BPH is another term for benign enlargement of the prostate gland. It is very common in older males, affecting approximately half of men in their 50’s, and the majority of men in their 70’s and 80’s. The prostate gland surrounds the urethra like a doughnut, and the urethra passes through it. Often enlargement of the gland can cause urethral compression, leading to difficulty with urination. At Comprehensive Urology, we offer a variety of treatments to help men with BPH, tailored to their specific situation.

BPH Symptoms

Symptoms of benign prostatic hyperplasia vary from person to person, and can include one or many of the following:

  • Difficulty starting urination (urinary hesitancy)
  • Slow urinary flow and having to “push” to urinate
  • Intermittent flow of urine
  • Sense of incomplete bladder emptying
  • Having to use the restroom too often and shortly again after urination
  • Having to wake up from sleep to urinate (nighttime urinary frequency interrupting sleep)
  • Urinary urgency and difficulty postponing urination
  • Urinary incontinence (leakage of urine)

When left untreated, BPH can lead to bladder dysfunction and physical damage to the bladder, recurrent urinary tract infections, and even obstruction of the kidneys and subsequent kidney failure.

Diagnosis

Los Angeles Benign Prostatic Hyperplasia TreatmentA proper diagnosis is essential to developing the optimal treatment plan for each patient with BPH. Our physicians first begin with a thorough history, including your IPSS or Internation Prostate Symptoms Score. Men can complain of a multitude of symptoms, and therefore it is essential that a treatment plan is based upon how BPH is specifically affecting each of their lives. Also, many symptoms of BPH can overlap with other disorders, such as overactive bladder syndrome or urinary tract infections. Therefore, it is important to thoroughly assess each patient to make the correct diagnosis.

Physical Examination – A thorough physical examination is paramount in the diagnosis of BPH. Specifically, the digital rectal examination is performed by inserting a gloved finger into the rectum in order to help determine if the prostate gland is enlarged, estimating the size and also other factors, such as pain or tenderness, which may be due to infection. Rectal exams are also used to help screen for prostate cancer.

Other tests to assist in the diagnosis and subsequent treatment of BPH include:

Urinalysis – A quick dip strip test of the urine can help detect abnormalities such as the presence of blood cells, inflammation or infection.

Urine Flow Test – This test measures the flow rate and amount of urine passed by the patient during a normal void. It is often used to monitor the response over time with treatment as well.

Post-Void Residual (PVR) – Usually done with a simple bladder scan with a probe placed over the lower abdomen to detect how much urine is actually left in the bladder after the patient has finished voiding.

Ultrasound – Ultrasound of the pelvis can aid with measurement of prostate gland size/anatomy, and changes in the bladder due to the enlarged prostate such as bladder stones or deformities. It can also help detect anatomic variations in the prostate gland or even prostate tumors. Ultrasound of the kidneys can also help determine the effects of BPH on the kidneys.

Cystoscopy – Direct visualization of the urethra and bladder by inserting a thin scope with a camera attached (called a cystoscope) after “numbing” the urethra with anesthetic gel. This invaluable test can help visualize the internal urethra and bladder with great detail and minimal to no discomfort in-office. It is used in many instances including in the determination of cause/degree of obstruction, the source of blood in the urine, checking for stones or tumors, removing objects from the bladder, etc.

prostate examinaton experts los angelesUrodynamic Studies – UDS precisely characterizes sensations and pressures within the lower urinary tract, and helps characterize the bladder’s response to filling and ability to empty with normal contractions, over-activity, reduced activity, and many other voiding issues. Often combined with a cystoscopy to thoroughly evaluate function and anatomy and plan for surgery or other treatments.

Our team at Comprehensive Urology will help determine which of these evaluations may assist in the diagnosis of BPH. They may also be used to help monitor progress once treatment has been initiated.

BPH Treatment

At Comprehensive Urology, there are a multitude of treatments available for BPH. The specific treatment options are tailored to each patient’s unique situation and needs, in order to provide the best possible outcome.

