BPH (Enlarged Prostate)

What causes Benign Prostatic Hyperplasia?

Your prostate may become larger as you age, often beginning in your 40s – 50s, sometimes earlier. The condition, called BPH, is non-cancerous and is very common. But it’s important to have BPH treated because the enlargement tends to block the urethra and urine flow out of the body. Without treatment, an eventual loss of bladder function can occur. Although commonly related to an enlarged prostate in men, symptoms can also be due to urinary tract infections, bladder or kidney stones, urethral stricture/scar tissue formation, inflammation of the prostate (prostatitis), problem with the nerves to the bladder, or a cancer of the bladder or prostate. That’s why it’s important to see your urologist if you experience these symptoms.

How is Benign Prostatic Hyperplasia diagnosed?

What to know before your visit to Michigan Institute of Urology in Southeast Michigan:

• During your visit, your doctor will ask about your medical history and will exam your abdomen and genitalia. You may be asked to complete a short survey regarding how you urinate.

Tests that may be performed during or after your visit:

• Digital rectal exam: The size of your prostate, and any possible abnormalities, are determined as your physician inserts a finger into your rectum.
• Urinalysis: A urine test evaluates for blood in the urine or infection.
• Cystoscopy: This is a procedure performed in the office where the physician inserts a small scope into the penis to assess the urethra for any scar tissue and evaluate the prostate for any evidence of obstruction.
• Prostate ultrasound: A probe is inserted into the rectum to check the size and shape of the prostate.
• Blood test: A blood test called a PSA (prostate-specific antigen) test will help determine your risk for prostate cancer.
• Post-void residual: You are asked to urinate. Then you are checked to make sure you are emptying your bladder.
• Urine flow: You urinate in a funnel to assess the speed of your urinary stream.
• Urodynamics: A small tube is inserted into the penis and another into the rectum to help measure the pressures in the bladder during urination.
• Urocuff test: An easy, in-office test to measure urine flow with the use of a small cuff around the penis.

How is Benign Prostatic Hyperplasia treated?

We offer a variety of BPH treatments to put you at ease and help protect your bladder and your kidneys. BPH is among the leading reasons men visit the urologists at Michigan Institute of Urology, and why we are dedicated to offering the most advanced treatments to suit a range of needs.

View BPH Treatment Pathway

NON-SURGICAL TREATMENTS

• Lifestyle modifications: The most conservative course of action is best to try first, unless circumstances warrant a more aggressive approach. These simple steps may include changing bathroom habits and dietary changes.
• Alpha blockers: Medication to relax the prostatic urethra and bladder neck, making urination less difficult. Most common are tamsulosin (Flomax), silodosin (Rapaflo), and alfuzosin (Uroxatral).
• 5-alpha reductase inhibitors: Medication to shrink the prostate (takes 4-6 months to start working). Most common are finasteride (Proscar) and Dutasteride (Avodart).
• Tadalafil (Cialis): Improves quality of life related to urination and is used to treat erectile dysfunction.

SURGICAL TREATMENTS

• Prostate Artery Embolization (PAE): Prostate artery embolization, or PAE, is a non-surgical procedure that can improve lower urinary tract symptoms by blocking the blood flow to the prostate, thereby reducing the size of the prostate. PAE is a revolutionary treatment for BPH at our IR Centers location in Troy. Learn more.
• UroLift®: This incision-free procedure involves retracting, not removing, the tissue that blocks the urethra. The surgeon inserts small implants into each side of the prostate, pulling the walls of the prostate away from the urethra and opening the channel.
• Rezum: A treatment that uses the natural energy stored in water vapor, or steam, to remove excess prostate tissue that is compressing the urethra. A catheter may be required for a short time after the procedure.
• Transurethral Incision of the Prostate (TUIP): This procedure involves in a precise pair of incisions being made in the bladder neck where the prostate merges with the bladder. This will release the restriction of the bladder-outlet and dramatically improve symptoms of BPH.
• GreenLight™ Laser Therapy and HOLEP Laser Therapy: These approaches rely on a laser to vaporize obstructing prostate tissue or enulcleate the obstruction altogether. A catheter is typically required temporarily post-op, and an overnight stay is often advised.
• Aquablation therapy: Using robotic technology, the surgeon delivers heat-free water jets to trim invasive prostate tissue. This procedure requires anesthesia and an overnight hospital stay.
• Transurethral resection of prostate (TURP): This remains the gold standard of treatment against which all other options are compared. During the procedure, the physician gently threads a thin instrument called a resectoscope through the urethra and into the prostate. The resectoscope, equipped with a camera, delivers electric currents to trim away obstructing tissue.
• Optilume® BPH Catheter System: Optilume BPH is a drug-coated balloon inserted into the urethra to the prostate via a telescopic camera. The balloon expands and creates an opening to release the safe and proven drug, paclitaxel, into the prostate. When the drug is fully released, the balloon is deflated and removed. The applied drug prevents re-fusion of the lobes during healing, keeping the prostate open, restoring the flow of urine, and relieving symptoms.
• Open Simple Prostatectomy: Simple prostate removal, or prostatectomy, is a procedure to remove the inside part of the prostate gland to treat an enlarged prostate. it is done through a surgical incision and generally requires a 2-4 day hospital stay, 6-8 weeks recovery.
• Single Port Robotic Prostatectomy: This is enucleation (keeping the capsule intact) of the prostate. It is done through a single incision approximately 1 ½ inches long below the belt line and accessing the prostate directly through the bladder. This is a safer technique with less pain postoperatively due to not having to use more than one incision and not going through the abdominal cavity.  The entire procedure usually takes around 90 minutes plus time for anesthesia. Patients are sent home the same day with a Foley catheter for 10-14 days. This is the only procedure that can remove 90% or more of the prostatic tissue blocking the bladder for prostate glands larger than 120cc in volume.

Additional treatments that MIU surgeons are studying and have experience with include iTind™ and Butterfly Stent. Both are minimally invasive procedures that hold great promise in the arsenal against BPH.