Enlarged Prostate (Benign Prostatic Hyperplasia)

When men get older, their prostate gland grows larger. In some cases, this puts pressure on the bladder and urethra resulting in the frequent and sometimes urgent need to urinate as well as other symptoms. It can even lead to a reduced sex drive and sexual dysfunction.

This condition, known as benign prostatic hyperplasia or BPH, is one of the most common health problems that men can experience. In fact, it affects half of all men over 50 and significantly more men in the decades that follow.

The symptoms of BPH are numerous and can include:

Increased frequency of urination
Nocturia (waking up 2 or more times at night to urinate)
Urgency (the sudden, uncontrollable need to urinate)
Weak or intermittent urine stream, or dribbling at the end
Difficulty starting to urinate
Inability to completely empty the bladder
Painful urination
Reduced sex drive or sexual dysfunction

Left untreated, BPH symptoms usually get worse, and can result in urinary tract infections (UTIs), bladder stones, kidney damage and the inability to urinate (urinary retention).

What causes BPH?

A normal prostate is about the size of a walnut. As men age, hormonal changes—shifting levels of testosterone and estrogen—can trigger prostate cells to grow. While the condition is common in men over 50, other factors such as obesity, type 2 diabetes, a physically inactive lifestyle and more can contribute to this condition. Men who have had their testicles removed at a younger age do not experience BPH.

Treatment Options

Conservative treatment

When men begin to experience BPH symptoms, their doctors will often prescribe what is known as “conservative” treatment. This can include lifestyle changes (less caffeine or alcohol), medication (such as alpha blockers or ED medications) or supplements. Your doctor may also ask you to avoid taking certain medications (like decongestants) that can affect the prostate.

Surgery

When BPH becomes severe, a surgery called transurethral resection of the prostate (TURP) may be recommended. This surgery removes a portion of the prostate gland to make it smaller. However, there are a high number of side effects associated with TURP that include infection, incontinence, bleeding and a loss of erections. Approximately 65% men who have TURP surgery will experience retrograde ejaculation (semen goes into the bladder and not out of the penis).

UroLift^®

UroLift is a new procedure that is less invasive than TURP surgery. It uses permanent implants to lift the prostate away from the urethra to reduce pressure on the urethra. UroLift is effective at alleviating the symptoms of BPH, but it does not address the underlying condition (the enlarged prostate). Because of this, the prostate can continue to grow and symptoms can return. Some UroLift patients will require another procedure within 24 months.

Rezum™ Water Vapor Therapy

This minimally invasive outpatient procedure is performed by injecting water vapor into the prostate to reduce blockages and improve urinary flow. This procedure has drawbacks, including the need for a catheter for several days after the procedure and the potential for 1-2 weeks of worsening urinary symptoms.

Prostate artery embolization (PAE)

Prostate artery embolization (PAE) is a minimally invasive, non-surgical treatment option for many men with moderate to severe symptoms of benign prostatic hyperplasia (BPH). At Carolina Endovascular, the procedure is performed by board-certified interventional radiologists using advanced imaging guidance.

Unlike procedures performed through the urethra, PAE is performed through a tiny catheter placed in the bloodstream at the wrist or groin. By selectively reducing blood flow to the prostate, the gland gradually shrinks, relieving urinary symptoms over time.

Because PAE does not involve cutting, heating, or mechanically manipulating the prostate tissue through the urethra, the risk of sexual side effects is effectively zero. In clinical studies, erectile function is typically preserved, and in some cases may improve as urinary symptoms resolve.

Please visit our PAE section to learn more about this option.

Prostate Artery Embolization