Benign Prostatic Hyperplasia (BPH)
From conservative therapies to the most innovative minimally invasive procedures, we are here to help men with urinary difficulties due to enlarged prostates.
What is BPH?
Benign Prostatic Hyperplasia, or BPH, is a condition in which the prostate enlarges as men get older. BPH is a very common condition that affects over 40 million Americans and over 500 million aging men worldwide. Over 40% of men in their 50s and over 70% of men in their 60s have BPH. While BPH is a benign condition and unrelated to prostate cancer, it can greatly affect a man’s quality of life.
As the prostate enlarges (called an adenoma), it presses on and blocks the urethra, which in turn, causes the bladder wall to thicken and weaken. This leads to bothersome urinary symptoms such as:
- Frequent need to urinate both day and night
- Weak or slow urinary stream
- A sense that you cannot completely empty your bladder
- Difficulty or delay in starting urination (hesitancy)
- Urgent feeling of needing to urinate
- A urinary stream that stops and starts
If you suffer from the above symptoms, you are not alone. BPH is the leading reason men visit a urologist. You can measure and understand your symptoms, treatment options, and share your treatment goals with your doctor using BPH Advisor™, a free, personalized, online program. Click here to assess your symptoms.
Treatment Options:
There are many options for treating BPH including medications, minimally invasive procedures, or more invasive surgeries. While most patients start with medications such as alpha blockers (tamsulosin, alfuzosin) or 5-ARI’s (finasteride, dutasteride), side effects including dizziness, fatigue, lightheadedness, nasal congestion, erectile dysfunction and ejaculation disorders can be bothersome. As a result, many patients can be considered for minimally invasive procedures such as the Urolift Prostatic Urethral Lift, or Rezum water vapor ablation. Some patients, however, have prostate anatomies that are not amenable to these minimally invasive procedures, and therefore must consider transurethral resection of the prostate (TURP) or robotic simple prostatectomy as better options. Choosing the right treatment option will depend on the size and orientation of the prostate, as well as each patient’s individual preference. Dr. Yu has tremendous experience in dealing with all shapes and sizes of prostates and will work with you to choose the option that best fits your needs.
At your visit, Dr. Yu will discuss with you about the preferred options to treat your BPH.
Some of the procedural-based treatment options that are offered by Dr. Yu include:
Option 1: The UroLift® Prostatic Urethral Lift (PUL) Treatment
The Urolift device is a minimally invasive treatment that uses a needle to place tiny implants in the prostate that retract, lift and hold the lobes of the prostate apart so that it no longer blocks the urethra. The procedure takes less than 10 minutes, and patients can go home the same day. It is usually done under a light anesthesia, although can be performed in the office if desired. Most patients go home without a catheter and are urinating on their own.
Urolift uses no cutting or heat to destroy or remove prostate tissue, and therefore, has a very small side effect profile. Some men may have pain or burning when passing urine, blood in the urine, or a strong urge to urinate after the procedure. These side effects usually go away within two to four weeks. There is a 0% risk of sexual side effects after Urolift, and is the only BPH procedure shown to not cause any new or lasting erectile or ejaculatory dysfunction. Because it does not cut or destroy tissue, most men see symptom improvement within about 2 weeks, and men can resume their daily activities and their lives very quickly.
Check out a video on how Urolift can help you improve your quality of life.
FAQ About UroLift®
Who is a good candidate for the UroLift® System treatment?
You may be a good candidate if you are a male, 45 years of age or older, and have bothersome urinary symptoms relating to BPH. If you have been taking medications and either do not like the side effects, or want to get off medications in general, then you may be a good candidate. Over 75% of Dr. Yu’s Urolift patients have been able to get off BPH medications in the long term. Dr. Yu will ultimately need to perform a cystoscopy to evaluate your prostate anatomy from the inside. An ultrasound may also need to be performed to assess your prostate size. Every BPH patient is different, and the treatment decision will depend on many factors that will be reviewed in depth at your visit with Dr. Yu.
What should I expect during the treatment? Is it painful?
In general, the UroLift System is a minimally invasive treatment that entails minimal downtime. About 85% of patients go home without a catheter, and will notice frequent urination, urgent need to urinate, and burning with urination for the first 1-2 weeks after the procedure. Patients will also notice intermittent blood in the urine for the first 1-2 weeks. You will be prescribed medications to help relieve some of these symptoms including pain medications, pyridium, as well as an antibiotic. If you were previously taking tamsulosin, you should continue to take that until 2 weeks after the procedure. Dr. Yu’s team will check-in with you a few days after the procedure by phone, and will see you in the office 1 month after the procedure.
Does the treatment affect my sexual function?
Clinical studies have shown the UroLift® System treatment does not cause any new, sustained instances of erectile or ejaculatory dysfunction. That’s a 0% risk! The same cannot always be said of other BPH therapies such as TURP, laser PVP, simple prostatectomy and even medications.
Will I need retreatment after the Urolift procedure?
Clinical studies have shown the UroLift® System has a re-treatment rate of about 3% per year, meaning after 5 years, almost 15% of patients will need to be retreated. This could involve another Urolift procedure, or may require other treatment approaches such as TURP or transurethral incision of prostate (TUIP). A major benefit of the Urolift procedure is that it does not preclude any other procedures from being performed, in essence, it does not burn any bridges, and can often be used as a first step to the treatment of BPH.