In general, BPH treatment involves the following:

  • Lifestyle modifications (fluid intake, voiding habits, etc.)
  • Medical management (medications)
  • Surgical procedures (in-office treatments or surgical treatment in the operating room)

Here, we briefly review these options:

Lifestyle Modifications

For mild urinary bother due to BPH, different adjustments such as reduced fluid intake before bedtime, decreasing use of bladder irritants (e.g. coffee, tea, etc.) and voiding before going to bed.

Medications

prostate medicine pills beverly hillsThere are two main classes of medications available to help manage urinary symptoms due to BPH:

  • Alpha Blockers:

These medications target the smooth muscle fibers inside the prostate gland and bladder causing them to relax. They will result in improved urinary stream and increased flow, usually within days. The low side effects profile and once-a-day regimen make them the first line of treatment for many patients.

  • 5 Alpha Reductase Inhibitors

These medications block the production or potent hormones that stimulate prostate growth. They take longer to show benefits compared to the previous group of medications but, in many cases, can actually cause the enlarged prostate to “shrink” with long-term use. They can be very effective either alone or in combination with alpha blockers.

  • ED Medications

Daily low-dose use of erectile dysfunction medications, such as Viagra or Cialis, has been found to improve urination in some BPH patients.

At Comprehensive Urology, your health care provider will discuss which treatment option is best for your particular situation.
In-Office Treatments

A number of procedures and treatments can be done in the office to treat BPH or manage its bothersome symptoms.

prostate cancer specialists beverly hillsOne of these options for BPH is a non-surgical technique called Trans-Urethral Microwave Therapy (TUMT). Using microwave energy applied to the prostate by inserting a special catheter into the urethra with local anesthetic, the prostate can be targeted with heat energy, which will cause the prostate to shrink and the urinary channel to enlarge. This procedure is performed in the office, is well-tolerated with minimal to no discomfort, and takes approximately 30 minutes. Urinary symptoms will gradually improve with the average maximum improvement seen between 8 and 12 weeks after the procedure. Many men are able to discontinue their use of medications for BPH after the procedure.

An option for improving some symptoms related to BPH is pelvic floor rehabilitation (PFR). This therapy combines a personalized home program that is developed from an office evaluation and various exercises are taught to the patient during office visits. The office evaluation consists of measurements of the pelvic floor muscles to establish a plan of care to strengthen them, and electrostimulation of the pelvic floor nerve and muscle tissues. It is relatively non-invasive and painless and has no significant side effects.
REZUM® is an exciting new BPH treatment that can also be done in the office, for details, please see the next section.

For treatment of irritative BPH symptoms (frequency, urgency, waking up to urinate at night, etc.) we perform peripheral tibial nerve stimulation (PTNS), which is a non-invasive treatment in-office that involves inserting a very small “acupuncture-sized” needle in the ankle and stimulating the tibial nerve close by with small electrical currents. This can be done within 30 minutes and initially on a weekly basis until the patient responds, and then just monthly or with even less frequency. Many patients who respond to this treatment may stop taking some of their bladder medication later.

Some men experience acute urinary retention due to BPH, in which traditionally an indwelling catheter is placed into the bladder which drains into an external drainage bag.  A newer option eliminates the need for an indwelling catheter during that time interval. Our physicians often place a temporizing SpannerTM prostatic stent instead which allows our patients to void normally and freely without the need for an external drainage bag until they are able to proceed with definitive treatment. No catheters or bags are needed. This treatment allows us to satisfy our goal of trying to optimize the management of the urinary obstruction while at the same time optimizing our patient’s quality of life.

Surgical Procedures

There are multiple surgical treatment options with various degrees of invasiveness for those men in whom medications may not be a suitable option. The concept of all treatments is essentially the same- to create a larger urinary channel through the prostate gland in order to allow easier urinary flow.

