Enlarged Prostate (BPH)
What is the UroLift System?
The UroLift® System treatment is a revolutionary, minimally invasive approach to treating an enlarged prostate, or BPH, that lifts or holds the enlarged prostate tissue out of the way so it no longer blocks the urethra. There is no cutting, heating or removal of prostate tissue.
Clinical data has shown that the UroLift System treatment is safe and effective in relieving lower urinary tract symptoms due to BPH without compromising sexual function1,4. The goal of the UroLift System treatment is to relieve symptoms so you can get back to your life and resume your daily activities.
Most common side effects are light blood in the urine, some pain or discomfort when urinating, some increased urge to go and discomfort in the pelvis that typically resolve within two to four weeks after the procedure.
Advantages of the UroLift
Rapid symptom relief, better than reported for medications
Risk profile better than reported for surgical procedures such as TURP
Preservation of sexual function
Return to normal activity in days not months
Increased quality of life
No ongoing BPH medications
How the UroLift Works
The UroLift System treatment is a straightforward procedure that is performed by a urologist. The urologist places tiny implants to hold the prostate lobes apart, like open curtains on a window, to relieve compression on the urethra. This allows urine to flow normally again. The UroLift System treatment can be done in the physician’s office under local anesthesia. Typically, patients return home the same day without a catheter.2
Enlarged Prostate: An enlarged prostate compresses on the urethra, making it difficult for urine to flow
Step 1: The UroLift Device is placed through the obstructed urethra to access the enlarged prostate.
Step 2: Small UroLift Implants are permanently placed to lift and hold the enlarged prostate tissues out of the way and increase the opening of the urethra. The permanent implants are delivered through a small needle that comes out of the UroLift delivery device and into the prostate.
Step 3: The UroLift delivery device s removed, leaving an open urethra designed to provide symptom relief.
McVary J Sex Medicine 2014
Roehrborn J Urology 2013; 2003 AUA Guidelines
Sonksen J Urology 2016
Roehrborn Urology Clinics 2016
As men age, one of the urological conditions they frequently experience is an enlarged prostate gland. This issue, also known as benign prostatic hyperplasia, or BPH, typically affects men over 40. As the prostate — which is just below the bladder — swells, it can cause associated issues in the urinary tract, like frequent urination and nighttime urination (nocturia), incontinence, dribbling after urination, difficulty urinating, painful urination, or blood in the urine.
What Is Rezum?
Rezum Water Vapor Therapy provides an alternative to traditional surgery for an enlarged prostate. It is recommended for men with bothersome urinary issues, including a prostate volume that falls within a treatable range and in a treatable area.
This procedure, which is conducted in our office, takes less than ten minutes per treatment. It targets any of the enlarged prostate tissue surrounding the urethra, with the goal of treating the tissue to shrink the prostate over time.
During Rezum, sterile water vapor, or steam, is inserted into the obstructing prostate tissue. Radiofrequency energy from this steam is released into the tissue. That energy then travels to the cell membranes, eradicating those problematic cells. The body’s natural healing mechanisms kick in to absorb the tissue that has been treated. The area around the urethra can then open and the flow of urine can resume as normal.
What Should I Expect During the Rezum Procedure?
The procedure will be performed in the office and a general sedative may be used and given intravenously. Patients first empty the bladder (with additional catheter draining, if needed) and then the prostate is numbed. We insert the Rezum device into the urethra and perform the vapor injection. Depending on the size of the enlarged prostate, patients may need two to seven treatments within this single visit.
If you are receiving Rezum, we have a few guidelines. The day before, we recommend drinking plenty of fluids, eating a light meal, and refraining from physical activity. You should refrain for food or drink for four hours prior to the procedure.
You will also need someone to accompany you to the visit, as we do not allow patients who receive Rezum to drive home on their own after being sedated.
Rezum is frequently covered by insurance and is typically covered under Medicare. Once we discuss this treatment option with you at your initial office visit, we can verify whether or not your insurance will cover the cost of the Rezum therapy.
What Is the Recovery Time?
While Rezum is not surgery, it does require some downtime after the procedure, primarily because you will have a catheter inserted for the next few days. Most men can return to normal activity within a few days. You may be prescribed medication if needed.
Rezum will not interfere with your ability to get an erection, but we do recommend against intercourse for the first few days following the procedure. If you have any issues with erectile dysfunction following your procedure, please let us know so we can treat the issue.
