Benign Prostatic Hyperplasia (BPH) or prostate gland enlargement, commonly affects men as they get older. BPH symptoms include a frequent, urgent need to urinate and straining when urinating. Doctors are not sure what exactly causes BPH.

Symptoms

• Dripping after urination
• Trouble urinating
• Unable to completely empty the bladder
• Constantly feeling the need to urinate
• Painful urination
• Slowed urinary stream
• Weak urine stream
• Straining to urinate

Once proper diagnostic testing determines the extent of the prostate problem, a treatment plan will be formulated based on the severity of your symptoms while considering any other complicating factors.

Treatment

• Avoid alcohol
• Avoid caffeine
• Do not drink anything two hours before you go to bed
• When you feel the urge to urinate, go immediately
• Reduce your exposure to stress
• Your doctor will prescribe medications such as alpha-blockers and antibiotics
• Surgical intervention (the invasiveness and recovery times associated with the procedures vary)

 A yearly exam will most likely be recommended in order to monitor your symptoms and treatment. If not treated, BPH can cause bladder, kidney or urinary tract problems.

GreenLight™ TURP

To treat men with Benign Prostatic Hyperplasia (BPH), also known as an enlarged prostate, our doctors can perform GreenLight™ Laser Therapy as an alternative to invasive surgery. During the procedure, an instrument is inserted up the urethra and laser light will vaporize the prostate tissue that is blocking urine flow.

The doctor will administer either general anesthesia or a spinal anesthetic to the patient.

What to Expect After Surgery

GreenLight Laser Therapy is an outpatient surgery, meaning no hospital stay is required. The procedure can be performed in a well-equipped doctor’s office, an outpatient center or hospital/surgical center.

After therapy, most patients do not need a catheter. However, if one is inserted, it is usually removed within 24 hours.

Patients can typically resume their normal daily activities within 2-3 days. Strenuous activity, exercise, sexual activity and working with vibrating equipment (lawnmowers, snow plows, etc.) should be avoided for at least 2 weeks.

You may experience new symptoms for about 1 week post-procedure, such as frequent urination, discomfort or burning while urinating and/or small traces of blood in your urine. To alleviate the discomfort, you may take a nonsteroidal anti-inflammatory drug. If you’re given an antibiotic to prevent infection, please take it as prescribed.

Why It Is Done

GreenLight Laser Therapy has been clinically proven as a comparable option to transurethral resection of the prostate (TURP) surgery.

The laser technology is precise and leaves the patient with fewer side effects. When the excess tissue is vaporized, there’s less blood loss. Therefore, GreenLight Laser Therapy is a better treatment option for patients who take blood thinning medications.

The procedure is outpatient, so patients can return home the same day. There are fewer cases of patients needing retreatment, and research indicates there are fewer sexual side effects. The cost of GreenLight Laser Therapy is also lower than traditional surgery.

How Well It Works

Typically within 24 hours, patients are alleviated of symptoms and have improved urine flow. Most patients who were taking BPH medications are able to discontinue use a few weeks after the procedure.

Studies also indicate that symptom-relieving results can last up to 5 years!

For more information, please visit the GreenLight™ Laser Therapy website.

Transurethral Resection of Bladder Tumor (TURBT)

Transurethral resection (TUR) of the bladder is a surgical procedure that is used both to diagnose bladder cancer and to remove cancerous tissue from the bladder. This procedure is also called a TURBT (transurethral resection for bladder tumor). General anesthesia or spinal anesthesia is usually used. During TUR surgery, a cystoscope is passed into the bladder through the urethra. A tool called a resectoscope is used to remove the cancer for biopsy and to burn away any remaining cancer cells.

Bladder cancer can come back after this surgery, so repeat TURs are sometimes needed.

What to Expect After Surgery

Following surgery, a catheter may be placed in the urethra to help stop bleeding and to prevent blockage of the urethra. When the bleeding has stopped, the catheter is removed. You may need to stay in the hospital 1 to 4 days.

You may feel the need to urinate frequently for a while after the surgery, but this should improve over time. You may have blood in your urine for up to 2 to 3 weeks following surgery.

You may be instructed to avoid strenuous activity for about 3 weeks following TUR.

Why It Is Done

TUR can be used to diagnose, stage, and treat bladder cancer.

• Diagnosis. TUR is used to examine the inside of the bladder to see whether there are cancer cells are in the bladder.
• Staging. TUR can determine whether cancers are growing into the bladder wall.
• Treatment. One or more small tumors can be removed from inside the bladder during TUR.