These include minimally invasive, office-based procedures, minimally invasive operative room procedures, and full surgical procedures:

  • TURP (Transurethral resection of the prostate)
  • PVP (GreenLight laser) and other laser treatments
  • UroLift® clip
  • REZUM®
  • Simple prostatectomy (open or robotic surgery to remove the blocking inner part of the prostate gland)

TURP

 

TURP (transurethral resection of the prostate) is considered the gold standard surgical treatment for BPH because of its durability and efficacy as a procedure. By using an endoscopic camera and an electrical loop, our surgeons can shave away the prostatic tissue and seal opened blood vessels until a larger urinary channel is created. No incision is made on the skin and you will be under anesthesia. A urinary catheter is left to drain the bladder until the channel is healed (usually 24 to 72 hours). Upon catheter removal, In most cases, the improvement in urinary flow and symptoms is dramatic.

A newer surgical option, called transurethral plasma vaporization and resection of the prostate (TURiP), allows our surgeons to perform a procedure almost identical to the TURP, but with several advantages. It allows vaporization of the prostate tissue as well as resection with bipolar electrical current. This current allows treatment to be performed in the setting of saline, a fluid found normally in our bodies. This, in turn, allows less risk of developing mineral abnormalities in the blood during the procedure, a problem found (although rarely) with TURP. This makes TURiP an even safer and more precise treatment of the prostate gland than the traditional TURP

Effectiveness of TURP

For men who experienced moderate to severe symptoms of benign prostatic hyperplasia, TURP has been proven to successfully improve undesirable symptoms associated with BPH. It is still the gold standard procedure for BPH. According to recent studies, men who underwent TURP experienced less symptoms compared with those who waited for the condition to fade away on its own.

Side Effects of TURP

Although TURP aims to improve symptoms of benign prostatic hyperplasia, some people have experienced unwanted post-surgery side effects. The most common side effects of transurethral resection of the prostate may include:

  • Bleeding After the Procedure – The bleeding gradually decreases over time and should stop completely after four weeks but usually stops much sooner.
  • Retrograde Ejaculation – Although most men are able to have erections and orgasms after TURP, some may not be able to ejaculate because the bladder neck is removed along with prostatic issue. This causes the ejaculate to enter the bladder, which will be passed out in the next flow of urine. This is completely harmless to the patient and may only disrupt fertility, but it has no effect on erections.

Less common side effects of TURP, which are rare, may include:

  • Erectile Dysfunction – The inability to achieve or maintain an erection during sexual intercourse (rare, but may happen)
  • Urethral Strictures – Scarring in the urinary tract that may cause even more obstruction to the urine flow
  • Urinary Incontinence – Surgery may result in the inability to hold or control the flow or urine (usually temporary and resolves more than 90% of the time in a week or two)
  • Infertility – This is linked to retrograde ejaculation. Although harmless, it may result in making natural insemination impossible
  • No Change in Urinary Symptoms – Unfortunately, surgery is not effective for very few people and the undesirable symptoms of BPH may persist, including difficulty emptying the bladder completely and frequent urination at night. Generally, the latter takes a while to improve after TURP.

Are You Considering TURP?

Surgery is not required for those suffering from BPH, as there are many non-surgical treatments to try first. If you are thinking about undergoing transurethral resection of the prostate to treat BPH, it is best to speak with an experienced urologist to understand all your options. TURP is best suited for those who have extremely bothersome symptoms of BPH.

PVP and Laser Treatments

Another newer minimally invasive surgical option is laser photovaporization of the prostate (PVP). The procedure is performed by using an endoscopic camera through the urethra as well, but instead of treating the tissue with an electric knife, the tissue is vaporized by utilizing a laser. The advantages of this procedure include less risk of complications (mostly bleeding) and indwelling catheter duration.

What is Laser Treatment for BPH?

Laser surgery is often an ideal option for men who have had little to no success treating moderate to severe urinary symptoms caused by an enlarged prostate. Unlike traditional surgery, laser treatment is minimally invasive and can be performed on an outpatient basis under general anesthesia. The procedure involves passing a scope through the penis into the urethra and then passing a laser through the scope to reach the prostrate. The laser is used to shrink or remove excess prostate tissue that has been blocking the urethra and causing the symptoms of BPH.

Types of Prostate Laser Surgery

There are several types of prostate laser treatments available, each using the concentrated light to direct precise, intense heat at the prostate tissue. These laser treatments include:

Holmium laser enucleation of the prostate – The laser cuts through excess tissue while another instrument is used to cut these pieces down even further to be easily removed.

