Prostate & Men's Urological Health

Benign prostatic hyperplasia (BPH) is an aging-related enlargement of the prostate gland. Over 80% of men will develop benign prostatic hyperplasia (BPH) at some point, and 50% of those men will develop it by the age of 50.

As men age, the prostate continues to grow. When you have BPH, pressure is put on the bladder and urethra, which weakens and irritates the bladder. This often results in frequent urination, an urgency to urinate, decreased flow or feeling like your bladder is still full after urinating.

If left untreated, BPH can lead to incontinence, stones, bladder damage or infection. It is crucial to get treatment to avoid damage to your kidneys or other serious conditions.

How is BPH diagnosed?

You will receive an initial evaluation including your medical history, a physical exam, a digital rectal exam (DRE) and urinalysis. A full assessment helps avoid the assumption that LUTS in men is due to BPH. Most of the causes can be diagnosed by an exam and a careful history. However, your urologist may order several tests including PSA, ultrasounds or x-rays, urodynamic testing, or cystoscopy to identify the underlying cause.

What are treatment options for an enlarged prostate?

Treatment options for men with symptomatic BPH, could include: medical therapy, lifestyle changes, transurethral resection of the prostate, UroLift®, Rezum, Greenlight PVP, Holep, Prostate Artery Embolization, and TULSA Procedure.

Greenlight PVP

This treatment option provides rapid relief of symptoms caused by benign prostatic hyperplasia (BPH). In many cases, GreenLight™ Laser Therapy also offers a shorter hospital stay, less catheterization time, less bleeding, and a faster recovery than traditional surgical options.

GreenLight is suitable for most patients with an enlarged prostate. One of the benefits of GreenLight is the speed in which the treatment works. Most patients return home a few short hours after the procedure and can return to normal, non-strenuous activities within days.

TURP

Transurethral resection of the prostate (TURP) is a surgery used to treat urinary problems that are caused by an enlarged prostate.

An instrument called a resectoscope is inserted through the tip of your penis and into the tube that carries urine from your bladder (urethra). The resectoscope helps your doctor see and trim away excess prostate tissue that's blocking urine flow.

TURP is generally considered an option for men who have moderate to severe urinary problems that haven't responded to medication.

Prostatic Urethral Lift Procedure (UroLift®)

The Prostatic Urethral Lift Procedure (UroLift®) is a minimally invasive surgical approach to treating LUTS (lower urinary tract symptoms) secondary to BPH. The UroLift® system lifts or holds the enlarged prostate out of the way so that it no longer blocks the urethra. There is no cutting, heating or removal of prostate tissue and the treatment can be performed in an outpatient setting. The goal is to relieve LUTS due to BPH, and allow you to improve the quality of your life by improving the urinary symptoms.

This FDA-approved system opens the urethra by using tiny implants to prevent the prostate tissue from blocking urine flow in the urethra and preserves sexual function and quality of life. Because it is minimally invasive, there are minimal complications and rapid and durable improvements in symptoms. The UroLift® procedure avoids sexual side effects associated with other procedures. The procedure is performed under local anesthesia, and provides relief from urinary discomfort as early as two weeks after surgery. There is no catheter and no overnight stay necessary.

While this is a permanent solution, it does not preclude other BPH treatments, if they later become necessary. If the implants need to be removed, it is a simple procedure. The implants will not interfere with MRIs or digital rectal exams (DREs). The UroLift® procedure will not complicate other BPH treatments such as laser prostatectomy in the instance that the procedure does not provide a satisfactory result.

Prostate Artery Embolization (PAE)

In addition to treating BPH with medicine or surgery, SSM Health offers Prostate artery embolization (PAE), a cutting-edge, minimally invasive outpatient procedure that reduces the size of the prostate by limiting blood supply. This image-guided technique results in few side effects and no negative impact on sexual function. A vascular interventional radiologist, a board-certified specialist with expertise in treating enlarged prostate, performs this type of procedure.

How Does PAE work?

PAE begins with a tiny incision in the wrist or groin. This incision provides the physician access to arteries that feed the prostate. Using specialized X-ray equipment, your physician passes a catheter (small tube) into the prostatic artery, and guides it near the location of the enlarged prostate. Small spheres are injected through the catheter and into the blood vessels feeding the enlarged prostate, reducing the flow of oxygenated blood, thus shrinking the prostate.

Once treated, the microscopic tools are removed and a Band-Aid® is applied. The entire PAE treatment typically lasts 3 - 4 hours. Most patients return home the same day, and after a couple of days of rest, return to work and normal activities.

Benefits to PAE

There are many benefits to PAE. Our success rate is up to 92%. Advantages include:

• No side effects of surgery, such as bleeding
• Preserves the prostate
• Dramatically improves quality of life
• Maintains sexual function

Ejaculatory dysfunction occurs when a man has a problem properly ejaculating his semen, either ejaculating too soon, too late, back into his own bladder, or not at all.

