The prostate is a gland in front of your bladder that is responsible for producing semen. Benign prostatic hyperplasia (BPH) develops when noncancerous cells multiply in the prostate, enlarging the gland until it presses against the urethra (the tube through which urine leaves the bladder and exits the body). Although BPH is not cancerous, it can occur at the same time as cancer and can lead to severe issues such as urinary retention and renal failure.

Causes of BPH

Your risk of developing BPH can increase with a number of factors, including the following:

• Age (BPH typically affects men over 50)
• Obesity
• Poor diet (lacking in fruits and vegetables)
• Family history of BPH

Symptoms of BPH

There are a range of BPH symptoms, which can become so severe that you cannot hold your urine or that you cannot urinate at all. The signs of BPH include the following:

• Frequent need to urinate, especially at night
• Urgency of urination, where you don’t think you will make it in time to the restroom
• Hesitancy or difficulty starting urination and/or maintaining a constant flow
• Feeling that urine is left in the bladder after urination
• Blood in the urine
• Urinary retention
• Renal failure

Treatments for BPH at Mount Sinai-Union Square

At Mount Sinai-Union Square, our specialists have extensive experience treating BPH. After diagnosing your condition we’ll explain your treatment options and decide which approach is best. The options include watchful waiting, medication, and minimally invasive surgery. 

If surgery becomes necessary, our urology specialists have extensive experience in the newest procedures. We understand that treatment isn’t just about controlling BPH; it’s about finding the best approach for you that involves the shortest recovery time and avoiding side effects such as ejaculatory dysfunction or erectile dysfunction.

Our urologists are skilled in the full range of procedures to treat BPH, including the following:

• ReZum: This is a minimally invasive, outpatient, and in-office procedure in which a small device is passed through the urethra to the prostate. Sterile water vapor is then released into the prostate, where the steam causes prostate cells to die. The dead cells are eventually absorbed as part of your body’s natural healing process, shrinking the prostate and taking pressure off the urethra. 
• Urolift: This is a minimally invasive, outpatient, and in-office procedure in which specialized staples are placed into the obstructed prostate through the urethra. The staples relieve pressure on the bladder, and the effects are generally immediate. There are no sexual side effects and most men are very happy with the results.
• Bipolar transurethral resection of the prostate (TURP): This minimally invasive procedure involves inserting a resectoscope (a special tube) into the tip of the penis to the urethra. The resectoscope then delivers a bipolar electrical current that cuts excess prostate tissue and seals up blood vessels. The excess tissue is removed, relieving pressure on the urethra. This procedure remains the gold standard for BPH and most men will be candidates for this procedure.
• Button TURP: This is similar to a traditional TURP procedure and also involves insertion of a resectoscope into the penis. But this procedure involves a plasma “button” which uses bipolar energy to melt prostate tissue. This technique also relieves pressure on the urethra and bladder.
• Holmium laser ablation (HoLAP): With this minimally invasive technique, a scope is inserted into the tip of the penis to the urethra. The scope then delivers a Holmium:YAG laser that uses precise, intense heat to remove or shrink excess prostate tissue, taking pressure off the urethra.
• Holmium laser enucleation (HoLEP): This minimally invasive procedure also uses Holmium:YAG technology to excise excess prostate tissue from the urethra. Rather than ablating or melting the prostate tissue, the prostate tissue is cut into smaller pieces and then removed through the urethra.
• Greenlight laser or photoselective vaporization of the prostate (PVP): This minimally invasive procedure uses a state-of-the-art laser to ablate and melt prostate tissue. The Greenlight laser wavelength is absorbed preferentially by hemoglobin or red blood cells and has some advantages for patients who may have a bleeding disorder.
• Robotic simple prostatectomy: This procedure enucleates, or removes, the obstructing part of the prostate. It involves passing robotic instruments through a few small incisions made in the lower abdomen and then removing the inner core of the prostate but leaving the outer shell. This would be similar to removing the fleshy portion of an orange but leaving the skin. This is generally performed for very large prostates that won’t respond well to other treatments.
• Robotic aquablation therapy: This minimally invasive procedure is one of the newest techniques available and involves no incisions. An instrument is inserted into the tip of the penis to the urethra. The instrument then delivers a high-pressure water jet that removes excess prostate tissue and is guided by a robotic camera and ultrasound machine.

BPH Specialists at Mount Sinai-Union Square

All our experts in benign prostatic hyperplasia are fellowship-trained in the latest techniques for treating BPH.

Michael Palese, MD
Sovrin Shah, MD
Aaron Grotas, MD