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Benign Prostatic Hyperplasia (BPH)

What is Benign Prostatic Hyperplasia (BPH)?

Benign Prostatic Hyperplasia is a condition in which the prostate enlarges as men age. More than 70 percent of men over the age of 60 have urinary symptoms attributable to BPH. 

What are the symptoms of Benign Prostatic Hyperplasia?

Symptoms of Benign Prostatic Hyperplasia can include; weak urinary stream, increased urinary frequency, waking up at night to urinate, difficulty initiating stream, and urgency and difficulty emptying the bladder. 

What causes Benign Prostatic Hyperplasia?

Although it is not entirely clear what causes the prostate to enlarge, it is thought that it may be due to changes in the balance of sex hormones as men grow older.

How is Benign Prostatic Hyperplasia diagnosed?

Benign Prostatic Hyperplasia can be diagnosed with a visit to the doctor. The doctor will ask detailed questions about your symptoms and perform a physical exam. This exam can include:

  • A digital rectal exam
  • Urine Test
  • Blood Test
  • Prostate-specific antigen (PSA) blood test

Your doctor may also recommend additional tests to confirm the diagnosis, such as:

  • Urinary flow test
  • Postvoid residual volume test
  • 24-hour voiding diary

For a more complex BPH case, your doctor may also recommend:

  • Transrectal Ultrasound
  • Prostate Biopsy
  • Urodynamic and pressure flow studies
  • Cystoscopy

How is Benign Prostatic Hyperplasia treated?

Urologists at Heywood Healthcare specialize in minimally invasive procedures to treat BPH. Each patient will receive an individualized treatment plan which can include:

  • Urolift™: The novel system uses a specialized stapling device to lift or hold enlarged prostate tissue out of the way so it no longer blocks the urethra, like opening curtains on a window.
  • Transurethral incision of the prostate (TUIP): An incision is made into the prostate to improve urine flow without removing tissue.
  • Laser Enucleation of the Prostate (LEP): A specialized laser is used to remove or “cut” the obstructive prostate tissue. The tissue is then removed from the bladder.
  • Transurethral resection of the prostate (TURP): BMC surgeons perform bipolar TURP to resect obstructing tissue. This is the gold standard treatment for BPH and has a long track record of success.
  • Robotic simple prostatectomy: For extremely large prostates that are too big for an endoscopic procedure the DaVinci robot is used.  It decreases blood loss, pain, hospital stay, and catheterization time.


The Urolift™ System uses a specialized stapling device to lift and hold enlarged prostate tissue out of the way so that it no longer blocks the urethra. The urologist inserts a cystoscope through the urethra to determine the precise area(s) of prostate tissue to be pulled back. Then a small needle is inserted through the sheath to stitch the tissues. This is an ideal procedure for men with a small to moderate size prostate gland who want to preserve their ejaculatory function.

What are the benefits of Urolift™?

  • Same-day procedure.
  • Insertion of a catheter is often unnecessary.
  • Immediate improvement in urinary flow and preservation of ejaculatory function.
  • There is no cutting, heating, or removal of prostate tissue.
  • Patients are able to return to their ordinary daily activities in 24-48 hours.

Transurethral Incision of the Prostate (TUIP)

TUIP is a minimally invasive treatment for benign prostatic hyperplasia to improve urine flow. It typically involves one or two cuts from the bladder neck into the prostate. It does not remove tissue and because of this, can be done as outpatient surgery and has a low bleeding risk. Additionally, it is often preferred in men who want to continue to have children, as it has a lower rate of retrograde ejaculation.

What are the benefits of TUIP?

  • Same-day procedure.
  • Improvement in urinary flow and preservation of ejaculatory function.
  • There is no removal of prostate tissue.
  • Patients are able to return to their ordinary daily activities in 24-48 hours.

Laser Enucleation of the Prostate (LEP)

Millions of patients have been successfully treated worldwide using a variety of FDA approved laser technologies and this technique is becoming the standard of care for the surgical treatment of BPH. The procedure is performed by inserting a thin laser fiber into the urethra with a high definition camera. The urologist is able to safely view and control the treatment area, tailoring it to a patient’s individual anatomy and needs. Natural urine flow is immediately restored and this results in an immediate improvement in urinary symptoms.

The laser enucleation procedure has been proven safe, effective and durable in clinical studies conducted over a seven-year period. Thousands of LEP procedures have been successfully performed worldwide and Boston Medical Center is now offering this treatment to men who suffer from BPH.

Where is the laser enucleation procedure performed?

The procedure is performed in a hospital typically as an outpatient. Most patients are discharged home 1-2 hours after the procedure with a catheter in place which is removed the following morning in the office or at home. Occasionally, men will spend the night in the hospital if they have no one at home with them for the first night or they live far away.

What are the benefits of laser surgery?

  • Immediate symptom relief.
  • Urine flow improves dramatically after virtually bloodless and painless procedure.
  • Most men do not take any pain medications following surgery.
  • Patients are typically catheter free within 24 hours.
  • Patients are able to return to their daily activities in 2-3 days.
  • Patients are usually able to stop all their prostate medications after surgery.

Bipolar TURP (Transurethral resection of the prostate)

Transurethral resection of the prostate (TURP) is the most common surgical procedure performed by urologists to treat BPH. It is performed by inserting a combined visual and surgical instrument into the urethra to remove excess prostate tissue. After a TURP, patients will typically be hospitalized for one night and have a catheter. Traditionally, TURP has been considered the most effective treatment for an enlarged prostate.

What are the benefits of TURP?

Obstructing tissue is rapidly removed with immediate relief of symptoms.
Patients are usually able to discontinue all their prostate medications following surgery.
Durable outcomes with minimal retreatment rate.

Robotic assisted simple prostatectomy

A simple prostatectomy is a procedure performed for BPH which involves removing the adenoma, or enlarged obstructing prostate tissue all at the same time. It is for men with extremely large prostate glands and differs from a radical prostatectomy, which is performed for cancer. Traditionally a simple prostatectomy is performed in an open fashion through a lower abdominal incision. This procedure can also be done minimally invasively using the DaVinci robot. One of the benefits of the robotic approach is that small veins which tend to bleed during the open operation are compressed, reducing blood loss and the need for transfusion.

What are the benefits of robotic simple prostatectomy?

  • Extremely large prostates can be approached in a minimally invasive fashion eliminating the need for an open incision.
  • Other benefits may include decreased pain, hospital stay, blood loss and catheterization time.