The prostate gland is an essential component of the male reproductive system. When a man is young, the prostate is the size and shape of a walnut or apricot and provides important additives such as enzymes, zinc, and citric acid that combine with semen to help sperm live longer and move more easily. One particular enzyme, prostate-specific antigen (PSA), helps make semen less viscous, allowing for a thinner, more fluid transport mechanism for sperm. As most men age, the prostate naturally grows in size. An enlarged prostate or benign prostatic hyperplasia, also referred to as BPH, is a benign, non-cancerous condition that isn’t and doesn’t lead to prostate cancer. However, an enlarged prostate can coexist with prostate cancer. PSA levels can be tested to help determine if a man could potentially have prostate cancer, so it is a good idea to begin checking PSA levels at age 40 if a man is at very high risk (those with more than one first-degree relative (brother or father) who had prostate cancer at an early age) and to get a digital rectal exam (DRE) each year. If a man is at high risk (this includes African Americans and men who have a first-degree relative diagnosed with prostate cancer at an early age (younger than age 65), PSA checks are recommended to begin at age 45. A man with an average risk of developing prostate cancer and who is expected to live at least another 10 years, may be able to wait till age 50 before checking their PSA levels.1 However, a doctor should always be consulted when making a PSA testing decision because each man is different. Also, BPH is not bacterial prostatitis, but some symptoms can overlap. Consulting with a urologist and some additional testing can tell the difference. Prostate enlargement doesn’t happen in all men as they age, but in most men it does. This prostatic hyperplasia is what causes lower urinary tract symptoms (LUTS) in men to the point where it becomes either a nuisance, bothersome, or health threatening depending upon how large the prostate tissue grows and in which direction(s).
If a man is over the age of 40, and especially 50 and older, he is much more likely to develop BPH than a man in his 30s. Some common symptoms to expect from benign prostatic hyperplasia or an enlarged prostate are frequency, starting and stopping, urgency, and urinary retention. Although not inherently life-threatening, the dangers of an untreated or poorly managed enlarged prostate are real and can be substantial if the prostate becomes too large or grows in the direction of the urethra and/or bladder in such a way as to completely block off the flow of urine out of the body. Fortunately, most men who are diagnosed with an enlarged prostate or benign prostatic hyperplasia, won’t experience health issues or dangers to this degree. Most prostate enlargement is of the nuisance or bothersome variety, but can still require medication or minimally invasive surgery to correct.
Dangers of an Untreated Enlarged Prostate
If an enlarged prostate grows too big and in a direction that more directly impacts the urethra, bladder, or both, and BPH symptoms become moderate to severe, additional intervention will likely be needed. If watchful waiting with no intervention is no longer effective or desired, then the best treatment for benign prostatic hyperplasia is the one that best addresses a man’s urologic goals. Typically, BPH medication or a minimally invasive procedure is the next step.
When prostate enlargement is left untreated and the prostate has either grown very large or in a direction that more severely impacts the urethra or bladder, then serious issues can develop. If prostate tissue grows too much and begins to significantly affect daily life, or complications such as acute urinary retention, urinary tract infections (UTIs), kidney issues or bladder stones arise, a minimally invasive surgical could be necessary. The dangers of an untreated enlarged prostate increase as the prostate tissue grows in size or in an abnormal orientation that impacts the urethra and bladder more aggressively.
Bladder outlet obstruction or BOO (the inability of urine to exit the bladder and body via the urethra), leads to progressive voiding dysfunction. When in the acute stage, the obstruction triggers inflammation that drives bladder dysfunction. Over time, inflammation leads to decreased bladder nerve density and increased fibrosis, which is then responsible for eventual bladder decompensation and irreversibility.2
The most common cause of BOO is benign prostatic hyperplasia, that is both chronic and progressive. In men with moderate to severe BPH, the obstruction can slowly worsen over time, causing a progression from initial obstructive symptoms (e.g., urinary hesitancy or starting and stopping) to early-stage irritative problems such as urinary frequency that can become quite bothersome. Over several years or decades, this BOO disorder can progress to a chronic stage characterized by bladder decompensation with urinary retention and overflow incontinence.2 If BOO becomes severe enough and the bladder loses its smooth muscle, stretches too much, and becomes too inflamed, it could lead to irreversible urinary incontinence or kidney failure and possibly the need for permanent catheter placement.3
If the enlarged prostate impacts the bladder for a long enough period to the point where the bladder hasn’t been able to fully empty itself for an extended timeframe, a man’s life could be in danger, especially if acute urinary retention occurs and medical assistance is not immediately available.
