Nearly all men will experience an enlarged prostate (benign prostatic hyperplasia, or BPH) in their lives. At some point, they will find themselves making constant trips to the bathroom, especially at night. And it may seem that urgency is required… but when you stand over the toilet you may only be able to dribble.
You see, a normal sized prostate is about the size of a golf ball. But over the years, it can become as large as a tennis ball. When this happens, it presses down on your urethra like a vice. This can cause all sorts of troubles when it comes to passing fluids from your bladder through to the toilet bowl.
As a result, up to 50% of men over the age of 50 – and up to 80% of men over the age of 80 – will experience urinary tract symptoms cause by BPH.
There are drugs for it. You’ve got your alpha blockers. They don’t do anything to reduce the volume of your prostate. All they do is relax the prostate and bladder neck muscles, and they come with a ton of side effects including impotence, dry ejaculation and fainting.
Then you’ve got your 5-alpha reductase inhibitors. They inhibit the production of dihydrotestosterone (DHT) in the prostate gland which helps reduce prostate volume. But I don’t like these drugs, either.
They decrease your sex drive and make it tough to get and maintain an erection. They increase your risk of growing male breasts and make your testes hurt. They’re basically a form of chemical castration, and that’s the last thing you want!
So what is a man with an enlarged prostate to do? Spend their entire lives in the bathroom?
The Ups and Downs of BPH Procedures
Well, there’s always surgery.
The so-called gold standard surgery for BPH is called a transurethral resection of the prostate (TURP). It’s awful. We often refer to it as the “roto-rooter,” because they go in through your penis and just start rotating this device around, destroying prostate tissue and pulling it out.
So you urinate blood for a couple of weeks and everything hurts. You don’t want to pee but you have to. Then you lose your ability for an erection and you no longer get to have sex.
Yikes! A lot of men would rather wear Depends or resort to self-catheterize before going this route.
But there are other treatments that are somewhat less invasive.
We have the prostatic artery embolization, or PAE. Tiny beads are injected into the artery that supplies blood to the prostate and partially block the blood flow. The reduced blood flow kills off some of the tissue in the prostate, which helps reduce the size.
The downside? The procedure can be affected by how far the median lobe of the prostate protrudes into the base of the bladder. Depending on how severe the protrusion is, this procedure could actually increase urinary retention and urinary tract symptoms.
Then we’ve got the UroLift system. It permanently inserts tiny implants that lift and hold prostate tissue out of the way so it doesn’t block the urethra.
Nobody seems to know why, but this procedure appears to result in a higher rate of emergency room visits afterwards than you would expect for a minimally invasive treatment. Plus, some men still remain catheter dependent at 30 days, and many have to be re-catheterized after 30 days.
You also have photoselective vaporization of the prostate (PVP, or Greenlight). It’s a laser surgery that involves inserting a tube into the penis and zapping excess tissue that blocks the urine flow.
This actually sounds like a pretty good option. But oddly enough, a two-year follow-up study found that most men who chose PVP had a significant decrease in erectile function afterwards. Another follow-up discovered that 65% of men lost the ability to ejaculate after PVP. That’s pretty alarming!
Give Your Prostate a Steam Bath
One on the newest treatments for BPH is called Rezūm water vapor therapy. And so far, I don’t see any downside to it. Well, except for the fact that the basic concept is pretty frightening.
It involves injecting steam into your prostate gland through the urethra to destroy the tissue that’s causing the blockage.
But here’s the thing. They tell you it’s only going to hurt a little bit. But don’t believe it. They’re lying!
It’s more of a screaming, burning, they’re pulling my tongue out with a pair of plyers kind of pain. So if you decide you want this procedure and they don’t offer you anesthesia or sedation, make sure to ask for it. That way, the most painful part will happen while you’re under.
Still, it works. And you’re not actually ripping anything out of your body, putting anything into it or changing the way it works. You’re just killing unwanted prostate tissue and your body will naturally carry it away. Most men see an improvement within just a few weeks, and the improvements continue for the next three to six months.
Better yet, these improvements generally come without the erectile dysfunction and ejaculation issues associated with other procedures. The treatment is also one of the few that works to reduce the size of the median lobe. Plus, it has a very short catheterization period. On average just about four days, sometimes less.
So if you haven’t been interested in taking BPH medications or undergoing BPH procedures in the past, this might be something you might want to check into. You can find a local urologist who specializes in Rezūm treatment here.
SOURCES:
Lokeshwar SD, Harper BT, Webb E, et al. Epidemiology and treatment modalities for the management of benign prostatic hyperplasia. Transl Androl Urol. 2019;8(5):529-539.
Naidu SG, Narayanan H, Saini G, Segaran N, Alzubaidi SJ, Patel IJ, Oklu R. Prostate Artery Embolization-Review of Indications, Patient Selection, Techniques and Results. J Clin Med. 2021 Oct 31;10(21):5139.
Yu SCH, Cho CCM, Hung EHY, Zou J, Yuen BTY, Shi L, Chiu PKF, Yee SCH, Ng ACF. Thickness-to-Height Ratio of Intravesical Prostatic Protrusion Predicts the Clinical Outcome and Morbidity of Prostatic Artery Embolization for Benign Prostatic Hyperplasia. J Vasc Interv Radiol. 2019 Nov;30(11):1807-1816.
Page T, Veeratterapillay R, Keltie K, Burn J, Sims A. Prostatic urethral lift (UroLift): a real-world analysis of outcomes using hospital episodes statistics. BMC Urol. 2021 Apr 7;21(1):55.
Park J, Cho SY, Cho MC, Jeong H, Son H. Changes in Erectile Function after Photoselective Vaporization of the Prostate with a 120-W GreenLight High-Performance System Laser: 2-Year Follow-Up. World J Mens Health. 2017;35(3):156-162.
Hossack TA, Woo HH. Sexual function outcome following photoselective vaporisation of the prostate. Int Urol Nephrol. 2012 Apr;44(2):359-64.
Elterman D, Bhojani N, Vannabouathong C, Chughtai B, Zorn KC. Large, Multi-Center, Prospective Registry of Rezūm Water Vapor Therapy for Benign Prostatic Hyperplasia. Urology. 2022 Feb 17:S0090-4295(22)00142-X.
McVary KT, Rogers T, Roehrborn CG. Rezūm Water Vapor Thermal Therapy for Lower Urinary Tract Symptoms Associated With Benign Prostatic Hyperplasia: 4-Year Results From Randomized Controlled Study. Urology. 2019 Apr;126:171-179.
Westwood J, Geraghty R, Jones P, Rai BP, Somani BK. Rezum: a new transurethral water vapour therapy for benign prostatic hyperplasia. Ther Adv Urol. 2018;10(11):327-333.
Mynderse LA, Hanson D, Robb RA, Pacik D, Vit V, Varga G, et al. Rezūm System Water Vapor Treatment for Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia: Validation of Convective Thermal Energy Transfer and Characterization With Magnetic Resonance Imaging and 3-Dimensional Renderings. Urology. 2015 Jul;86(1):122-7.
Woo HH, Gonzalez RR. Perspective on the Rezūm® System: a minimally invasive treatment strategy for benign prostatic hyperplasia using convective radiofrequency water vapor thermal therapy. Med Devices (Auckl). 2017;10:71-80.