Option 2: Rezum Water Vapor Ablation
Rezum is a minimally invasive treatment that uses the stored thermal energy in water vapor (steam) to destroy excess prostate adenoma tissue. Inside a handheld device, sterile water is heated to just above the boiling point, when it turns into steam. A precise dose of thermal energy from the steam is then injected into the prostate with a small needle. The release of this thermal energy causes rapid cell death. The body’s natural healing response then breaks down and removes the dead tissue, causing the prostate to shrink, and the urethral channels opens for urination relief.
The procedure itself takes less than 10 minutes, and patients can go home the same day. It is usually done in the doctor’s office with local anesthesia and oral pain medications. After the procedure, all patients go home with a catheter for 3-4 days, and will be instructed on how to care for the catheter. Patients will notice intermittent blood in the urine, mild pelvic pain, and possibly leakage around the catheter with the catheter in place. Once the catheter is removed, most patients notice frequent and urgent urination, intermittent blood in the urine, and pelvic discomfort, which usually resolve spontaneously within about 2-3 weeks. Most of these symptoms are mild and tolerable. Sexual side effects, including erectile dysfunction and ejaculation disorder, are uncommon, but occur more frequently than the Urolift procedure. The Rezum procedure does have a much lower side effect profile compared to TURP, and therefore, is often a preferred treatment modality as a first step. Most men see urinary symptom improvement within about 4-6 weeks after the procedure, and these results appear durable for at least a few years, based on clinical trials.
Dr. Yu has extensive experience with the Rezum device, and can discuss with you if this is the best option for your situation.
FAQ About Rezum
Who is a good candidate for the Rezum treatment?
You may be a good candidate if you are a male, 45 years of age or older, and have bothersome urinary symptoms relating to BPH. If you have been taking medications and either do not like the side effects, or want to get off medications in general, then you may be a good candidate. Over 80% of Dr. Yu’s Rezum patients have been able to get off BPH medications in the long term. Dr. Yu will ultimately need to perform a cystoscopy to evaluate the prostate anatomy from the inside. An ultrasound may also need to be performed to assess prostate size. Every BPH patient is different, and the treatment decision will depend on many factors that will be reviewed in depth at your visit with Dr. Yu.
What should I expect during the treatment? Is it painful?
In general, the Rezum procedure is a minimally invasive treatment that entails much less downtime compared to TURP. Most patients go home with a catheter for 3-4 days. Once the catheter is removed, they will likely notice frequent urination, urgent need to urinate, and burning with urination for the first 2-3 weeks after the procedure. Patients will also notice intermittent blood in the urine for the first 2-3 weeks. You will be prescribed medications to help relieve some of these symptoms including pain medications, pyridium, as well as an antibiotic. If you were previously taking tamsulosin, you should continue to take that until 2 weeks after the procedure. Dr. Yu’s team will see you in the office 3-4 days after the procedure to take out the catheter, and check-in on you by phone about 2 weeks after the procedure.
Does the treatment affect my sexual function?
Clinical studies have shown the Rezum treatment has very low rates of erectile or ejaculatory dysfunction. The same cannot always be said of other BPH therapies such as TURP, laser PVP, simple prostatectomy, and even medications.
Will I need re-treatment after the Rezum procedure?
Clinical studies have shown the Rezum procedure has a low re-treatment rate of about 3-5%. This could involve another Rezum procedure, or may require other treatment approaches such as Urolift, TURP or transurethral incision of prostate (TUIP). A major benefit of the Rezum procedure is that it does not preclude other procedures from being performed, in essence, it does not burn any bridges, and can often be used as a first step to the treatment of BPH.
Option 3: Surgery
When medical therapy fails or when prostate anatomy limits the ability for a minimally invasive option such as Urolift or Rezum, more invasive surgeries can be done to remove obstructing prostate tissue. These types of surgery can be performed for BPH.
- Transurethral Incision of the Prostate (TUIP)
- Photoselective Vaporization of the Prostate (PVP)
- Transurethral Resection of the Prostate (TURP)
- Robotic Simple Prostatectomy
At your visit, Dr. Yu will discuss with you about the preferred options to treat your BPH.
We only have good things to say about Dr. Yu and his staff. Start to finish – Dr. Yu is simply the best. He is knowledgeable, competent and personable. My surgery was wonderfully unremarkable and recovery was made easier by Dr. Yu’s availability and attention.
– Anonymous
Dr. Yu’s rapid grasp of the complexities of my case was reassuring and his professional care in treating my condition was excellent. He used clear logic, skillful use of drawings and precise speech to describe my condition and what he planned to do about it.
– Anonymous
I had robotic surgery with Dr. Yu at Marin General. One of the fun things to do after surgery is share your scars with your friends, but I cannot do this: the 5 scars are virtually invisible.
– Jeff H.
Dr Yu treated me with a simple laparoscopic robotic prostatectomy to relieve problems associated with a very large prostate. No side effects after the prostate procedure. Dr. Yu conveys a humanness that many surgeons do not. I was really lucky to find him.
– Mike L. DDS
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