What is an enlarged prostate (BPH) and how is it treated

The prostate gland is part of the male reproductive system that sits just below the bladder. It wraps around the urethra, the duct through which urine passes, and is about the same size and shape as a walnut. However, it continues to grow over the course of a man's life, sometimes becoming lemon-sized or even larger. If the prostate becomes big enough to press on the urethra, it can block the flow of urine causing symptoms including:

• A need to urinate more often
• Difficulty starting urination
• A weak or interrupted flow
• A feeling that the bladder isn't completely empty after urinating

This condition is called benign prostatic hyperplasia, or BPH. It is extremely common, affecting about 50% of men by age 60, 70% of men aged 60 or older and around 90% of men by age 85. For many people, the frequent and urgent need to use the bathroom can be embarrassing, uncomfortable and start to interfere with sleep, sexual activity and the routines of daily life, such as commuting to work or participating in hobbies.

Fortunately, there are many BPH treatments available, starting with lifestyle modifications like getting regular exercise and limiting caffeine and alcohol in the evening. Medications are often the next step, but they may not work for everyone and can have side effects such as dizziness and erectile dysfunction. A range of device-based alternatives also exist - from minimally invasive in-office procedures to surgeries - that can either shrink the prostate or move prostate tissue away from the urethra, providing symptom relief.

"Having an enlarged prostate as you get older may be inevitable," says Ronald Morton, M.D., chief medical officer, Urology, Boston Scientific. "But the good news is that given the range of treatment options available, you can do something about it. Patients can work with their doctor to select the appropriate therapy for them based on symptom severity, prostate size and the type of relief they're looking for."

Shrinking the prostate with water vapor therapy

For mild to moderate prostate enlargement, a urologist may recommend water vapor therapy. This is a minimally invasive procedure that uses the natural energy stored in steam to shrink excess prostate tissue. It takes about an hour and can be performed in a urologist's office or clinic. There is only one such vapor treatment currently available for BPH: Rezūm™ Water Vapor Therapy.

During this procedure, after a patient has received local anesthesia or light sedation, a doctor inserts a delivery device into the urethra, then delivers sterile water vapor to the targeted prostate tissue. Patients go home the same day and usually return to normal activities within a few days. Most begin to experience symptom relief within two weeks, with effects reaching their maximum within six months, as the body's natural healing response absorbs the treated tissue, shrinking the prostate.

Studies show Rezūm continues to provide lasting relief from BPH symptoms five years later. One recent clinical trial comparing Rezūm to combination drug therapy - a dual drug regimen that can bring unwanted side effects - found that Rezūm provides superior symptom relief (measured by the International Prostate Symptom Score) while preserving sexual function. Watch how it works:

Vaporizing excess tissue with laser therapy

For people whose moderate-to-severe BPH results in difficult-to-tolerate symptoms - including complications like bladder stones or recurrent infections - getting fast relief has typically meant removing prostate tissue through an invasive surgery called transurethral resection of the prostate (TURP). Now, however, less invasive procedures can remove excess tissue using lasers, with minimal bleeding risk, shorter hospital stays and quicker recovery times. Some can even be performed on an outpatient basis, with the patient typically going home the same day.

Using the Greenlight™ XPS Laser Therapy System, for example, a urologist inserts a delivery device into the urethra of an anesthetized patient and uses laser technology to remove overgrown prostate tissue. The laser heats up the prostate tissue, causing it to vaporize. The heat from the laser also seals up the tissue so that there is minimal bleeding, allowing the urologist to maintain a clear view - and making the procedure available for men who take blood thinners.

Most patients resume their normal activities within a couple of days and experience initial symptom relief within 24 hours of the procedure. The Greenlight procedure has been shown to relieve symptoms for up to 15 years, and one study showed 86% of patients reported improved or unchanged sexual satisfaction. To date, this treatment has helped more than one million men around the world. Watch how it works:

Removing excess tissue with holmium laser therapy

Moderate to severe BPH can cause significant symptoms - for example, the inability to urinate without a catheter - that may call for excess prostate tissue to be removed more definitively. In such situations, a doctor might recommend another type of laser therapy that not only blasts away excess tissue but also completely removes it from the body. This method is called holmium laser enucleation of the prostate, or HoLEP.

In a HoLEP procedure, while the patient is under anesthesia, the doctor inserts an instrument with a camera called a resectoscope through the urethra. Much like in the previous method, they then push through a fiber with a laser beam at the end. This time, however, instead of vaporizing the tissue, the laser beam cuts the tissue away. The resectoscope is then replaced with a device that suctions out the tissue and removes it from the body.

The HoLEP procedure typically requires an overnight hospital stay. However, the efficiency of the Lumenis Pulse™ 120H Holmium Laser System with MOSES™ 2.0 Technology has been shown to reduce overall HoLEP treatment time, which can lead to fewer complications. As a result, 90% of patients treated with this technology are discharged the same day - and since the HoLEP procedure has a very low reoperation rate, patients are rarely troubled by prostate enlargement again.

Learn more about enlarged prostate (BPH) causes, symptoms and treatments.

There are risks associated with all medical procedures. Risk and safety information for the treatment options discussed above can be found here. Be sure to ask your doctor to thoroughly explain the risks associated with all BPH treatment options.