What is the prostate?

The prostate is part of a man’s reproductive system. It is a walnut-sized gland that lies at the base of the bladder and surrounds the urethra (a tube that takes urine from the bladder, along the penis, and out of the body). The main function of the prostate is to produce the fluid that provides nutrition to the sperm.

What is an enlarged prostate?

As men get older, the cells of the prostate begin to swell, which increases the size of the prostate. This condition is non-cancerous and is called benign prostatic hyperplasia (BPH). The enlarged prostate puts pressure on the urethra (the tube through which urine passes). This can make it difficult to pass urine and may cause urinary symptoms, such as hesitancy, straining, weak stream, dribbling, incomplete emptying, frequency, urgency, and nighttime urination. The enlargement can also lead to complications like retention (inability to urinate), urinary tract infections, hematuria (blood in urine), epididymo-orchitis (infection of testicle) and, in rare cases, bladder damage and kidney failure.

How do you treat an enlarged prostate?

Not everyone who develops an enlarged prostate will need treatment. Only patients who have complications from prostate enlargement and who are bothered by their urinary symptoms require treatment. The first-line treatment is medical therapy. These involve alpha blockers, 5-alpha reductase inhibitors, phosphodiesterase inhibitors, and anticholinergics. In some patients, combination therapy may be utilized.

Patients not responding to medical therapy or patients having complications from BPH usually require surgical therapy. The following surgical treatments are utilized to treat BPH. The type of therapy depends on the prostate size, prostate anatomy, and patient factors. The urologist may perform additional studies, like cystoscopy, transrectal prostate ultrasound, and urodynamic study to decide the best procedure for the patient.

The main complications of prostate procedure include bleeding, urinary tract infection, retrograde ejaculation, urinary incontinence, urinary frequency, need for post-operative catheterization, and need for reoperation.

Below is a list of some of the treatment options for an enlarged prostate.

The Urolift System is an FDA-approved, minimally invasive procedure that involves inserting four to six implants in the prostate that lift and secure it so that it no longer blocks the urethra. There is no cutting or heating during this five-to-10-minute procedure so there is minimal post-procedure bleeding and pain. There are no sexual side effects and symptom relief extends up to five years following treatment.

MedStar Health’s Georgetown location is the only site in Northern Virginia and Washington, D.C. to offer the UroLift System. The procedure is appropriate for patients with a prostate size between 20 and 80 cc and can be performed on patients who are on blood thinners.

TUMT is an office-based procedure where microwave therapy is delivered to the prostate using a special catheter. Although it is a minimally invasive procedure, it requires post-operative catheterization for about 1 week and has very high retreatment rates (up to 50%). It is ideally performed on patients who are not the best candidates for surgical therapy.

TURP involves resection (cutting) of the inner part of the prostate using electrocautery. The procedure is performed using a telescope inserted through the penis. It can be done utilizing monopolar or bipolar electrocautery. Most patients require overnight catheterization and hospitalization.

Retreatment rates are low (<10%). The main complications include retrograde ejaculation (>75%) and urinary incontinence (<5%). TURP can cause post-operative bleeding and is not recommended in patients with large prostates (>100 gm) and where the bleeding risk is high. This procedure is considered the gold standard for surgical treatment for BPH.

HOLEP involves enucleation of the inner part of the prostate using a laser. The procedure is performed using a telescope inserted through the penis. The enucleated tissue is morcellated and removed from the bladder. Most patients require overnight catheterization and hospitalization.

Retreatment rates are very low (<5%). The main complications include retrograde ejaculation (>75%) and urinary incontinence (<5%). It can be performed in patients with large prostates (>100 gm) and in patients where the bleeding risk is high. This procedure is considered the “new” gold standard for treatment of BPH, as it is minimally invasive and can be performed in all patients with BPH.

PVP involves vaporization (evaporation) of the inner part of the prostate using a laser. The procedure is performed using a telescope inserted through the penis. No tissue is obtained for pathologic examination. Most patients require overnight catheterization and it can be performed in an outpatient setting.

Retreatment rates are higher than TURP and HOLEP (10-20%) and some patients may have worsening of their urinary frequency and urgency. The main complications include retrograde ejaculation (>75%) and urinary incontinence (<5%). It cannot be performed in patients with large prostates (>100 gm); however, it is safe to perform in patients where the bleeding risk is high.

Simple prostatectomy involves enucleation of the inner part of the prostate using an abdominal approach. This can be performed using an incision (open surgery) or using laparoscopic surgery. Most patients require prolonged catheterization (5-10 days) and hospitalization (2-3 days).

Retreatment rates are very low (<5%). The main complications include retrograde ejaculation (>75%), blood transfusion (<10%), and urinary incontinence (<5%). It is only performed in patients with large prostates (>100 gm).

In this new procedure, the interventional radiologist will thread a tiny catheter through the artery in the groin to the arteries supplying blood to the prostate gland. The radiologist will then embolize (cut off the blood flow) to the prostate gland. The decreased blood flow causes the prostate gland to shrink. The procedure is investigational and is best suited for patients who are not the best candidates for other surgical therapies.

The urologists at MedStar Health provide the whole range of medical and surgical therapies for treatment of an enlarged prostate.

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