How Well It Works

TUR is the most common and effective treatment for early-stage superficial bladder cancer. It may also be effective for more advanced cancer if all the cancer is removed and biopsies show that no cancer cells remain.

About 70% of people with early-stage and low-grade superficial bladder cancer can be effectively treated with a TUR.

Risks

The risks of TUR include:

• Bleeding.
• Bladder infection (cystitis).
• Perforation of the wall of the bladder.
• Blood in the urine (hematuria).
• Blockage of the urethra by blood clots in the bladder.

What to Think About

Treatment with TUR may be followed by chemotherapy or biological therapy.

If superficial bladder cancer recurs, follow-up TURs may be done regularly.

About 30% of people with early-stage and high-grade superficial bladder cancer are treated with TUR, but additional chemotherapy or biological therapy may be recommended.

Transurethral Resection of the Prostate (TURP)

During transurethral resection of the prostate (TURP), an instrument is inserted up the urethra to remove the section of the prostate that is blocking urine flow.

TURP usually requires hospitalization and is done using a general or spinal anesthetic.

What to Expect After Surgery

The hospital stay after TURP is commonly 1 to 2 days.

Following surgery, a catheter is used to remove blood or blood clots in the bladder that may result from the procedure. When the urine is free of significant bleeding or blood clots, the catheter can be removed and you can go home.

Strenuous activity, constipation, and sexual activity should be avoided for about 6 weeks. Symptoms such as frequent urination will continue for a while because of irritation and inflammation caused by the surgery. But they should ease during the first 6 weeks.

Why It Is Done

Your doctor may recommend TURP if symptoms caused by benign prostatic hyperplasia (BPH) have not improved in response to home treatment and medicines.

TURP is now the most common surgery used to remove part of an enlarged prostate. Open prostatectomies (in which an incision is made into the abdomen) generally are needed only when the prostate is very large.

How Well It Works

For men who have moderate to severe symptoms of prostate enlargement, TURP is more effective than watchful waiting in relieving urinary symptoms. Studies have found that:

• Men who had TURP had a lower symptom score compared with those who used watchful waiting.
• Symptoms get better for 7 to 10 out of 10 men who have the surgery.

On the average, men experience an 85% improvement in their American Urological Association (AUA) symptom index scores. For example, if you had a score of 25, after this surgery it might be reduced to about 4. Men who are very bothered by their symptoms are most likely to notice great improvement in their symptoms after TURP. Men who are not very bothered by their symptoms are less likely to notice a significant change.

Risks

The risks of transurethral resection of the prostate (TURP) include problems with sexual performance, incontinence, and problems from surgery.

Problems with sexual performance

• Ejaculation into the bladder (retrograde ejaculation) is very common, occurring in about 25 to 99 men out of 100. This does not affect sexual function.
• Erection problems may develop in men who did not have problems before the procedure. The risk of this may depend on how sexual performance is defined and measured, how sexually active the man was before the surgery, and how old he is. Many men in the age group who are likely to have BPH also have some problems with getting an erection. Subsequent erection problems are reported by about 3 to 35 men out of 100. Medicine can help some men achieve an erection after they have had TURP.

Loss of ability to control urine flow (incontinence)

• A small number of men (about 1%) say they are completely unable to hold back their urine after the surgery.
• Some men find that they can still hold in their urine after the surgery, but they tend to leak or dribble.

Problems related to having surgery

• About 5 out of 100 men have severe bleeding and need a blood transfusion.
• TURP syndrome occurs in about 2 out of 100 men who have TURP. This syndrome occurs when the body absorbs too much of the fluid used to wash the area around the prostate while prostate tissue is being removed. The symptoms of TURP syndrome include mental confusion, nausea, vomiting, high blood pressure, slowed heartbeat, and visual disturbances. TURP syndrome is temporary (usually lasting only the first 6 hours after surgery) and is treated with medicine that removes excess water from the body (diuretic).
• About 2 or 3 men out of 100 need to have another operation after 3 years.
• Repeat surgery because of a complication of the surgery is needed less than 10% of the time.

What to Think About

Surgery usually is not required to treat BPH, although some men may choose it because their symptoms bother them so much. Choosing surgery depends largely on your preferences and comfort with the idea of having surgery. Things to consider include your expectation of the results of the surgery, the severity of your symptoms, and the possibility of having complications from the surgery.

Men who have severe symptoms often have great improvement in quality of life following surgery. Men whose symptoms are mild may find that surgery does not greatly improve quality of life. Men with only mild symptoms may want to think carefully before deciding to have surgery to treat BPH.