Photoselective vaporation of the prostate – The laser melts or vaporizes the excess prostate tissue to make the urinary channel larger.

Holmium laser ablation of the prostate – This laser also melts away or vaporizes the excess prostate tissue.

The type of laser that a surgeon chooses will depend on the size of the enlarged prostate, as well as the patient’s health, and the lasers that are available. Comprehensive Urology has access to the most advanced technology and instruments available courtesy of Cedars Sinai Medical Center.

What are the Benefits of BPH Laser Treatment?

Laser therapy is one of the most commonly used treatments for an enlarged prostate because it has several advantages over traditional surgery, including:

Reduced risk of bleeding – Laser therapy is minimally invasive and leaves the surrounding tissue and muscle relatively untouched. The laser can be used to precisely remove an exact amount of the prostate, therefore, patients suffer less blood loss and can heal much quicker.

Shorter recovery time – Recovering from minimal incisions on the prostate is much quicker for most patients compared to traditional operations.

Limited or no hospital time – Patients can often return home the same day or the next day after the treatment, whereas other procedures may require several days of hospital time.

Less time with a catheter while healing – Following many prostate surgeries, patients often need a catheter for the first few days or weeks to ensure urinary function, however, after laser surgery, patients are able to recover quickly enough that they may need a catheter for less than a day.

Immediate improvement in urinary function – Patients typically experience a noticeable improvement in urinary function right after laser therapy, unlike other procedures, which may take several weeks to see any results.

What are the Risks of Laser Treatments for BPH?

Laser treatment, especially when conducted by a skilled urologist, is less likely to cause serious or long-term side effects or complications. However, as with any operation, there are potential risks, including:

  • Urinary tract infections
  • Difficulty urinating
  • Narrowed urethra
  • Retrograde ejaculation (dry orgasm)
  • Erectile dysfunction
  • Need for follow-up

Laser treatment for BPH is safe and highly effective, but it is crucial to work with a skilled and highly trained urologist with a proven track record of success, such as the urologists at Comprehensive Urology.

TUMT and Microwave Treatment

Benign prostatic hyperplasia(BPH)causes a number of lower urinary tract symptoms that can interfere with daily life and even lead to painful obstruction and infection. At Comprehensive Urology, our team of expert urologists can safely and effectively treat BPH with a number of treatments, including Transurethral Microwave Thermotherapy (TUMT). This non-surgical option is recommended for men who have not responded well enough to medications or other conservative methods. Microwave therapy is minimally invasive and can be safely and comfortably performed on an outpatient basis. Only a single session is necessary to achieve the best possible outcome.

What is Transurethral Microwave Thermotherapy?

TUMT uses microwave energy to heat the prostate, which causes the tissue to tighten and shrink, effectively relieving pressure on the urinary channel that runs through the prostate. The procedure is non-surgical and minimally invasive because it requires simply inserting a special urinary catheter into the urethra. A microwave antenna within the catheter is activated and emits microwaves from inside the prostate, while a cooling fluid is also circulated around the antenna to avoid causing any damage to the wall of the urethra. In most cases, the procedure may take no more than 30 minutes to one hour and requires only a local anesthetic. It is recommended that patients have a friend or family member drive them home afterward.

Recovering from BPH Microwave Therapy

While microwave therapy leaves the surrounding tissue intact, the procedure can cause swelling and mild discomfort for a few days. Voluntary urination may be difficult during this short recovery period, which is why many patients are catheterized to assist with urination while the prostate and urinary tract heal.

In order for a patient to experience the full results of the microwave therapy, the body must absorb the prostatic tissue that has been treated, which can take up to six to 12 weeks. During this time, patients will not immediately notice any changes in BPH symptoms, however, the full results are gradual but long-term.

What are the Benefits of Microwave Therapy?

