Benign Prostatic Hyperplasia
Geisinger's Urology Department includes seven urologists offering a multifaceted approach to the treatment of Benign Prostatic Hyperplasia (BPH).
What is BPH?
BPH affects the majority of men as they age. BPH is a non-cancerous enlargement of the prostate that blocks the flow of urine out of the bladder, causing a number of urinary symptoms. Your urologist will discuss your symptoms with you. A common screening test used by urologists is the International Prostate Symptoms Score (IPSS). It contains questions about urinary symptoms. Higher symptom scores generally correlate with increased severity of BPH.
The treatment of BPH is tailored for each individual. You will discuss your situation with your urologist, and together plan a treatment strategy. An overview of treatments available at Geisinger is provided here:
Some men are minimally bothered by their symptoms and chose no active therapy.
There are many medicines that can help alleviate the symptoms of BPH. Men may be placed on a single medication or a combination of two or three drugs. Medications must be taken life-long to maintain symptom relief. Commonly used drugs are listed by class with the generic name listed first followed by the trade name in parentheses.
Alpha blockers are medications taken to relax the tone of the muscles in the prostate, thus opening the urine channel and increasing urinary flow. These medications can cause symptoms of fatigue and dizziness due to a lowering blood pressure:
- Terazosin (Hytrin)
- Doxazosin (Cardura)
- Tamsulosin (Flomax)
- Alfuzosin (Uroxatral)
5-Alpha Reductase Inhibitors
5-alpha reductase inhibitors are medications taken daily to decrease the blood flow and size of the prostate. This reduction in size improves urinary flow rates. It typically takes at least three months before symptom improvement is noticeable and works best for men with larger prostates. These drugs have been shown in several studies to provide the best symptom relief when combined with an alpha blocker and have also been shown to decrease the risk of urinary retention. Sexual side effects, like lowered libido, are possible:
- Finasteride (Proscar)
- Dutasteride (Avodart)
Anticholinergics are medications taken once, twice or three times daily (depending on the formulation) to slow down bladder muscle activity. These medications are used to decrease bladder urgency and urge incontinence. They may also help to decrease urinary frequency. Side effects include dry mouth and constipation. People who have uncontrolled (untreated) narrow angle glaucoma should not use this class of medications:
- Oxybutinin (Ditropan)
- Tolterodine (Detrol)
- Trospium (Sanctura)
- Solfenacin succinate (Vesicare)
We offer several options for treating symptomatic BPH in the office setting. These procedures accomplish destruction of prostate tissue to open the urinary channel and improve flow. Procedures are done in an office procedure room under sedation, thus avoiding a trip to the operating room for general anesthesia. Procedures generally take 30 to 60 minutes. These procedures generally provide more dramatic improvements in BPH symptoms compared to medical therapy. Most men are able to stop their BPH medications after undergoing a treatment. Studies of men undergoing these procedures have shown symptom relief to endure for five to seven years:
TUNA - Trans Urethral Needle Ablation of the Prostate
Trans urethral needle ablation uses radiofrequency energy to create high temperatures to kill prostatic tissue and open up the urine channel. A special scope is placed through the urethra up to the level of the prostate. Two needles are deployed into the prostate tissue under direct vision for a series of three-minute heat treatments. The number of needle treatments per procedure vary depending on the size and shape of the gland. We use the Medtronic TUNA System.
Uses microwave energy to create high temperatures to kill a rim of prostate tissue around the urethra, thus opening up the urine channel. The microwave antenna is positioned in the prostatic urethra via a special catheter very similar to a Foley catheter used to drain the bladder.
During alcohol ablation, absolute alcohol is injected into the prostate to kill portions of the gland that are then absorbed by the body, thus decreasing the size of the gland and improving urinary flow. Injection is done via a needle placed through the perineal skin under trans-rectal ultrasound guidance. This procedure takes about 15 minutes.
These procedures are done in the operating room under anesthesia. They can be done as outpatient surgery (home the same day), or as an overnight stay:
- Greenlight Laser Prostatectomy - A high-energy laser is used to vaporize obstructing prostate tissue. More information here.
- Trans Urethral Electro-Vaporization of the Prostate (TEVAP) - High-power electrical energy is used to vaporize obstructing prostate tissue.
- Trans-Urethral Resection of Prostate (TURP) - Electrical energy is used to resect and remove obstructing prostate tissue.
- Open Prostatectomy - An incision made between the umbilicus and pubic bones and the majority of the prostate is removed. This operation is reserved for very large prostates in men who can tolerate a major operation. Most patients stay in the hospital for five to seven days after this procedure.
Foss Clinic 1
100 N. Academy Ave.
Danville, Pa. 17822