The PROSTATE GURU answers your prostate questions!

Prostate enlargement (Benign Prostatic Hyperplasia or BPH) is a common medical problem affecting more than 50% of men by age 60 and 90% of men by age 80. Of course, it affects men to varying degrees. Some men may develop weak urinary stream, urinary frequency, and get up in the middle of the night to void more frequently (nocturia). In other men, BPH can lead to urinary retention where the bladder grows weaker and weaker and is ultimately not able to expel the urine. These men may need a foley catheter.

In years past, Transurethral Resection of the Prostate (TURP) was the only treatment for BPH. In this surgical procedure, the prostate is "hollowed out" like a roto-rooter to allow urine to pass more easily. Although very effective, TURP also carries significant risks of retrograde ejaculation (semen ejaculates back into the bladder), bleeding (even requiring blood transfusions).

Currently, the initial 1st line treatment for men with bothersome and symptomatic BPH are oral medicines which help relax the prostate. Drugs such as Rapaflo (silodosin), Uroxatral (alfluzosin), Flomax (tamsulosin) all relax the smooth muscle within the prostate and thereby open the urine channel.

Not all patients will have relief with these medicines and many will ultimately still need surgery. TURP continues to be an excellent choice for these patients, although in recent years several other minimally-invasive surgical treatments have become available including use of various lasers to perform this surgery as well as bipolar energy. These advances may reduce the risk of bleeding with this operation. In my practice, I have also found great success with robotic surgery to core out the prostate, but it's usually only recommended in patients with very very large glands (>80gm).