BPH microwave therapy is proven to be safe and effective at relieving the uncomfortable symptoms and risks of benign prostatic hyperplasia. As a minimally invasive procedure, patients do not have to go through the physical and emotional stress of undergoing surgery, while also enjoying a marked improvement of urinary function. Unlike surgery, there is a reduced risk of damage to surrounding muscle and tissue, which means that patients can maintain their quality of life. Microwave therapy is also less likely to cause side effects than traditional surgery, which allows the surgeon to help preserve quality of life.

Additional benefits include:

  • Patients can return home the same day as the procedures
  • Reduced risk of bleeding
  • Shorter recovery time
  • No lengthy hospital stays
  • Long-lasting relief of BPH symptoms for two to five years or more
  • Typically covered by Medicare and other private insurance plans

What are the Potential Risks?

While the risks associated with microwave treatments are minimal, the procedure can cause an increased risk of urinary tract infection, particularly during the one to two week period in which the patient is catheterized. Other potential side effects include:

  • Urinary retention
  • Short-term incontinence
  • Blood in the urine
  • Difficult or painful urination
  • Sexual dysfunction
  • Abdominal pain
  • High fever

It is important to note that even minimally invasive procedures carry a small potential for complications or risks, which is why it is crucial to seek treatment from a highly trained and skilled urologist, such as Dr. Kia Micheland his team at Comprehensive Urology. With access to the most state-of-the-art equipment and professional nurses at Cedars Sinai Medical Center, patients undergoing microwave therapy for BPH will be in the most capable and reliable hands.

Urolift

Beverly Hills UroLift Treatment System
UroLift System Treatment Beverly Hills BPH CancerTreatment Los AngelesUroLift System Urologist Los Angeles

The UroLift® System is one of the latest a minimally-invasive procedures for treating BPH. This state-of-the-art system provides permanent relief from the symptoms of BPH without the cutting, removing part of the prostate or even heat. The UroLift® essentially uses tiny implants to hold the enlarged prostate tissue out of the way of the urethra, allowing the patient to return to his normal physical activities in as little as two weeks. Many patients experience only minor discomfort during the recovery period. The procedure is performed in-office with an experienced urologist and patients may return home the same day without a catheter.

Although there is no cure for benign prostatic hyperplasia (BPH), there are various treatment options that aim to reduce your symptoms. Medication is normally the first line of therapy. However, if you are against surgery, have tried medication and are still not seeing long-term relief, the UroLift System may be a good option to consider.

The UroLift System is a minimally invasive treatment that aims to hinder the negative effects of BPH, such as chronic urinary tract symptoms (LUTS), loss of productivity and sleep, depression and more. It is a permanent implant designed to open the urethra directly without the need for any incisions, surgical resection or thermal injury to the prostate.

How Effective is the UroLift System?

In September 2013, the U.S. Food and Drug Administration (FDA) approved marketing for the UroLift System. The UroLift System is a minimally invasive treatment that aims to hinder the negative effects of BPH while increasing urine flow. It is considered to be the first permanent implant designed to open the urethra directly without the need for any incisions, resection or thermal injury.

Prior to FDA approval, a number of clinical trials were performed to review the procedure’s effectiveness. According to the FDA, the UroLift System produced successful results in 98 percent of cases and resulted in a 30 percent increase in urine flow. A significant decrease in BPH symptoms and improved quality of life were also observed within two years of receiving treatment.

What to Expect During the Procedure

Although the UroLift System is relatively new, the urologists at Comprehensive Urology are exceptionally skilled in performing the procedure. This treatment can be performed under local or general anesthesia, either in a doctor’s office or hospital.

First, the urologist will insert a delivery system through the urethra in order to determine the precise area(s) of the prostate tissue to be pulled back. The urologist will then insert a small needle into the sheath, which will be used to stitch the tissue. The number of implants (stitches) will vary depending on the size and shape of the obstructive tissue. Once complete, the instruments and delivery system are safely removed.

