Benign Prostatic Hyperplasia BPH

Enlarged Prostate Symptoms and BPH Treatment, Los Angeles, CA

image of bladder and prostate with BPH

BPH or benign prostatic hyperplasia is one of the most common male health conditions that results in the prostate gradually becoming enlarged. 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 (the urine tube) like a doughnut, so when it becomes prostate becomes enlarged, it can compress the stream of urine and make it difficult to urinate. At Comprehensive Urology, we offer a variety of treatments to help men with BPH, tailored to their specific situation. Book an appointment with our team today.

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Kia Michel, MD

Kia Michel, MD

Written by Dr. Kia Michel, a board certified urologist, surgeon, and founding member of Comprehensive Urology in Beverly Hills, Los Angeles. Dr. Michel's expertise includes focal therapy (HIFU/TULSA), prostate cancer treatment, robotic surgery, and male enhancement treatments such as Shockwave Therapy for ED and penile injections.

Dr. Michel's Bio

Benign prostatic hyperplasia (BPH), also known as enlarged prostate, is a non-cancerous condition that occurs in almost all me as they age. While is can share some of the symptoms with prostate cancer, BPH is not associated with prostate cancer. This is why visiting an urologist to get an accurate diagnosis is essential.   Common urinary problems associated with BPH include difficulty starting a urine stream, frequent need to urinate, weak urine stream and incomplete emptying of the bladder after urination. Although a wide variety of treatments are available for BPH, including minimally invasive therapy and surgical procedures, this article will focus on medication for enlarged prostate.

Today I’ll guide your through BHP symptoms, diagnosis and the many treatment options that we offer here at Comprehensive Urology. 

BPH Symptoms

Symptoms of BPH (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
  • Intermittent urinary flow
  • Sense of incomplete bladder emptying
  • Urinary frequency
  • Nocturia (nighttime urinary frequency interrupting sleep)
  • Urinary urgency
  • Urinary incontinence (leakage of urine)

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


It’s important to have a full evaluation since Prostate Cancer and BPH can have similar symptoms even though BPH is not a form of cancer.


BPH Diagnosis

A proper diagnosis is essential to developing the optimal treatment plan for each patient with BPH. Our physicians first begin with a thorough history. 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.

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. It is also used to help screen for prostate cancer.

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

Urinalysis – An evaluation of the urine can help detect abnormalities such as inflammation or infection.

Urine Flow Test – This test is performed in order to evaluate the flow rate and amount of urine during a normal void. Our team often uses this test to monitor changes over time with treatment.

Post Void Residual – Often used to detect how much urine is left over in the bladder after voiding. This can often be performed with a noninvasive ultrasound of the bladder.

Prostate Specific Antigen (PSA) Test – PSA is sometimes elevated with BPH, cancer, and infection. It can be used to monitor risk of prostate cancer over time.

Ultrasound – Ultrasound can aid with measurement of prostate gland size. It can also help detect anatomic variations in the prostate gland or even prostate tumors. Ultrasound can also help determine the effects of BPH on its surrounding structures such as the bladder or kidneys.

Cystoscopy – A thin tube with a lens and camera attached, called a cystoscope can be inserted into the urethra to help visualize the internal urethra and bladder. This scope, which is smaller than a standard urinary catheter, can help evaluate compression from the enlarged prostate gland.

Urodynamic Studies – This specialized study precisely characterizes pressures within the urinary tract, and helps characterize the bladder’s response to filling and ability to empty with normal contraction.

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. Book an appointment with the Best Urologist in Los Angeles today.

BPH Treatment

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. This is often required to stay indwelling until medications can take effect or until the patient is ready for a surgical procedure to relieve the obstruction. A newer option eliminates the need for an indwelling catheter during that time interval. Our physicians often place a temporizing SpannerTM intraprostatic 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. 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.


Aquablation is a minimally invasive surgical treatment for benign prostatic hyperplasia (BPH), a condition where prostate enlargement obstructs urine flow. It uses robotic technology and high-powered water jets to precisely ablate (remove) obstructing prostate tissue while avoiding damage to the urethra.

During an aquablation procedure, the surgeon inserts a handheld wand transurethrally into the prostate. Real-time ultrasound imaging guides a computer-controlled robot to direct water jets at the targeted overgrown areas of the prostate. The water jet quickly ablates the excess tissue causing blockage without heat or electrical current.

Clinical studies show aquablation significantly improves BPH/enlarged prostate symptoms like frequent/urgent urination, weak stream, and incomplete emptying. It has a lower risk of sexual side effects compared to traditional BPH surgeries. While aquablation requires postoperative catheterization, it provides immediate symptom relief.

Surgical Options

There are multiple surgical treatment options 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. The most effective options include transurethral resection of the prostate (TURP) and laser photovaporization of the prostate.

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.

TURP is considered the gold standard surgical treatment because of its durability and efficacy as a procedure. By using an endoscopic camera, our surgeons can shave away the prostatic blockage and seal blood vessels with an electrical blade until a larger urinary channel is created. No incision is made on the skin. A urinary catheter is left to drain the bladder until the channel is healed (usually 24 to 48 hours). Upon catheter removal, In most cases, the improvement in urinary 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.

Another newer minimally invasive surgical option is laser photovaporization of the prostate (PVP). The procedure is performed by using an endoscopic camera though 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 and indwelling catheter duration.

