Benign Prostatic Hyperplasia (BPH)

Benign Prostatic Hyperplasia (BPH)

Benign prostatic hyperplasia, or BPH, is a non-cancerous enlargement of the prostate that affects millions of men. Symptoms are usually related to problems with urination. Symptoms may include:

  • Slow urinary stream
  • Straining to empty the bladder
  • Urinary frequency
  • Urinary urgency
  • Nocturia - Waking at night to urinate
  • Urinary retention - inability to urinate

Treatment of this condition is usually driven by the symptoms. If the symptoms are mild, some men elect no treatment. More bothersome symptoms may necessitate treatment.

There are many available treatments for this common condition including:

1.  Observation:

Some men with mild symptoms choose no active treatment, with regular follow-up by their physician to monitor for progression.

2.  Medications:

Several medications are available to treat the symptoms of BPH including alpha-blockers such as terazosin, doxazosin, or tamsulosin. Another group of drugs, known as 5 alpha reductase inhibitors ( e.g., finasteride or dutasteride), may be used in combination with the alpha-blockers to control the symptoms of BPH including urinary frequency, slow stream, and nocturia.

3.  Thermotherapies: 

There are several urologic procedures that involve placing an instrument into the urethra to heat the prostate and destroy prostate tissue. These include microwave therapy, interstitial laser therapy , and needle ablation therapy.

4.  Surgical Therapies including:

  1. Laser ablation: A surgeon uses a laser guided through a telescope placed in the urethra to vaporize the prostate tissue under anesthesia. Examples include the GreenLight HPS (available at the Univeristy of Virginia), and the Holmium Laser. This therapy uses a high power laser to evaporate the prostate tissue. Patients can often go home the same day with a catheter in their bladder that is removed in 1-2 days.
  2. TURP: This is traditional prostate surgery using an electocautery loop and is done under anesthesia.  This is  sometimes called "the roto-rooter" operation by laymen. A telescope is introduced into the urethra to visualize the prostate as tissue is removed from the prostate while cautery is applied (diagram). Patients stay overnight and have a catheter in their bladder for 1-2 days.
  3. Open surgery: In highly selected patients with very large prostates, the traditional open surgery with anesthesia may be necessary to remove the obstructing tissue in the prostate. A catheter is placed for several days and a hospital stay of several days is the norm.

All of these procedures are available at the University of Virginia.