Like many urological conditions and their corresponding procedures, the UroLift System may have some side effects, which include:

  • Blood in the urine (hematuria)
  • Decreased urine flow
  • Incomplete emptying of the bladder
  • Pain/burning during urination
  • Urgent urination

Benefits of the UroLift System

Since the UroLift System treatment is a minimally invasive approach to BPH, recovery time after the procedure is usually quick. Furthermore, unlike other BPH procedures, recover normally does not require the temporary use of a catheter. Studies have shown that this procedure has been successful in preserving sexual function. It is also not known to cause serious side effects such as retrograde ejaculation or permanent erectly dysfunction.

Rezum System®

Rezum Prostate Treatment Beverly HillsRezum® is the latest and most advanced transurethral procedure designed to treat benign prostatic hyperplasia (BPH) without interfering with a patient’s sexual function including erection and ejaculation. Rezum® received FDA approval for BPH treatment in 2015 after successfully passing multi-center clinical trials that proved it to be safe, minimally invasive, and possible to perform as an outpatient procedure. Patients can return to the comfort of home on the same day as the treatment. This life-changing procedure has been used with great success since 2013 and offers one of the most efficient methods for reducing or eliminating the symptoms of BPH. [Reference: http://www.ncbi.nlm.nih.gov/pubmed/26614889 ]

Unlike traditional BPH treatments which involve removing all or portions of the enlarged prostate with surgical incisions, Rezum® utilizes convective WAVE® technology to gently and immediately damage only the targeted prostate tissues by causing cell death. This, in turn, allows the body to absorb the dead cells through the natural healing process later, thus de-bulking the enlarged gland. The Rezum® procedure is quick, minimally invasive (no incisions needed), and often only requires a local anesthetic. And best of all, it is so effective that patients typically do not have to undergo any additional treatments.

In a nutshell, the Rezum® system is a revolutionary BPH treatment for the following reasons:

  • State of the Art: The newest treatment option for urinary issues due to enlarged prostate
  • Minimally Invasive: No cuts or incisions and the procedure can be done without anesthesia
  • Quick: Only one treatment session is necessary (less than 1 hour)
  • Effective: “Rapid and durable improvements” noted in multi-center clinical trial
  • Safe: No sexual side effects (erections and ejaculation are not affected)

How Does the Rezum® Procedure Work?

The Rezum® system has a generator and a handheld device that uses water vapor (steam) which is injected through openings of a very fine needle. During the procedure, the device transforms a small amount of water into sterile steam in a controlled fashion, that is then transferred to the targeted prostate tissue through the retractable needle. The urologist uses direct vision (live video) to navigate the urethra and then deploy the very thin needle through the specific enlarged portions of the prostate, ensuring that healthy tissue is unaffected and only the obstructing areas are targeted.

Rezum 3D Animation with Patient Audio from REZUM on Vimeo.

Once the steam is injected into specific parts of the enlarged prostate gland, it transforms back into a liquid and the high temperature effectively kills the targeted prostate cells in as little as nine seconds. Rezum® essentially uses convective energy to affect specific tissues without interfering with the surrounding nerves and muscle tissue that are essential to proper genitourinary function. The dead cells are eventually simply absorbed and eliminated by the body and the prostate gland as a whole is reduced in size. Within 2-3 weeks of the Rezum® therapy, patients can expect to have significantly improved urination, and experience maximal improvement up to three months.

What are the Benefits of Rezum® BPH Treatment?

Following Rezum® BPH treatment, patients can expect to experience the following benefits as early as two weeks:

  • Improved urinary stream
  • Ability to completely empty the bladder
  • No straining to urinate
  • Less frequent urination
  • Pain-free urination
  • Less nighttime urination

Transurethral water vapor therapy is highly effective at shrinking the prostate gland and relieving urinary obstruction caused by an enlarged prostate (BPH). Unlike other BPH treatments, Rezum® does not harm the nerves and muscle tissue responsible for normal sexual and urinary function. [Reference: http://www.ncbi.nlm.nih.gov/pubmed/27129767]. It also does not cause the uncomfortable side effects, such as dizziness or sexual dysfunction that are seen with most BPH medications. The water vapor therapy option is ideal for patients who do not qualify for surgery due to health issues, do not wish to take lifelong BPH medications, or simply are unwilling to undergo more invasive BPH treatments and wish for a minimally invasive yet highly effective approach.