In some patients in whom the gland is markedly enlarged (>100gm), the most definitive therapy to treat their obstruction may be a simple prostatectomy. In this procedure, a small incision is made on the lower abdomen (similar to that of a caesarean section for women). The interior tissue of the prostate is removed, leaving the exterior “shell” of the prostate intact. This procedure is highly successful in resolving the obstructive process and requires a hospital stay of a few days.

At Comprehensive Urology Medical Group, our Physicians have the extensive knowledge and expertise with all of these therapies in order to help you find which may be most suitable for you.


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 (stiches) 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.

Robotic Simple Prostatectomy

Simple 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.

Microwave Therapy

One option for BPH treatment is a non-surgical technique called Trans-Urethral Microwave Therapy (TUMT). Using microwave energy, the prostate can be targeted with heat 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. At Comprehensive Urology, our physicians will help determine if this treatment may be suitable for you.

Laser surgery is one of the least invasive and highly effective treatment options for benign prostatic hyperplasia, which is an uncomfortable condition that can greatly interfere with daily life. From experiencing a frequent urge to urinate to frequent urinary tract infections, it is in most BPH sufferers’ best interests to seek reliable treatment. With laser surgery, patients can achieve more immediate results than possible with more traditional treatments.

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 therefore health 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.

Transurethral Resection of the Prostate (TURP)

image of bladder and prostate with BPH

Benign prostatic hyperplasia (BPH), commonly known as enlarged prostate, obstructs the normal flow of urine from the bladder to the urethra. There are a few non-surgical and surgical treatments available for BPH treatment. Transurethral resection of the prostate, or TURP, is a surgical procedure that treats the obstruction of the urethra from BPH. Your doctor may recommend this procedure if your condition has not improved from home remedies and medication.

Transurethral resection of the prostate (TURP) is considered an effective surgical procedure that removes all or part of the enlarged prostate gland. TURP involves inserting an instrument, called a resectoscope, through the urethra and into the bladder, and aims to remove the middle part of the prostate to allow easier urine flow. This procedure is most often used for non-cancerous blockage, however, it has been used for some cases of prostate cancer as well. Patients who under go transurethral resection of the prostate typically stay in the hospital for up to three to four days after surgery.

Effectiveness of Transurethral Resection of the Prostate

For men who experienced moderate to severe symptoms of benign prostatic hyperplasia, TURP has been proven to successfully improve undesirable symptoms associated with 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.
  • 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 collect with urine, which will be passed out in the next flow of urine.

Less common side effects of TURP may include:

  • Erectile Dysfunction – The inability to achieve or maintain an erection during sexual intercourse
  • 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
  • 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 some people and the undesirable symptoms of BPH may persist, including difficulty emptying the bladder completely and frequent urination at night

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. There is also an updated procedure called Mini-Turp which is minimally invasive.

Types of Medication for Benign Prostatic Hyperplasia

Since benign prostatic hyperplasia cannot be cured, treatment focuses on reducing the uncomfortable symptoms of BPH. Medicines have been effective in relieving urination problems caused by BPH and may result in minor side effects only. However, if medication is stopped, the symptoms usually return, unless prostate surgery is performed.

Alpha Blockers

These medications relax the muscles surrounding the prostate and bladder neck, which allows for easier urination. There are at least five medications that are considered alpha blockers:

  • Terazosin (Hytrin)
  • Doxazosin (Cardura)
  • Tamsulosin (Flomax)
  • Alfuzosin (Uroxatral)
  • Silodosin (Rapaflo)

Alpha blockers begin to work rather quickly and are normally recommended as a first-line treatment for men with mild to moderate symptoms of BPH. Each medication may affect people differently, however, the most common side effects may include dizziness and low blood pressure after sitting or standing up.

Alpha-Reductase Inhibitors

Alpha-reductase inhibitors are medicines that stop the growth of the prostate, or in some cases, even cause the prostate to decrease in size. The two types of alpha-reductase inhibitors are:

  • Finasteride (Proscar)
  • Dutasteride (Avodart)

These types of medicine work better in men with a larger prostate and have been effective in reducing urinary problems such as urinary retention, which is the inability to empty the bladder completely. Alpha-reductase inhibitors also may prevent the need for surgery. Most men see an improvement within 6 months of starting treatment. Side effects of this type of medication may include a decreased sex drive or difficulty with erection or ejaculation. This side effect is usually reversed once medication is topped.

Combination Treatment

For some men, a combination of alpha blockers and alpha-reductase inhibitor medications may be recommended. This benefits men with severe BPH symptoms, have a large prostate and who have not improved with the highest dose of alpha blocker.

Herbal Medicines

Although herbal medications for BPH treatment do exist, such as Palmetto, which is commonly used in Europe, they have not been proven to reduce the bothersome symptoms of enlarged prostate. Thus, health care professionals do not normally recommend them.


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 Michel and 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.

Rezum System®

Rezum® 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. 

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.

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. 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.


What is BPH?

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.

What is the prostate?

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.

When does BPH typically occur?

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.

Who is more prone to developing BPH?

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

What are the symptoms associated with BPH?

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
  • Erectile Dysfunction

What causes BPH?

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

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?

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. Another option is to consider Aquablation Therapy for BPH. In more severe cases of BPH, Prostate Artery Embolization could be necessary. 

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)?

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.

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

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.

What is the average hospital stay for TURP and PVP?

The typical hospital stay is 1-2 days.

How long does it take to return to my normal activities?

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.

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) 278-8330.

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