Ejaculation disorders, also called aspermia, can be caused by a problem at birth (primary) or by acquired dysfunction (secondary), which happens after birth and is often caused by disease, injury, or adverse drug reactions later in life. The four types of ejaculation dysfunction are premature ejaculation, delayed ejaculation, retrograde ejaculation, and anejaculation.

An erection problem occurs when a man cannot get or keep an erection that is firm enough for intercourse. You may not be able to get an erection at all. Or you may lose the erection during intercourse before you are ready. Erection problems do not usually affect your sex drive.

Erection problems are common. Almost all adult men have trouble getting or keeping an erection at one time or another. Often the problem goes away with little or no treatment. But for some men, it can be an ongoing problem. This is called erectile dysfunction (ED).

Erection problems can affect men at any age, but are more common as you get older. If you have trouble getting or keeping an erection more than 25% of the time, you should see your health care provider.

Certain health conditions, medicines, or injury can lead to low testosterone (low-T). Beginning around age 30 to 40, testosterone levels may start to slowly decrease. This occurs naturally. Low testosterone can affect sex drive, mood, and changes in muscle and fat.

Treatment with testosterone therapy may help reduce symptoms.

It’s estimated that 16% of men suffer from conditions that impact the pelvic floor, which is the combination of muscles, ligaments, and tendons at the bottom of your pelvis. The pelvic floor:

• Supports your internal organs
• Controls the urethral and rectal openings
• Assists with sexual function
• Supports your hips, spine, and pelvis

Factors and conditions such as age, overactive bladder, diabetes, trauma, obesity, chronic cough, or prostate surgery can weaken or damage the pelvic floor. An overly tight or tense pelvic floor can also cause problems for some. The inability to effectively control function of the pelvic floor can result in a number of symptoms:

• Incontinence: loss of bladder or bowel control, leakage of urine or feces
• Emptying disorders: pain or difficulty urinating or moving bowels (constipation)
• Chronic pain or cramping: discomfort in the lower back, genitals, or rectum
• Erectile dysfunction

Can I go to physical therapy for pelvic floor dysfunction?

If you’re suffering from any of these symptoms, speak to a urologist. They can help determine if your symptoms are pelvic floor related and can be addressed with a non-invasive treatment such as pelvic health physical therapy, an individualized program with private, one-on-one sessions to help improve function through:

• Personalized exercise program, including stretching and strengthening
• Manual therapy
• Use of biofeedback for pelvic floor training and improving awareness
• Education for body mechanics and posture

Pelvic floor therapy can help alleviate treat pelvic floor dysfunction in many men. Other potential therapies include medication and electrical stimulation. Occasionally, surgery may be recommended to treat incontinence or organ prolapse.

In Peyronie’s disease, fibrous scar tissue develops in the deep tissues of the penis resulting in pain, curvature, and other symptoms. The cause of this fibrous tissue is often not known. It can occur spontaneously. It can also be due to a previous injury to the penis, even one that occurred many years ago.

Peyronie’s disease is uncommon and usually affects men ages 40 to 60, or older. Men are at higher risk of developing curvature of the penis after surgery or radiation treatment for prostate cancer.

The four main urological cancers treated are bladder cancer, kidney cancer, prostate cancer, and testicular cancer.

What are the symptoms of urological cancers?

Often symptoms of urological cancers are slow to appear and will vary based on the type of cancer. Blood in the urine, without accompanying pain, can be a sign of bladder, kidney, or prostate cancer. Lesions, swelling, or other skin changes may be visible with penile or testicular cancer. Weight loss and fatigue can be symptoms of any cancer.

Transurethral Ultrasound Ablation (TULSA) is a minimally invasive, MRI-based treatment for BPH. It relies on heat to target problem areas while protecting the healthy tissue around it.

While under anesthesia, an ultrasound probe is guided through the patient’s urethra robotically. Using real-time images, affected prostate tissue is eliminated using high-temperature directional ultrasound.

The TULSA procedure is safe for those using blood thinners. It is also low risk for causing urinary incontinence or erectile dysfunction. Most patients experience minimal pain and downtime. The TULSA Procedure is available at SSM Health Saint Louis University Hospital.

Prostatitis is a swelling, inflammation or infection of the prostate gland. It can cause burning or painful urination, the urgent need to urinate, difficult or painful ejaculation, or pain in the area between the scrotum and rectum or in the lower back. It can occur to men at any age and should not be confused with cancer. There are four types of prostatitis:

• Acute bacterial prostatitis
• Asymptomatic inflammatory prostatitis
• Chronic bacterial prostatitis
• Chronic prostatitis