What to Expect After Rezum®:

After Rezum® therapy, the prostate will likely be swollen for a few days, so it is recommended that patients wear a catheter temporarily until the swelling has subsided in order to prevent urinary blockage. Unlike other methods of reducing or managing the symptoms of benign prostatic hyperplasia, patients can return to everyday activities within a few days after the procedure and do not have to adjust to uncomfortable or embarrassing side effects, such as loss of sexual ability, urine leakage, etc.

Rezum® is more than just a quick and easy procedure; it can significantly improve a patient’s quality of life while also preserving his sexual function. When nearly 75 percent of all men in the United States over the age 65 suffer from BPH and compromised sexual and urinary function as a result, Rezum® offers the best possible outcome with minimal invasiveness and without the painful or debilitating side effects.

Rezum® is not an invasive surgical procedure and, as a result, does not have a lengthy recovery process. This cutting edge treatment has a significantly lower risk of infection or other complications. Rezum® is a quick and convenient procedure that can be performed at the Comprehensive Urology office and is usually completed in less than 10 minutes. Additionally, it is covered by most insurance companies.

Simple Prostatectomy

bladder stones treatment experts LASimple prostatectomy is a BPH treatment option recommended mostly for men who have a very large prostate. If signs of bladder diverticula or bladder stones are present, this procedure may also be recommended.

Men who are most suitable to undergo this procedure should generally be in good health, which means if you have been treated for prostate cancer before, an open prostatectomy cannot be done.

Types of Open Prostatectomy

Simple prostatectomy involves the surgical removal of the prostate gland and is usually done under general or spinal anesthetic. Patients who undergo open prostatectomy are normally required to stay in the hospital anywhere from two to three day and will require four to six weeks of recovery time. There are three ways this procedure can be performed for BPH treatment:

  • Suprapubic Prostatectomy – involves opening the bladder in order to remove the inner portion of the prostate gland through the bladder. Upon completion, two catheters are placed in the bladder, one of which is placed through the urethra. The other is inserted through an opening made in the lower abdominal wall. The catheters are not removed until three to seven days after surgery.
  • Retropubic Prostatectomy  – involves moving the bladder aside to in order to remove the inner prostate tissue without entering the bladder. After this procedure, a catheter is placed in the bladder through the urethra and cannot be removed for an entire week after surgery.
  • Robotic Simple Prostatectomy- advances in surgical technology now allow a simple prostatectomy to be done robotically using the da Vinci surgical robotic system.  With a robotic approach, much smaller incisions are made, and precise surgical techniques are utilized leading to excellent outcomes and relatively minimal risk for bleeding.

Complications Associated with Open Prostatectomy

Due to the complexity of the procedure, open prostatectomy is only reserved for generally healthy men who have very large prostates. Although this is an effective way to achieve relief from BPH symptoms, complications can occur including bleeding and infection.

Frequently Asked Questions

Click on the question to see the answer

Q: What is BPH?


A: BPH (benign prostatic hyperplasia) is commonly known as enlarged prostate gland. Although BPH is a non-cancerous condition, it can cause uncomfortable symptoms in the male urinary system and should be treated. Other names for benign prostatic hyperplasia are benign prostatic hypertrophy or benign prostatic obstruction.

Q: What is the prostate?


A: The prostate is about the size of a walnut. Its main function is to make a fluid that goes into semen. This fluid is an essential part of a man’s fertility. The prostate gland is located near the bladder and the urethra.

Q: When does BPH typically occur?


A: The size of the prostate increases as men age, with two main growth periods. The prostate doubles in size during early puberty then goes through another growth when a male is around 25 years old. The prostate continues to grow throughout a man’s life. Benign prostatic hyperplasia often occurs during the second growth phase.

Q: Who is more prone to developing BPH?


A: Benign prostatic hyperplasia is more likely to develop in men who have the following characteristics:

  • Are 40 years old or over
  • BPH runs in the family
  • Diagnosed with obesity, heart and circulatory disease, type 2 diabetes
  • Lacks physical activity
  • Has erectile dysfunction


Q: What are the symptoms associated with BPH?