It is important to note that because Rezum destroys cells with the ultimate outcome of healing the enlarged prostate, symptoms can worsen slightly over the couple of weeks following the procedure. You may notice additional difficulty or frequency in urination. This is not a cause for alarm; in fact, it means the body is healing. The inflammation will subside and within several weeks — between two and eight — your urinary tract should be functioning normally and your symptoms should be gone.
How Successful Is Rezum and What Are the Risks?
Unlike surgeries to treat BPH, Rezum has shown very few side effects in small numbers of patients who undergo the procedure. These rare side effects may include the following:
- Painful urination
- Frequent urination
- Difficulty urinating or completely emptying bladder
- Blood in urine or semen
Rezum has not been shown to cause erectile dysfunction, but these issues may naturally occur in men who have received Rezum simply because they are within an age range that is more frequently diagnosed with ED. This is not related to the Rezum therapy itself.
Rezum is a cutting edge alternative to surgery, which is more invasive and can be more costly. If you are suffering the effects of an enlarged prostate or have been diagnosed with benign prostatic hyperplasia, make an appointment with us today so we can discuss your options, including Rezum Water Vapor Therapy.
Greenlight Laser (LP)
Catching BPH early, before it wreaks havoc on other organs, is one of the reasons men are encouraged to see a doctor for annual rectal exams and any associated prostate blood tests. When an enlarged prostate has become an issue requiring treatment, there are a couple of options — one being GreenLight Laser Therapy, which has treated over 1 million men globally to date.
What Is GreenLight Laser Therapy?
GreenLight Laser Therapy involves the removal of affected tissue from the enlarged prostate gland. This treatment method, which is also sometimes referred to as Photoselective Vaporization of the Prostate, uses a laser, or focused beam of light, to cut away problematic tissue surrounding the urethra.
The GreenLight procedure is an outpatient therapy conducted in our office. It takes about an hour. It is ideal for patients who are unable to stop taking certain medications, usually blood thinners or anticoagulants, whereas other procedures may require patients to stop these prescriptions for several days or weeks.
GreenLight Laser Therapy is an alternative to traditional prostate surgery, which can have a variety of risks and may require hospitalization. This procedure has been shown to have fewer complications than other types of prostate surgeries.
What Should I Expect During the GreenLight Procedure?
GreenLight Laser Therapy requires anesthesia but depending on whether the doctor uses spinal or general anesthesia, you may be required to fast prior to your appointment. The doctor will also let you know what medications to stop taking, if applicable, though anticoagulants and blood thinners do not interfere with GreenLight as they do with other procedures.
Also depending on the type of anesthesia used, you may or may not be conscious during the procedure. The doctor will insert a fiber-optic cystoscope into the tip of the penis and feed it through the urethra to the place of the affected prostate tissue. The laser will then destroy this prostate tissue by means of removal or vaporization, effectively destroying the blockage.
If you are receiving GreenLight Laser Therapy, we do require that someone accompany you to the appointment in order to drive you home afterward, as you will have a catheter inserted after the procedure. The doctor may prescribe antibiotics to prevent infection, if applicable.
GreenLight is often covered by insurance and/or Medicare. We can verify your coverage options prior to the procedure.
What Is the Recovery Time?
After the GreenLight procedure, you will want to take it easy for the rest of the day. Some mild side effects can include nausea or constipation, so patients are advised to drink plenty of fluids and try to stick to soups and liquid meals for a day or two if either of these issues are present.
You will have a catheter in for several days, which will require some care. Additional common side effects include some light blood in the urine — or pink-tinged urine — as well as frequent urination and a burning sensation during urination. These issues should resolve themselves within a few days to weeks.
We recommend that patients wait to resume normal physical activity for 1 week after GreenLight Laser Therapy, and then to start slowly, with walks instead of runs, for instance. We do not recommend any heavy lifting for at least 2 weeks after the procedure. We also strongly recommend patients do not have sexual intercourse for at least 1 to 2 weeks post-procedure.
Within 4 to 6 weeks, the inflammation from the prostate’s healing process should subside and side effects should be gone.
How Successful Is GreenLight and What Are the Risks?
The majority of patients who receive GreenLight Laser Therapy notice relief from BPH symptoms within 24 hours. This is typically reported as an almost immediate return to normal urine flow. GreenLight has been shown to last for up to 5 years post-procedure. 86% of patients reported either an improvement in sexual satisfaction, or no change following the GreenLight therapy.
