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U.S. News and World Report: America's Best Hospitals, Urology, 2012-13

 

Understanding Prostate Enlargement

Dr. David Paolone and UW Health urologists perform GreenLight Laser therapy for non-invasive treatment of benign prostatic hyperplasia (BPH).Benign prostatic hyperplasia (BPH), the non-cancerous enlargement of the prostate that occurs with age, affects more than 26 million men each year in the United States. The resulting pressure on the urethra can interfere with the normal flow of urine, causing a variety of symptoms.

 

While oral medications are the typical starting point for treatment, surgical management is often indicated. UW Health urologists perform the traditional transurethral resection of the prostate (TURP), which surgically removes a portion of the prostate tissue through the urinary tract.

 

They also perform the newer minimally invasive alternative, GreenLight Laser photoselective vaporization of the prostate. This treatment has the advantage of being done without the need for an inpatient hospital stay. In addition, GreenLight Laser can be safely done on patients receiving anti-coagulation medication.

 

It is now understood that more than prostate enlargement can be involved in the genesis of lower urinary tract symptoms (LUTS). Past studies conducted at UW School of Medicine and Public Health and elsewhere revealed that obstruction and symptoms can occur in the absence of prostatic enlargement. More recently it has been shown that clinically silent prostatic inflammation contributes in a major way to the development of LUTS, though the mechanism for this remains unclear.

 

UW Health Urologist Dan Williams, MD discusses Benign Prostatic Hyperplasia (BPH)

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Department of Urology investigators are on the cutting edge of laboratory research aimed at understanding this complexity, with several grants funded by the National Institutes of Health (NIH). Here, research laboratories are examining how age-related changes in testosterone and estrogen levels in aging men may re-activate prostate growth, and investigating how diabetes and prostate inflammation may produce sensory changes in the bladder that lead to symptoms of frequency and urgency.

 

In addition, Department of Urology researchers are collaborating with colleagues across campus to perform translational studies using human tissues. What does this mean for the patient and clinician? First and foremost, it means that one cannot assume LUTS is due to prostatic enlargement. The exceptions to the rule are many and the emerging challenge is to match the right therapy to each patient. For men with LUTS without obstruction, alternative forms of medical therapy can be considered.

 

In other cases, a relatively novel therapy involving sacral nerve stimulation may be considered for recalcitrant symptoms of frequency and urgency. The key to improving patient outcomes is comprehensive and meticulous evaluation, involving something as simple as a home voiding diary or as complex as videourodynamic testing. By understanding each patient as an individual in whom multiple factors may contribute to the development of LUTS, therapy can be individualized to improve patient outcomes and quality of life.