, it has a higher rate of urinary incontinence early in the postoperative period. Long-term, this procedure has been shown to be the most effective surgical option.
  • Green light photo-vaporization (PVP): For patients who require surgery and must take blood thinners, this is the best option. Otherwise, this procedure has a higher retreatment rate compared to other options. Also, patients tend to have more irritation and pain after this procedure, as compared to the others.
  • Bipolar enucleation: This approach is similar to the HoLEP procedure, but the obstructing tissue is left attached to the capsule near the bladder, where it is removed in a standard fashion. The advantage here is that there is no special equipment required.
  • Robot simple prostatectomy: This procedure removes the prostate through the bladder and is used for men with large prostates measuring over 150-200 grams. It is a good option for men who also need to have a bladder diverticulum removed.

Surgical side effects

  • Bleeding:  All prostate surgery carries a risk of bleeding. Normally the bleeding is mild, but in rare cases it can be severe, requiring reoperation and blood transfusion.
  • Retrograde ejaculation: This phenomenon occurs when climax is achieved, but rather than having emission of semen, the semen goes backward into the bladder. There is no harm to the body when this happens, but it does impact fertility.
  • Urethral strictures: Urethral stricture is a condition where the urethra narrows. This is a rare complication, but when scopes are placed into the urethra, it can cause damage and lead to scar tissue formation and strictures. All procedures carry about a 1-2 percent chance of strictures.
  • Bladder neck contractures: The rate of bladder neck contractures is low for prostate surgery, but some procedures have a higher rate than others. Bladder neck contractures occur when scar tissue develops at the base of the bladder as it leads into the prostate.  
  • Stress urinary incontinence: This rare complication is characterized by leakage from your bladder when you cough or sneeze. In some of the more thorough procedures, men will leak urine for the first few weeks of recovery.
  • Erectile dysfunction (ED): Depending on the type of operation, between 0 and 10 percent of patients will experience erectile dysfunction as a result of enlarged prostate procedures. The severity of ED is usually mild after these surgeries.
  • Temporary worsening of symptoms: After surgery it is not uncommon for some patients to experience a worsening of their symptoms, particularly frequency of urination, pain when urinating and urgent urination. These usually resolve over the first two weeks.
City of Hope brings expert urologic care to treating any urologic condition.

Urologic Surgeons - Duarte

Clayton S. Lau, M.D.

Clinical Specialties

  • Urologic Oncology
  • Urology
Kevin G. Chan, M.D.

Clinical Specialties

  • Urologic Oncology
  • Urology
Laura Crocitto, M.D., M.H.A.

Clinical Specialties

  • Urologic Oncology
  • Urology
Jonathan Lim Yamzon, M.D.

Clinical Specialties

  • Urologic Oncology
  • Urology
Bertram Yuh, M.D., M.S.H.C.P.M., M.I.S.M.

Clinical Specialties

  • Urologic Oncology
  • Urology

Urologic Surgeons - Community

Clayton S. Lau, M.D.

Clinical Specialties

  • Urologic Oncology
  • Urology
Seth A. Cohen, M.D.

Clinical Specialties

  • Female Pelvic Medicine and Reconstructive Surgery
Donald Hannoun, M.D.

Clinical Specialties

  • Urology and Urologic Oncology
Roger W. Satterthwaite, M.D., M.P.H.

Clinical Specialties

  • Urologic Oncology
  • Urology
Jonathan N. Warner, M.D.

Clinical Specialties

  • Urology and Urologic Oncology
  • Reconstructive Urology
Kristina Wittig, M.D.

Clinical Specialties

  • Urology and Urologic Oncology
Jonathan Lim Yamzon, M.D.

Clinical Specialties

  • Urologic Oncology
  • Urology
Benjamin J. Yuh, M.D.

Clinical Specialties

  • Urologic Oncology
  • Urology
Bertram Yuh, M.D., M.S.H.C.P.M., M.I.S.M.

Clinical Specialties

  • Urologic Oncology
  • Urology
Ali Zhumkhawala, M.D.

Clinical Specialties

  • Urologic Oncology
  • Urology

Urologists - Community

Edward L. Davis, M.D.

Clinical Specialties

  • Urology and Urologic Oncology
Philip G. Pearson, M.D.

Clinical Specialties

  • Urology and Urologic Oncology
David W. Rhodes, M.D.

Clinical Specialties

  • Urology and Urologic Oncology
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