Mayo Clinic specialists have experience diagnosing complex conditions involving enlarged prostate. You have access to the latest diagnostic testing, including urodynamic and pressure flow studies.
Guidelines for the Treatment of Benign Prostatic Hyperplasia
A wide variety of treatments are available for enlarged prostate, including medication, minimally invasive therapies and surgery. The best treatment choice for you depends on several factors, including:. If your symptoms are tolerable, you might decide to postpone treatment and simply monitor your symptoms.
For some men, symptoms can ease without treatment. Medication is the most common treatment for mild to moderate symptoms of prostate enlargement. The options include:. Any type of prostate procedure can cause side effects. Depending on the procedure you choose, complications might include:. A lighted scope is inserted into your urethra, and the surgeon removes all but the outer part of the prostate.
TURP generally relieves symptoms quickly, and most men have a stronger urine flow soon after the procedure. After TURP you might temporarily need a catheter to drain your bladder. A lighted scope is inserted into your urethra, and the surgeon makes one or two small cuts in the prostate gland — making it easier for urine to pass through the urethra.
U.S. Food and Drug Administration
This surgery might be an option if you have a small or moderately enlarged prostate gland, especially if you have health problems that make other surgeries too risky. Your doctor inserts a special electrode through your urethra into your prostate area. Microwave energy from the electrode destroys the inner portion of the enlarged prostate gland, shrinking it and easing urine flow.
TUMT might only partially relieve your symptoms, and it might take some time before you notice results. This surgery is generally used only on small prostates in special circumstances because re-treatment might be necessary. In this procedure, a scope is passed into your urethra, allowing your doctor to place needles into your prostate gland.
Radio waves pass through the needles, heating and destroying excess prostate tissue that's blocking urine flow. TUNA may be an option in select cases, but the procedure is rarely used any longer. A high-energy laser destroys or removes overgrown prostate tissue. Laser therapy generally relieves symptoms right away and has a lower risk of side effects than does nonlaser surgery. Laser therapy might be used in men who shouldn't have other prostate procedures because they take blood-thinning medications.
Special tags are used to compress the sides of the prostate to increase the flow of urine. The procedure might be recommended if you have lower urinary tract symptoms. PUL also might be offered to some men concerned about treatment impact on erectile dysfunction and ejaculatory problems, since the effect on ejaculation and sexual function is much lower with PUL that it is with TURP. In this experimental procedure, the blood supply to or from the prostate is selectively blocked, causing the prostate to decrease in size. Long-term data on the effectiveness of this procedure aren't available.
The surgeon makes an incision in your lower abdomen to reach the prostate and remove tissue. Open prostatectomy is generally done if you have a very large prostate, bladder damage or other complicating factors. The surgery usually requires a short hospital stay and is associated with a higher risk of needing a blood transfusion. Your doctor might recommend limiting heavy lifting and excessive exercise for seven days if you have laser ablation, transurethral needle ablation or transurethral microwave therapy. If you have open or robot-assisted prostatectomy, you might need to restrict activity for six weeks.
What is the Prostate
Toby Kohler, a Mayo Clinic urologist, says the enlarged prostate forces the urethra to narrow, causing a variety of urination problems. And as men age, the symptoms occur more frequently. Treatment for BPH has long been medications and procedures, such as lasers or an electric loop, which burn the prostate from the inside out. But, now, a relatively new convective water therapy treatment uses steam to make the prostate smaller. Kohler says the procedure, performed right in the doctor's office, has a very low risk for complications or sexual side effects.
Mayo Clinic specialists have training in a wide range of state-of-the-art technology to treat enlarged prostates. Your Mayo Clinic specialist will explain the range of treatments available and help you choose the best approach based on your symptoms. Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.
The Food and Drug Administration hasn't approved any herbal medications for treatment of an enlarged prostate. Studies on herbal therapies as a treatment for enlarged prostate have had mixed results. One study found that saw palmetto extract was as effective as finasteride in relieving symptoms of BPH, although prostate volumes weren't reduced.
But a subsequent placebo-controlled trial found no evidence that saw palmetto is better than a placebo. Other herbal treatments — including beta-sitosterol extracts, pygeum and rye grass — have been suggested as helpful for reducing enlarged prostate symptoms. But the safety and long-term efficacy of these treatments hasn't been proved.
If you take any herbal remedies, tell your doctor. Certain herbal products might increase the risk of bleeding or interfere with other medications you're taking. Your doctor is likely to ask you a number of questions. Being ready to answer them might give you more time to address any concerns. You might be asked:.
Mayo Clinic does not endorse companies or products. You will be redirected to verify your credentials. George's University School of Medicine, St. George, Grenada. Corresponding Author Sardar Ali Khan. Keywords: Benign prostatic hyperplasia Median lobe hypertrophy Intravesical prostatic protrusion Transrectal ultrasonography Lower urinary tract symptoms. Background: Intravesical prostatic protrusion IPP is a manifestation of benign prostatic hyperplasia marked by overgrowth of the prostatic median lobe into the bladder, producing bladder outlet obstruction and related storage and voiding symptoms.
In addition, depending on grade, IPP can influence outcomes and complications of prostatectomies. Conclusion: Upon report of lower urinary tract symptoms, initial performance of TRUS along with digital rectal examination prevents delay in the appropriate evaluation and management of prostatic diseases. Benign prostatic hyperplasia BPH is one of the most widespread diseases amongst men, but there is no consensus or clear practical guideline to define the presence and severity of obstruction, other than pressure-flow studies.
