Prostate Problems

• A frequent and urgent need to urinate. You may get up several times a night to go to the bathroom.
  
• Trouble starting a urine stream. Even though you feel you have to rush to get to the bathroom, you find it hard to start urinating.
  
• A weak stream of urine.
  
• A small amount of urine each time you go.
  
• The feeling that you still have to go, even when you have just finished urinating.
  
• Leaking or dribbling.
  
• Small amounts of blood in your urine.
  

• Digital rectal exam. This exam is usually the first test done. A gloved finger is inserted into the rectum and feels the part of the prostate that sits next to it. This exam gives a general idea of the size and condition of the prostate in addition to the presence of nodules or bumps that may be suspicious for prostate cancer.
  
• Blood test. Dr. Bevan-Thomas may want to test a sample of your blood to look for prostate-specific antigen, or PSA. If your PSA is high, it may be a sign that you have prostate cancer. But this test isn't perfect. Many men with high PSA scores don't have prostate cancer and conditions such as infection, inflammation, and urinary retention also cause the PSA to be elevated.
  
• Imaging. We may want to get a picture of your prostate using either x rays or a sonogram. An IVP, or intravenous pyelogram, is an x ray of the urinary tract. For an IVP, dye will be injected into a vein. Later, when the dye passes out of your blood into your urine, it will show up on the x-ray. A rectal sonogram uses a probe, inserted into the rectum, to bounce sound waves off the prostate thus producing an image of the prostate and surrounding structures.
  
• Urine flow study. You may be asked to urinate into a special device that measures how quickly the urine is flowing. A reduced flow may mean that you have BPH.
  
• Cystoscopy. Another way to see a problem from the inside is with a cystoscope, which is a thin tube with lenses like a microscope. The tube is inserted into the bladder through the urethra while Dr. Bevan-Thomas looks through the cystoscope.

• Watchful waiting. If your symptoms don't bother you too much, you may choose to live with them rather than take pills every day or have a procedure. But you should have regular checkups to make sure your condition isn't getting worse. With watchful waiting, you can be ready to choose a treatment as soon as you need it.
  
• Medicines. In recent years, scientists have developed several medicines to shrink or relax the prostate to keep it from blocking the bladder opening. One medicine, an alpha blocker relaxes the prostate which helps the passage of urine, and another type of medicine, a 5-alpha reductase inhibitor causes shrinkage of the prostate. Often, these medications are used together to combat the prostate symptoms.
  
• Nonsurgical procedures. A number of devices have been developed to remove parts of the prostate. These procedures can usually be done in a clinic or hospital without an overnight stay. The procedures are transurethral, which means the doctor reaches the area by going through the urethra. Dr. Bevan-Thomas has tried all of the recent techniques, including the Indigo laser treatment, Microwave thermotherapy, Transurethral Needle ablation and most recently the Prolieve thermodilatation system. Currently, Dr. Bevan-Thomas utilizes the Prolieve thermodilatation system because of its effectiveness and tolerability. Most patients do not require a catheter after the procedure and notice an immediate relief of symptoms after leaving the office once the 45 minute procedure is completed.

  Watch this 2 minute video providing an overview of the Prolieve Thermodilation System. This unique non-surgical technique for the treatment of BPH is offered by Dr. Bevan-Thomas. [ Watch Video ]

• Surgical treatment. Surgery removes the obstructing part of the prostate and can be done through the urethra or through an incision in the abdomen. Because Dr. Bevan-Thomas specializes in minimally invasive surgery, there is rarely a need to make an open incision any longer. The most common surgery is called transurethral resection of the prostate, or TURP. During a TURP, the surgeon inserts a thin tube up the urethra and cuts away pieces of the prostate with a wire loop under direct vision through a cystoscope. Dr. Bevan-Thomas no longer performs the traditional TURP as he currently uses a special laser which vaporizes the prostate thus opening the urinary channel. This procedure is referred to as a PVP (Photoselective Vaporization of the Prostate) or a HOLAP (Holmium Laser Ablation of the Prostate)There is a minimal chance for blood loss and most patients have the procedure done as an outpatient, usually going home without a catheter with immediate relief of symptoms

No. TURP and other procedures for BPH remove only enough tissue to relieve urine blockage. In a few cases, the prostate may continue to grow, and urinary problems return. You should continue to have your prostate checked once a year even after surgery to make sure that BPH or prostate cancer has not developed. The prostate is only removed entirely for prostate cancer and Dr. Bevan-Thomas utilizes the Da Vinci Robot to laparoscopically remove prostates with prostate cancer.

What are the side effects of prostate treatments?

Surgery for BPH rarely has an effect on sexual function, with the exception of ejaculation. After a laser ablation of the prostate, some men will find that semen does not go out of the penis during orgasm. Instead, it goes backwards into the bladder. This does not cause any discomfort and rarely requires treatment. In some cases, this condition can be treated with a drug that helps keep the bladder closed during ejaculation.

If you have any problems after treatment for a prostate condition, contact Dr. Bevan-Thomas. Erection problems and loss of bladder control are a rare occurrence, but can be treated. Chances are good that you can be helped.