Minimally Invasive Treatments for BPH


Since the beginning of time, if men lived long enough, they were at risk of problems with urinary obstruction commonly called BPH (Benign Prostatic Hypertropy).

This is usually benign but tends to cause increased urinary frequency during the day and night. Symptoms frequently include frequent, urgent urination, leakage of urine and decreased emptying of the bladder. In the 1800’s men would carry hollow bamboo sticks in their hats and then catheterize themselves when they couldn’t empty their bladders. Fortunately, the treatments for BPH have changed dramatically since then.

Oral Medication Options for BPH

Typically when men start to have problems with urination, the first line therapy is medications such as alpha blockers which open the inside of the prostate (Flomax, Uroxatrol, Hyrin and others) and 5 alpha reductase inhibitors which shrink the prostate (Proscar and Avodart). These frequently will be effective enough to not require any further treatment. When men do not improve with the medications and/or get worse while on medications, the next line of therapy is usually surgical. Some of the original ways to surgically remove obstructing prostate tissue were wrought with complications such as bleeding, extended hospitalizations and hyponatremia (low sodium that can lead to neurologic problems).

Minimally Invasive Treatment Options for BPH

Fortunately, the last 20 years have dramatically changed the way prostates are surgically treated. The basic idea behind surgery is to remove the tissue that has grown into the prostatic urethra and eventually leads to decreased emptying of the bladder.

Transurethral Resection of the Prostate (TURP)

The gold standard for treatment has been the Transurethral Resection of the Prostate (TURP). This is a procedure that scrapes the obstructing prostate tissue out and opens up the prostatic urethra so men can urinate much better after the surgery. The TURP has always been a very effect way to help men urinate better but has significant side effects including inpatient hospitalization, bleeding, hyponatremia and prolonged catheterizations. Due to the side effects, new minimally invasive technologies have been developed. Some of the initial therapies used thermal (ie. heat) technologies or radiofrequency to kill prostate tissue and therefore decrease the obstruction, hopefully improving a person’s symptoms. Unfortunately, the effects of these treatments were not long lived in most cases. Frequently men would be improved initially, but 6-12 months later their symptoms would return.

UroLift® for BPH, or Enlarged Prostate

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The UroLift® system is a new approach to treat BPH that lifts and holds the enlarged prostate tissue out of the way so it no longer blocks the urethra. It is the only BPH procedure that does not require cutting, heating or removal of the prostate tissue. Click here for more information about UroLift.

Laser Therapy for BPH

The last 10 years have shown the greatest promise in minimally invasive BPH therapies. The advent of lasers and the Gyrus Plasma Button have helped many patients urinate better with minimal side effects. Laser therapies – such as the Green Light laser and Revolix laser – are used to vaporize and remove the obstructing tissue. With this obstruction gone, urination after a person healed, will usually improve dramatically. One of the downsides to the lasers is that you may not be able to get as much tissue out to completely relieve the obstruction. The Gyrus Plasma Button is the most commonly used minimally invasive technology currently used in the Austin area. The Plasma Button uses a combination of electricity and radiofrequency to create a plasma arc that literally vaporizes large amounts of obstructing tissue. This technology is usually done in an outpatient surgery center. Patients usually only need a catheter for a day or two. The risks of bleeding and hyponatremia are minimal and large amounts of obstructing tissue can be effectively and efficiently removed during the operation.

Most people who are undergo these procedures have tried medications previously and their symptoms are either getting worse or did not improve prior to the procedure. Many patients will come in after the procedure and state that they wish they would have done the procedure 10 years earlier. Initially after the Plasma Button patients have a catheter over night and then remove it the next morning. Their symptoms may get worse before they get better over a period of days to weeks. This is so they can heal. Once the area of the operation has healed, they usually go to the bathroom less often during the day and night. They frequently will have less urgency and are routinely happy they had the procedure done. The effects of this procedure appear to be long term with very little risk of needing to have another procedure years later as some of the other earlier generation minimally invasive procedures did. After the Plasma Button, most patients can stop their prostate medications. Patients and insurance companies are usually very happy about not needing medications.

Surgical treatment for BPH has come a long way from archaic treatments of early medicine to minimally invasive treatments that allow a patient to return to work and normal function, rapidly with good long term results. The field of medicine and especially minimally invasive BPH treatments, is constantly changing and as new technologies are developed, patients will continue to see improvement in their symptoms. If you think you are a candidate for minimally invasive therapies, please contact your urologist to discuss treatment options in greater detail.

GreenLight™ Laser Therapy

This treatment option provides rapid relief of symptoms caused by benign prostatic hyperplasia (BPH). In many cases, GreenLight™ Laser Therapy also offers a shorter hospital stay, less catheterization time, less bleeding, and a faster recovery than traditional surgical options.1-5

How It Works

During the procedure, your doctor uses a laser to rapidly heat and vaporize the excess prostate tissue, resulting in a larger channel for urine to pass through. Removing the excess tissue rapidly restores natural urine flow in most patients.

The Procedure

The GreenLight Laser procedure is typically performed on an outpatient basis under general anesthesia. Most patients experience rapid relief of BPH symptoms and improvement in urine flow after the procedure. Your doctor can tell you more about the surgical procedure.

Recovery

Every patient’s experience is different, and you should talk to your physician about what to expect. Patients typically go home within a few hours after the procedure. If a urinary catheter was placed in the bladder at the end of the procedure, it will typically be removed within 24 hours. However, some patients may require a catheter for a longer time. Patients can usually return to everyday activities within a short time. As with any medical procedure, complications can occur. Side effects include, but are not limited to:

  • Blood in the urine
  • Irritation of the bladder, resulting in frequent and/or urgent need to urinate
  • Irritation of the urethra, resulting in frequent urination and/or a burning sensation
  • Retrograde ejaculation (during sexual climax, semen travels backward to the bladder rather than exiting through the penis)