Intravesical prostatic protrusion IPP is a phenomenon in which the prostate adenoma enlarges into the bladder along the plane of least resistance [ 1 ]. Interestingly, though its usage is ubiquitous in clinics, customary DRE examination fails to detect the configuration of IPP. We review how the pathogenesis of IPP deviates from that of other forms of BPH, leading to the presentation of distinctive clinical signs and sequelae. We also explore how the approach to the diagnosis and management of IPP as traditional BPH may lead to treatment inefficacy. Moreover, we identify how the outcomes of robot-assisted laparoscopic prostatectomy may be influenced by varying severity levels of IPP.
Although, there was no date restriction on the search, we placed an emphasis on the past 5 years.
No specific exclusion criteria were set. Publication quality was assessed using the relative citation ratio derived from iCite bibliometrics.
We selected papers that revealed artifacts for the pathophysiology, clinical manifestations, clinical evaluation, and management of IPP. In BPH, all lobes of the prostate may routinely be affected and many types of patterns are recognized by transrectal ultrasonography TRUS. Initially described by Alexander Randall in the early 20 th century [ 1 ], these patterns include lateral lobe, trilobular, median lobe, subtrigonal lobe, and subcervical hypertrophy, as well as a median bar.
Frequently, hypertrophy may assume any combination of these configurations. However, the morphological change defined by IPP is distinct from any of these types. The types implicated in IPP are median lobe, trilobular, and median bar because they can occupy bladder space at a measurable capacity. The median lobe, which arises from the peri-urethral zone [ 4 ], is situated between the urethra and ejaculatory ducts. Its upper surface is bound by the bladder trigone and projects into the bladder producing the uvula vesicae, i.
Urethral resistance ensues due to IPP and impedes the hydraulic energy that normally drives micturition [ 7 ]. A fluid structural interaction analysis study demonstrated that IPP predisposed the prostate to deformation caused by intravesical pressure. The authors found that the compression of the prostatic urethra and increased variation of cross-sectional area around bladder neck would diminish urine flow efficiency, as well as compromise the effect of obstruction alleviation treatment [ 7 ].
The prostate is adjoined anteriorly by pubo-prostatic ligaments, posteriorly by Denonvilliers' fascia, and laterally by endopelvic fascia [ 8 ]. Superior to these connections, there is merging with other fascia that leaves the IPP susceptible to the radial component of intravesical pressure, thus leading to prostatic deformation.
This study provided further evidence suggesting that IPP influences BOO independently, and that flow deterioration is more resistant to alleviation of obstruction during treatment as the IPP grade increases [ 7 ]. The intravesical pressure fundamental to opening the bladder neck is increased when detrusor pressures increase in response to voiding through resistance i. While the bladder can yield a higher transitory voiding pressure, the constant pressure needed will force the detrusor muscle to gradually wane.
In response to the need for a higher intravesical pressure to overcome BOO, hypertrophy of isolated muscle bundles occurs followed by bladder trabeculation or increased detrusor wall thickness [ 9 ]. The area between hypertrophied bundles becomes narrower, resulting in less viable detrusor muscle with eventual progression to total lack of function. A clinical study found that the International Prostate Symptom Score IPSS voiding subscore had a strong correlation with terminal dribbling and an underrated LUTS, while IPP was the only significant risk factor for uroflowmetry-confirmed terminal dribbling [ 10 ].
The prostate's conformation, shape, and IPP may interfere with the voiding process. In fact, the positive predictive value of the combined parameters IPP and resistive index of the prostatic capsular artery increases to Because this resistive index is a signal of vascular resistance [ 13 ], it is a good indicator for BPH-related BOO This is encountered with a significant elongation of the prostatic urethra and trigonal stimulation, thus contributing to storage symptoms e.
Storage symptoms in patients with IPP have three potential explanations. First, there can be a coexistent state of primary storage of bladder dysfunction. Third, there may be a fixed effect of the bladder neck; an enlarged bladder neck with a collagen tissue component could compromise the effect of the internal bladder neck sphincter.
Normally, during the storage phase of the bladder, the bladder neck demarcates entry of urine into the prostatic urethra. However, in the presence of IPP, the bladder neck may not be tightly closed during the storage phase, allowing small amounts of urine to pass into the prostatic urethra, thus prematurely activating the micturition reflexes typically observed with urinary incontinence [ 20 ] and clinically presenting as irritative and obstructive symptoms of bilobar BPH. Extroversion of the prostatic urethral mucous membrane at the bladder neck and the associated urethral distension may trigger a urethrovesical stimulating reflex to enable bladder contractions [ 21 , 22 ] responsible for storage symptoms and overactive bladder.
Dilatation of the non-sphinteric urethra during bladder contractions i. Additionally, as explained previously, the added connective tissue between detrusor muscle fascicles due to prolonged BPH may lead to the myogenic changes responsible for overactive bladder with or without urge incontinence [ 24 ].
Due to the bearing of IPP on bladder neck funneling, incomplete voiding and the subsequent urine stasis have been linked in the pathogenesis of bladder stone formation [ 25 ]. Kim et al. Moreover, because IPP can affect the integrity of the internal urethral sphincter via mechanical distension, there may be concerns for retrograde ejaculation because due to the failure of the internal urethral sphincter to close during ejaculation. However, there is presently a dearth of physiological and clinical studies on these potential secondary complications.
Prostate-specific antigen PSA is speculated to be elevated in IPP patients because they usually already have, save for a few clinical exceptions [ 27 ], a large prostatic volume [ 28 ]. Since a more forceful vesical contraction is required to open a channel between the lobes in those with significant IPP, it may contribute to more PSA leakage from the prostate into the serum. Additionally, it has been long known that PSA leakage from the prostate into the serum originates at the transition zone, where hypertrophy indicates BPH [ 29 ].
Unearthed in a modeling study by Xu et al.