The prostate is a walnut-sized gland important for reproduction. It sits in between the bladder and the penis. All the urine leaving the bladder runs through a channel in the middle of the prostate called the urethra. No one knows why the prostate gets bigger as we get older, but as it enlarges, it squeezes the channel causing a narrowing and a blockage. The bladder has to work extra hard to push the urine through this tight channel, resulting in a weak stream, frequent urination, and waking up at night to pee.
It is important to make sure that there is nothing else causing your symptoms. Sometimes the bladder just isn’t working properly and sometimes there is something else causing the blockage. Aside from your physical examination, your urine will be sent for analysis. Samples of a medication may be offered to see if it will help your symptoms. A flow study may be recommended to determine whether there is a blockage or a bladder problem. A cystoscopy might be needed to determine the precise source of the blockage. The problem and the solution can be determined in two visits.
- Medication: Pills can be used to relax the muscles of the prostate or to shrink it depending on the size, allowing urine to flow through it a little easier. Although very good at relieving symptoms, you will likely be dependent on these medications for the rest of your life. There are several sexual side effects that your doctor will discuss with you.
- Microwave thermotherapy: We offer a simple office-based heat treatment that takes about 45 minutes. This offers symptom relief without medication and lasts between 2 and 5 years. You will need a catheter for a few days. There is potential for sexual side effects, but less than with medication.
- Surgery: The “roto-rooter” will give you symptom relief for about ten years. It is typically an outpatient procedure that destroys and removes prostate tissue to open the channel. You will require a catheter for a few days and nearly 100% of patients have sexual side effects.
- Prostatic Urethral Lift: The Urolift procedure (www.urolift.com) pulls the prostate away from the channel using a piece of suture material. This takes about ten minutes and can be done in the office. There is no catheter and no sexual side effects. Although it has not been around as long as the “roto-rooter”, it seems to be just as good without any side effects.
Once we know what the problem is, all of these options will be discussed and together we will come up with a plan that is best for you.