Since GreenLight is a surgical procedure, there are some risks associated with it. Some men experience heavier bleeding or a urinary tract infection. If blood in the urine is thick or lasts longer than a week, contact your doctor immediately.
Occasionally, men may experience “retrograde ejaculation,” when semen is emitted into the bladder instead of through the urethra and out of the penis during orgasm. This is a rare side effect, but if you do experience this, talk to your doctor about your options.
GreenLight has been shown to be an extremely effective alternative to traditional prostate surgeries and offers a safe option for those on certain medications. There are fewer risks and no hospitalizations required with the GreenLight procedure, making it a popular option among men with BPH. If you are suffering from uncomfortable symptoms related to an enlarged prostate, give us a call to book an appointment. We will talk through the pros and cons of all of your options, including GreenLight Laser Therapy.
TURP – Transurethral Resection
With annual rectal exam and regular blood testing for prostate issues, BPH can usually be detected and treated early. However, if BPH detection is delayed, symptoms are severe enough, or the prostate is enlarged within a certain range, additional procedures may be necessary. There are minimally invasive, non-surgical options available, as well as surgeries such as a transurethral resection of the prostate.
What Is Transurethral Resection?
Transurethral resection of the prostate, or TURP, removes portions of the prostate gland via surgery. However, there are no incisions made on the patient’s outer skin. Instead, the doctor uses a resectoscope, a thin tube inserted into the tip of the penis. This device has a loop of wire and a camera that allows the doctor to see internally.
Surgery is preformed by heating up a wire loop with electricity and cutting up sections of prostate blocking urethra and not allowing bladder to empty. It is the Gold Standard of BPH therapy under which all other therapies are tested.
Postoperatively a catheter may be placed into the urethra either for 1 night or 1 week. Most patients are admitted for 24 hour observation.
Not all patients are suitable or eligible for TURP. Our doctors discuss various options for treating BPH during in-office appointments.
What Should I Expect During the Transurethral Resection Surgery?
Patients are anesthetized during TURP and may either be conscious with a spinal anesthetic or unconscious under a general anesthetic but will not feel any pain during the surgery. The surgery itself takes between one and two hours and takes place in a hospital.
If you are receiving transurethral resection surgery, we have several important guidelines. We generally recommend that patients stop certain prescription drugs, including blood thinners, Ibuprofen, and aspirin, several days prior to the procedure.
You will need to fast for 8 to 10 hours prior to surgery. You will also need someone to accompany you to the surgery, as you will be unable to drive home on your own. Patients will either go home after surgery or be admitted overnight for observation.
What Is the Recovery Time?
Postoperative care for TURP patients includes remaining in the hospital for an additional one or two days after the surgery. You will receive an antibiotic prescription to guard against infection, and will have a catheter inserted to facilitate the flow of urine. The catheter is usually removed within a couple of days, once the inflammation surrounding the surgery site goes down.
Patients who receive TURP are typically not able to do any strenuous activity for several weeks after surgery, and it is highly recommended that you take several days or weeks off work after your hospital stay, if possible. Refraining from exercise and other physical activity will greatly accelerate your healing time, and engaging in it could hinder your results or cause additional damage.
Blood in the urine can occur immediately following surgery, but should not last for longer than a few days. If the blood appears to be about the consistency of ketchup, you may have a blood clot and it is important to notify your doctor immediately.
It is also normal to have some pain during urination or to have the urge to frequently urinate. This should subside within the first one to two months post-surgery. Your doctor may also prescribe a stool-softener to prevent constipation, as straining during a bowel movement could disrupt the surgery site.
The doctor will discuss any additional lifestyle modifications when reviewing your treatment plan with you, but you should expect not to have sex for four to six weeks, to drink excess water and foods high in fiber, and not to drive until you are finished taking any medications. Your doctor may also recommend you stay off of certain prescription medications throughout the recovery process.
How Successful Is TURP and What Are the Risks?
TURP is a highly successful procedure very often used to treat BPH. Unlike non-surgical procedures which can reduce or eliminate an enlarged prostate for a period of several years, TURP typically reduces BPH permanently.
However, as transurethral resection of the prostate is a surgery, there are risks of ongoing complications or continued discomfort. The most common is retrograde ejaculation, where either very little semen or none at all is released during orgasm. While this issue does not affect the ability to orgasm, they can impact fertility.
Other side effects include urinary tract infections (UTIs) or incontinence. In extremely rare instances, a long-term and potentially harmful condition called TUR Syndrome can occur.
