Benign Prostate Hyperplasia causing Lower Urinary Symptoms
Maiden Lane Medical
Multi-Specialty Group Practice located New York, NY
Benign prostatic hyperplasia (BPH) is an enlargement of the prostate. It’s a normal condition of male aging, but some men develop serious urinary complications. At the Urology Division at Maiden Lane Medical in Midtown Manhattan, our top-rated urologists have extensive expertise in treating BPH and relieving your symptoms. Call or make an appointment online to book a consultation.
One of the most common situations that I see in my Urology practice at Maiden Lane Medical involves a 60+ year old man coming to the office complaining of a bothersome change in his urinary pattern.
The changes are generally slow and insidious, occurring over a period of months to years but may eventually reach a point when they have a negative impact on the quality of that person’s life.
They usually first note:
- a slower urinary stream
- dribbling of urine following “completion” of urination
- these problems can exacerbate over time into more frequent trips to the bathroom during the day (every 1-2 hours)
- waking every few hours at night
- taking longer to initiate urination
- having the sense that they are unable to completely empty their bladders at the end of urination
It’s usually at this point that they decide to speak to a Urologist to better understand the cause of their symptoms and treatment options.
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Sitting below the bladder in the lower male urinary tract is the prostate gland. Aside from causing these troublesome urinary problems later in life, its primary purpose is:
- contribute prostatic fluid to the seminal discharge,
- providing sperm cells with a proper environment for their transport from the man’s body.
This is certainly a good thing…..but it is mostly downhill from here. The prostate gland starts off relatively small in younger men, but in one of those many unfortunate twists that occur as we age, the prostate continues to grow for no good reason, compressing the urethra draining urine from the bladder, and forcing the bladder to work harder to “squeeze” urine through the prostatic section of the urethra.
The bladder eventually has more and more trouble expelling urine, resulting in more frequent and weaker voids. More urine is left behind in the bladder after each void, resulting in urine buildup, thus shortening the intervals between each urination. Progression of these lower urinary symptoms or “LUTS” are unpredictable.
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In many men, they can remain stable for years, but in some, they progress quickly until the obstruction is so significant that the bladder is unable to empty, overfills, and leaves the individual in a condition known as “acute urinary retention”. These patients are not happy campers, and must go emergently to a medical facility to have the urine drained from the bladder with a catheter……not a lot of fun, and reason enough to take care of the problem before things progress to this level.
Treatment can range from “reassurance” that their symptoms are mild enough so that no medical intervention is warranted at the time, to surgical treatment of significant prostatic obstruction.
However, in most cases, our first level of treatment involves pharmacologic management; we first try medications, of which there are several, with minimal to no side effects that can result in an almost overnight improvement in urinary symptoms. Certainly, the vast majority of our patients fall into this category and potentially can remain there for many years.
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When pharmacologic treatment fails, or the patient is unable to tolerate the medication, or a patient just is uncomfortable with the notion that they will be on drugs for years…….. we suggest minimally invasive treatments. These “MITs” have evolved over the years- they just keep getting better and better.
The procedures being used today are easily tolerated in the office setting under straight local anesthesia, have a longer duration of benefit (at least 5 years and counting), and take under 10 minutes to perform from beginning to end.
The procedure that is performed at Maiden Lane Medical is the Rezum Procedure. Essentially, the Rezum device injects steam for a few seconds into the prostate gland at several locations. Once injected, energy is transferred into the prostate tissue as the steam converts to water, destroying prostate tissue in the process.
The tissue sloughs out of the prostate over a period of weeks, so that most patients’ note an improvement in their urinary symptoms as soon as 3-4 weeks, with full benefit seen by 3-4 months.
We have performed over 100 of these procedures in the practice, and the vast majority of patients have seen substantial improvements in their urinary symptoms, and have been able to discontinue all medications previously prescribed for their prostate condition.
Unfortunately, not all patients are candidates for MIT – due to their co morbid medical conditions, prostate size, severity of symptoms, etc. In these cases, we bring the patients to the hospital where prostate surgery is performed in the operating room under general anesthesia.
These surgeries use laser or high voltage electrical energy to similarly destroy prostate tissue, reducing prostatic obstruction and resulting in an improved flow of urine through the lower urinary tract.
Bottom line, LUTS need to be recognized by the patient and not ignored. They don’t get better over time – they only get worse.
A consultation with a urologist is not something to be put off but scheduled when these symptoms begin, so that the patient has a better understanding of what to expect, his treatment options, and have an opportunity to improve the quality of his life.
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