A: Since the urethra is so close to the prostate gland, an enlarged prostate adds pressure to the urethra causing it to narrow and block the natural flow of  urine. As a result, the bladder weakens and is overworked as it attempts to pass urine through a blocked urethra. Common symptoms of BPH may include:

  • Frequent urination (eight or more times per day)
  • Urgent urination (inability to delay urination)
  • Difficulty starting a urine stream
  • Dribbling at the end of urination
  • Nocturia (frequent urination during sleep)
  • Urinary incontinence (accidental loss of urine)
  • Pain after ejaculation or during urination
  • Unusual color or smell in urine


Q: What causes benign prostatic hyperplasia?


A: The direct causes of BPH are not fully understood. However, it is evident that the condition affects mainly older men. According to some researchers, some of the factors that may cause BPH have to do with aging and may be related to the testicles. Common theories as to why benign prostatic hyperplasia may occur:

  • As men age, the amount of active testosterone in their blood decreases, which leaves a higher proportion of estrogen within the prostate. Scientific studies have suggested that estrogen may promote prostate cell growth.
  • Other research suggests that when there is a drop in blood testosterone levels, older men continue to produce and accumulate high levels of DHT (male hormone that is linked to prostate development and growth). Some believe that the accumulation of DHT may encourage prostate cells to continue to grow.


Q: What are the complications that may arise with BPH?


A: Although benign prostatic hyperplasia is non-cancerous, treatment is recommended to restore the male reproductive system back to normal function. Furthermore, some symptoms of BPH can also signal more serious conditions, including prostate cancer. Untreated BPH may also give rise to the following complications:

  • Acute urinary retention
  • Chronic urinary retention
  • Blood in the urine
  • Urinary tract infections (UTIs)
  • Bladder damage
  • Kidney damage
  • Bladder stones


Q: What are the benefits of the newer minimally invasive surgical treatments for BPH transurethral plasma vaporization and resection of the prostate (TURiP) and greenlight photovaporization of the prostate (PVP) compared with the traditional TURP?


A: The benefits include less risk of bleeding, as well as virtually negligible risk of developing mineral abnormalities in the blood after surgery as sometimes can be seen with traditional TURP (TUR syndrome). Although a foley catheter is required to drain the bladder immediately after the procedure in these cases, it is usually only required overnight with TURip and PVP, whereas with TURP the catheter time is usually two nights.

Q: What are the risks involved with the newer minimally invasive surgical treatments for BPH transurethral plasma vaporization and resection of the prostate (TURiP) and greenlight photovaporization of the prostate (PVP)?


A: The risks of infection, scarring, and irritative urinary symptoms are present but small with all types of transurethral procedures. The risk of bleeding is much less but still present with the newer approaches as well. All of these procedures carry a risk of retrograde ejaculation (the ejaculate, instead of coming out of the penis during orgasm, flows into the bladder). This side effect carries no risk of physical danger to the patient, and occurs quite commonly due to the nature of the procedure. There is a very small risk of urinary incontinence and erectile dysfunction with all surgical procedures for BPH, but these side effects are rarely encountered.

Q: When can I expect to see results of my surgical treatment for BPH?


A: The result of treatment is often seen immediately upon catheter removal, and urinary flow typically continues to improve over the first few months postoperatively. A minority of patients who have required a urinary catheter for a period of time before the surgery due to complete obstruction may require a period of bladder retraining after the procedure prior to seeing the full benefits of treatment.

Q: : What is the average hospital stay for TURip and PVP?


A: The typical hospital stay is 1-2 days.

Q: How long until I can return to my normal activities?


A: Typically our patients are walking the same day, and back to normal activities of daily living within a week. We ask our patients to refrain from working out and from other strenuous activity 4 weeks in order to allow optimal healing.

Contact a BPH Specialist

The skilled doctors at Comprehensive Urology are leaders in the BPH treatment. If you would like to receive a prostate cancer screening and biopsy or are interested in learning more about your treatment options, please contact us today at (310) 499-2756.
Next, learn more about prostate cancer.

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