Benign prostatic hyperplasia (BPH), one of the most prevalent urologic conditions among men, affects approximately 50 percent of men between the ages of 51 and 60 and up to 90 percent of men over the age of 80.
Brian Whitley, MD, a urologist who specializes in treating BPH at Duke Urology Men’s Health Center, says that a variety of treatment options are important because individuals are affected in many different ways. Here, he discusses the latest minimally invasive technologies as well as traditional treatments for improving symptoms including frequency or urgency to urinate, irregular flow, weak stream, straining, and waking up multiple times at night to urinate.
Question: What are some of the newer minimally invasive techniques available at Duke?
Whitley: The newest technique is Rezūm (NxThera, Inc., Maple Grove, MN), which uses a radiofrequency device to harness the stored thermal energy in water vapor to treat extra prostate tissue and reduce pressure on the urethra. The condensation releases energy that causes the surrounding cells to die and results in retraction of the prostate and opening of the urethra.
Another relatively new therapy is implantation of a small prosthetic device, called the UroLift System (Neotract, Pleasanton, CA), that lifts and holds the enlarged prostate tissue out of the way so it no longer blocks the urethra.
Both of these treatments were recently added to the American Urological Association guidelines as acceptable first-line treatments for prostate enlargement, so there are excellent data that show they’re safe, effective, and durable. These procedures are less invasive and typically have fewer sexual adverse effects than other treatments. They’re also usually performed as outpatient or office procedures, which means shorter hospital stays. Our experience has been very promising with these technologies.
Question: Are these two newer technologies appropriate for everyone?
Whitley: No, these procedures aren’t perfect for everyone. For example, patients with prostates larger than 80 cc, patients on anticoagulation medications, or patients with severe obstruction aren’t good candidates, but there are other treatments we can offer them.
Question: What drug therapies are available for treating BPH?
Whitley: We typically start with finasteride and tamsulosin to shrink the enlarged prostate. For many men, continuing on these medications long-term is effective for treating their symptoms, and they’re happy to continue taking them. But for men who aren’t getting relief or don’t want to take pills, there are a number of procedures that may improve their symptoms.
Question: What are some of the common surgical procedures, and what are their adverse effects?
Whitley: Transurethral resection of the prostate is used to open up the channel by inserting a resectoscope through the tip of the penis into the urethra. Laser enucleation of the prostate involves endoscopic removal of prostatic tissue from larger prostates. Both of these procedures are associated with sexual adverse effects, such as retrograde ejaculation. They’re also performed in the operating room under general anesthesia and may require an overnight stay in the hospital afterward.
Question: What advice do you have for patients with BPH and their providers?
Whitley: The most important thing to remember is that men don’t need to just accept the bothersome symptoms of BPH as a normal part of aging. There are now a number of good options that we can offer based on an individual’s needs, so I encourage providers to refer their patients to a urologist with specific expertise in treating this condition.