An elderly man talks to his doctor at his appointment.
If you’re experiencing urinary problems, you should consult your doctor to rule out prostate enlargement. (For Spectrum Health Beat)

Take 10 men, all age 80 or older, and stand them side by side.

Now pick just one.

Got him? Odds are you just picked a guy who suffers from benign enlarged prostate, also known as benign prostatic hyperplasia.

It’s one of the most common ailments in aging men, affecting 90 percent of those age 80 and older and about half of all men ages 51 to 60, according to the American Urological Association. The symptoms manifest mainly as urinary issues, such as an increased need to urinate or a weakened urinary stream.

Benign means it’s not cancerous and it doesn’t lead to cancer.

But that doesn’t mean it’s not a big problem.

“Enlarged prostate is very common in men as they age,” said John Humphrey, MD, a urologist at Spectrum Health’s urology clinic. “It can cause significant symptoms in terms of urinary issues—not being able to urinate, or having to go the bathroom all the time.”

With older Americans living longer than ever before, urologists expect to see an ever-increasing number of men seeking treatment for this condition.

A doctor can diagnosis it through a combination of steps, starting with a physical exam.

Early treatments for enlarged prostate typically involve medication, while in more complicated cases urologists use non-invasive or invasive procedures. These are chosen based on a few variables, namely the characteristics of the patient and the severity of the condition.

Old ways

Transurethral resection of the prostate, typically known as TURP, is an often-used procedure to treat prostate enlargement. About 150,000 men undergo the procedure each year, according to the urological association.

Transurethral resection is done under sedation, with the surgeon inserting a device called a resectoscope into the tip of the penis to reach the prostate gland. The device cuts away and removes pieces of the prostate.

This is done for small- to medium-sized prostate enlargements. One downside of this procedure, however, is the prostate can grow back.

“When it gets to be a certain size, TURP is not effective,” Dr. Humphrey said. “You can’t remove as much tissue with the TURP.”

In cases of severely enlarged prostate, open surgery is an option. This is more involved and there are inherent risks as in any surgical procedure.

“In certain men, the prostate becomes so large that, traditionally, they would have to have open surgery,” he said. “It’s an incision in the abdomen to remove the prostate.”

But there’s yet another option for men with severely enlarged prostate.

Proselytizing

When Dr. Humphrey joined Spectrum Health’s urology clinic a year ago, finishing up a residency in Boston after graduating from Vanderbilt University School of Medicine, he brought with him a procedure that had never been offered in West Michigan.

See the signs

It’s inevitable. Some guys will ignore an ailment as long as possible, if it means delaying a doctor’s visit by just one more day. But that’s about the worst way to catch a problem before it turns bad.

“I try to encourage people to not ignore symptoms,” said Dr. John Humphrey, of Spectrum Health’s urology clinic. “Men can be stoic sometimes, and not want to go to the doctor. Oftentimes, we can help them with treatments … that they would otherwise not know about.”

Among these treatments is holmium laser enucleation of the prostate, a procedure Dr. Humphrey is specially trained to perform. It’s a modern, highly effective method to treat severely enlarged prostate.

Of course, you must first recognize when there’s a problem.

Dr. Humphrey said men with these symptoms should schedule an exam with their doctor:

• Weakened urinary stream.

• Urinating more frequently day and night.

• Waking up several times at night to urinate.

• Developing infections in the urine.

• Unable to urinate, urine retention, requiring a catheter.

It’s called holmium laser enucleation of the prostate, commonly referred to as HoLep.

“It’s a technique that takes a certain skill set,” said Dr. Humphrey, who came to acquire the skill while training under the mentorship of Jessica Mandeville, MD, at Lahey Hospital and Medical Center in Burlington, Massachusetts.

Dr. Mandeville had a fellowship at Indiana University that connected her to James Lingeman, MD, a widely recognized authority on holmium laser enucleation of the prostate, Dr. Humphrey said.

“Dr. Mandeville learned it from him,” he said. “I was able to learn it from her during my training.”

Holmium laser enucleation isn’t a likely procedure for patients with small- to medium-size prostate enlargements, according to Dr. Humphrey. He recommends the procedure mainly for men with severely enlarged prostate, although it’s also the only procedure he recommends for these men.

It effectively replaces the methods of yesteryear for this specific type of patient.

Open surgery has too many complications, and transurethral resection leaves open the possibility of recurrent issues.

The most notable upshot of holmium laser enucleation is its long-lasting effect. It effectively eliminates a man’s prostate issues.

“If you did a TURP on a really big prostate, it would have the potential to grow back and you’d need another procedure,” Dr. Humphrey said. “HoLep really gives patients one procedure that can last a long time.”

There are cautions.

“The risks are similar to TURP,” he said. “You’re always going to have a risk of bleeding and infection with any type of surgery, but it’s not increased with this procedure.”

Men who undergo the procedure also face the risk of temporary urine leakage, but this usually resolves itself in a matter of weeks to months, the doctor said.

Another upside to holmium laser enucleation: The patient can be on blood thinners during the procedure.

“That would be one advantage,” Dr. Humphrey said. “You cannot do a TURP on man with blood thinners.”

Laser focus

To understand how holmium laser enucleation works on the prostate gland: “Think of the prostate like an orange,” Dr. Humphrey said. “We’re removing the fruit, not the peel.”

The urologist’s tool reaches the prostate gland through the tip of the penis. The gland itself is encapsulated in a layer.

The urologist uses a laser to “dissect” the prostate off its capsule.

“Think of taking off a peel of an orange with your thumb,” the doctor said. A device called a morselator is used to chop up the prostate tissue, and a suctioning device concludes by removing the morselated material. The capsule of the prostate remains in place.

“So basically, we take the fruit of the prostate and push it into the bladder, carving it out with the laser,” Dr. Humphrey said. “Then we use a different machine to morselate the prostate in the bladder.”

The patient is sedated during the procedure, which can take anywhere from two to three hours depending on the size of the prostate. The patient remains in the hospital overnight with a catheter in place to help flush out any blood from the procedure, the doctor said.

“Then the routine is to have the catheter removed the morning after the surgery, and then they go home thereafter,” Dr. Humphrey said.

Beyond that, there are few restrictions.

“We don’t want patients to do any heavy lifting for a couple weeks, but they can walk around, move around, drive, anything like that starting the day after surgery,” he said.

The procedure could be used on about 1 in 4 patients with enlarged prostate, the doctor said.

“At this point, I would not offer the open surgery because I’m able to do this,” Dr. Humphrey said. “This replaces that.”

Patients who have undergone the procedure thus far have been pleased.

“The goal is that this is the one procedure they’ll need in their lifetime,” Dr. Humphrey said. “It’ll basically take care of this problem so that men can freely urinate and not have the symptoms associated with large prostate for the rest of their lives.”