Benign Prostatic Hyperplasia: what you need to know

Brian DeCastro, MD is a board-certified urologist at Inova. He served in the U.S. Army as a urologist for 11 years before entering private practice. His clinical areas of interest include kidney stones, low testosterone, erectile dysfunction, benign prostatic hyperplasia, urologic malignancies and other urologic conditions. Named a “Top Doc” by Northern Virginia Magazine, Dr. DeCastro believes that the patient always comes first and thrives on helping others. 

What is Benign Prostatic Hyperplasia (BPH)?

The prostate is a gland found in men and people assigned male at birth. It’s located around the lower portion of the bladder. Over time, the prostate can get larger. When this happens, it’s called benign prostatic hyperplasia, or BPH – better known as an enlarged prostate.

Prostate enlargement can start as early as 25 and can continue to grow as men age. Although BPH is not cancer, and having it does not increase the risk of developing prostate cancer, a growing prostate can squeeze the urethra (the tube carries urine from the bladder out of the body). This enlargement can lead to bothersome urinary symptoms over time. 

What are the symptoms of BPH?

BPH can cause problems with urination. Symptoms can start out mild but get worse as the prostate continues to grow and obstruct the urethra. Symptoms of BPH include:

• A slow stream of urine
• A stream that stops and starts
• A delay in the start of the flow
• Straining to urinate
• Needing to urinate frequently
• Feeling an urgent need to urinate
• Getting up twice or more a night to urinate
• A feeling of incomplete emptying of the bladder
• Dribbling after urination
• Urinary incontinence (“leaking”)

Does BPH require treatment? What about just dealing with the symptoms?

Too often, men suffer with their symptoms and don’t get evaluated by a urologist. It’s important to know that untreated BPH can have silent consequences. The longer a bladder must squeeze against a blocked opening, the more likely it is to suffer long-term damage. This can lead to urinary retention that requires catheterization, as well as kidney damage – and at that point, it’s too late. That’s why it is important for patients to see a urologist and not just “live with” their symptoms. 

At Inova Urology, we sit down to discuss the various treatment options at every step of the evaluation process. It is important for men to understand the long-term effects of untreated BPH and the great options that are available for symptom relief. 

How is BPH treated?

The first option we try is medication, and there are two classes of medications that we typically use to treat BPH. The first family of medicines works by relaxing the smooth muscle of the prostate, helping to open the channel so the urine can flow better. The second type of medicines works to shrink the overall size of the prostate. A combination of these two medications often works best to improve urinary symptoms related to BPH.

When patients have severe symptoms, or if medications are not controlling the symptoms, we start to consider surgical options for BPH. We conduct a full evaluation in our clinic including a urine flow test, a bladder scan to measure residual urine and a cystoscopy, which is a scope of the prostate, urethra and bladder. This evaluation can help us to determine who might need to proceed with surgical intervention. 

What procedures are available to treat BPH?

At Inova Urology, we offer all of the state-of-the-art treatments for BPH.  Some patients with milder symptoms might be candidates for Rezum™ or Urolift™. Rezum is a steam treatment of the prostate that can be done in the office. Urolift includes several small implants that are permanently placed to lift and hold the prostate tissue out of the way.  Both are not recommended for severe cases and often will only be temporary fixes. 

Patients who are not good surgical candidates due to medical problems or age may benefit from prostatic arterial embolization (PAE). PAE shrinks the prostate tissue by cutting off the blood supply to the enlarged prostate tissue. 

For patients with more severe symptoms, we have three excellent options:

• Transurethral resection of the prostate (TURP) – the gold standard for decates, TURP removes prostate tissue without an external incision
• Holmium laser enucleation of the prostate (HoLEP) – a laser beam removes the enlarged prostate tissue in bulk
• Aquablation® – uses a high-pressure water jet and robotic precision to remove the excess prostate tissue

In Aquablation, the accuracy of the water jet allows maximum symptom relief with the fewest side effects. Inova is proud to be one of the first centers in Northern Virginia to offer Aquablation therapy. 

The patients who undergo surgical intervention for BPH are some of my happiest and most thankful patients. They often did not realize how bad their symptoms had gotten over the years. Many patients say that they cannot remember the last time their flow was that strong. Whether it is a TURP, HoLEP or Aquablation, these surgeries have high patient satisfaction rates. 

Are there lifestyle changes men can make to improve BPH symptoms?

There unfortunately is not a lot that men can do through lifestyle modification to improve their BPH symptoms. There are several prostate supplements on the market that contain various ingredients such as saw palmetto extract, pumpkin seed extract, pygeum and lycopene. While some patients report feeling some symptomatic improvement, there is not a lot of clinical evidence to support their efficacy in treating BPH.   

What is the most important thing men need to know about BPH?

The biggest misconception about BPH is that it is a “normal part of aging” and that men should just accept these symptoms. We have gotten very good at managing BPH with very little long-term side effects. I hate to see men come to the clinic with catheters, because I feel like we have failed them as a medical community.  It is my hope that men will read this and seek treatment before it gets to that point.  You don’t have to live with your symptoms! Make an appointment today with one of our Inova urologists to see which treatment option is right for you. 

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