It is important to contact a doctor if you experience any of the following symptoms after surgery:
- Inability to urinate
- Signs of blood clotting (thick blood in the urine)
- Blood in the urine that lasts more than two days after surgery
If you are dealing with the symptoms of an enlarged prostate, give us a call. We can diagnose the issue and if you are diagnosed with BPH, we can talk through your options, including non-surgical procedures. If transurethral resection surgery is necessary, we will work with you on preoperative and postoperative plans, and ensure all your questions are answered.
An enlarged prostate gland can occur as men age, or occasionally when there is another underlying medical condition. This urological condition, known as benign prostatic hyperplasia (or BPH), can manifest symptoms such as frequent urination, especially during the night (nocturia), dribbling, incontinence, painful or difficult urination, or traces of blood in the urine.
Since the swollen prostate is pressing on the bladder or blocking the urethra, it can affect the entire urinary tract. If caught earlier on, it can sometimes be treated with minimally invasive procedures. If left untreated for some time, it may require surgery. One of the surgical options to treat BPH is called a robotic simple prostatectomy.
What Is a Robotic Simple Prostatectomy?
Simple prostatectomy is a surgical procedure used to treat men with severely enlarged prostate glands. Generally, this procedure is reserved for patients having a prostate greater than 80 gm in size as measured by transrectal ultrasound.
This procedure is a specialized technique performed by a robotically trained Urologist. The procedure aims to remove enlarged tissue but keep the prostate itself intact, as opposed to a radical prostatectomy which removes the entire prostate gland when localized prostate cancer is present. Simple prostatectomy involves accessing the inner tissue of the prostate gland through small laparoscopic incisions made in the abdomen. The outer portion of the prostate is left intact and the surgical cut is closed with sutures (stitches). This technique is analogous to taking the fruit from an orange while leaving the peel behind. The capsule (or peel) is where the nerves foe erectile function and continence reside.
While simple prostatectomy surgery is considered more invasive than other procedures to treat BPH, the success rate is quite high, and the need for additional treatment — even years down the line — is very rare in comparison to other methods.
What Should I Expect During Simple Prostatectomy Surgery?
Patients are anesthetized, either generally or spinally, which means they are either asleep or awake, but either way, they do not feel any pain. The surgery itself lasts between two and four hours and requires staying in the hospital for one to two days.
Since anesthesia is used, you will need to fast prior to the surgery, typically from midnight the night before. You may also need to stop taking certain medications a few days in advance. In addition, the doctor may ask you to use an enema to assist you will a bowel movement that morning. Our specialists will guide you on the specific instructions to prepare for your procedure.
What Is the Recovery Time?
Since you will have a catheter in for up to two weeks after the surgery, you will need to refrain from sex and strenuous physical activity for at least four to six weeks. You may also need a drain for fluids while recovering in the hospital. Patients will usually be able to determine when they feel well enough to add light activity back in.
The doctor will give you postoperative care guidelines, but usually we recommend taking off of work for up to one week after the procedure if possible. You will be prescribed pain medication and possibly an antibiotic to prevent infection.
Sutures are internal, so they will gradually dissolve on their own and a scar will form over the incision site. You will be given specific instructions on how to care for the site. Compliance is critical so that the site does not become infected and the scar tissue heals optimally.
You may have pain when urinating or difficulty urinating for some time after the surgery as your body heals. Since the enlarged prostate tissue will no longer be blocking urine flow, the urinary tract will be adjusting to the lack of strain. This could also result in incontinence.
You may notice blood in the urine, or pink-tinged urine, which is a common side effect. This should clear up on its own within a week or two, but if bleeding becomes worse, is thick and ketchup-like, or if you develop a fever or severe pelvic pain, call your doctor immediately.
How Successful Is Simple Prostatectomy and What Are the Risks?
Since this procedure is a more invasive surgery, complications are more likely, but most men do not have long-term side effects. One of the common sexual side effects after simple prostatectomy is tthe emission of very little semen during an orgasm, called retrograde ejaculation. For this reason, the doctor will likely not recommend this surgery if you are planning to conceive in the future.
Serious complications could include bleeding from the surgical site, erectile dysfunction, urinary incontinence, or the inability to urinate without a catheter due to constriction around the urethra if the site does not heal properly. Many complications result from patients not taking care of their sutures properly, but following the doctor’s guidelines will greatly decrease this risk.
Unlike other procedures, simple prostatectomy typically only needs to be done once, so follow up surgeries five or ten years later are not usually necessary. A full recovery with normal urinary function is the most common outcome.