Side Effects or Complications of BPH Treatment
Even though there can be side effects or complications from BPH medication or treatments, these therapies are still preferable over complications that can arise when benign prostatic hyperplasia isn’t properly managed or treated. The watchful waiting phase doesn’t require BPH medication or medical treatment, so there are no side effects or complications resulting from this observation period and lifestyle adjustments. However, there can be side effects when taking BPH medication and side effects or complications when enlisting a minimal or full surgical procedure to treat an enlarged prostate.
Side effects from benign prostatic hyperplasia medications such as alpha-blockers and 5-alpha reductase Inhibitors can include:
Alpha Blockers Side Effects
- Sudden drop in blood pressure (dizziness or lightheadedness) when transitioning from lying down or sitting up to standing up
- Sexual dysfunction in the form of diminished or retrograde ejaculation
- Headaches
- Rhinitis (nasal congestion)
- Nausea
- Lethargy (tiredness)
- Sleep disturbance
- Swollen legs or ankles
- Rash or skin irritation
- Erectile dysfunction (rarely)4
5-Alpha Reductase Inhibitors Side Effects
- Reduced sex drive
- Impotence (trouble getting and keeping an erection)
- Ejaculatory disorder (retrograde ejaculation)
- Infertility
- Gynecomastia (enlargement of male breast tissue)
- Anxiety
- Depression
- Increased risk of high-grade prostate cancer
- Breast cancer
- Cardiovascular risk5,6
Possible side effects or complications from minimally invasive surgical therapies like water vapor, prostatic urethral lift, or similar benign prostatic hyperplasia procedures are minimal compared to prostate surgical procedures such as open prostatectomy, TURP, or RASP, but a few side effects are possible right after a minimally invasive surgical therapy procedure is performed. These typically resolve in a few weeks and can include*:
- Urinary tract infection
- Blood in the urine
- Bleeding
- Burning sensation when urinating
- A sudden need to urinate
- Infection
- Erectile dysfunction (less often)
- Retrograde ejaculation (less often)
- The need to re-do a procedure 7
Side effects and complications from more invasive BPH surgical procedures can include*:
- Bleeding
- Blood in the urine
- Painful or difficult urination
- Infection
- Overactive bladder
- Bladder injury
- Loss of erections
- Urinary incontinence (usually temporary)
- Retrograde ejaculation 8
* For a full list of possible side effects or complications, please consult a healthcare provider
In Conclusion
An enlarged prostate or Benign prostatic hyperplasia will affect nearly all men as they get older. BPH isn’t prostate cancer, doesn’t cause it, and luckily BPH is very manageable since there are many effective lifestyle changes, medications, and therapies available to address LUTS brought on by benign prostatic hyperplasia. However, if BPH is not managed properly or treatment is delayed beyond a reasonable time frame for men with moderate to severe BPH, prostatic hyperplasia can become troublesome and even dangerous to a man’s health or life.
Side effects from BPH medications or minimally invasive surgical therapies pale in comparison to potential complications from ignoring BPH for too long. If BPH becomes bad enough that acute urinary retention (AUR) becomes a problem or bladder or kidney damage occurs, the functionality of those organs can be compromised and result in permanent incontinence or loss of life if acute urinary retention occurs and medical assistance or self-catheterization is not immediately available.9
References:
- https://www.cancer.org/cancer/types/prostate-cancer/detection-diagnosis-staging/acs-recommendations.html#:~:text=The%20discussion%20about%20screening%20should,risk%20of%20developing%20prostate%20cancer.
- Hughes FM Jr, Sexton SJ, Ledig PD, Yun CE, Jin H, Purves JT. Bladder decompensation and reduction in nerve density in a rat model of chronic bladder outlet obstruction are attenuated with the NLRP3 inhibitor glyburide. Am J Physiol Renal Physiol. 2019 Jan 1;316(1):F113-F120. doi: 10.1152/ajprenal.00400.2018. Epub 2018 Oct 24. PMID: 30353742; PMCID: PMC6383202.
- https://www.verywellhealth.com/symptoms-of-bladder-outlet-obstruction-3300109#:~:text=Chronic%20BOO%20can%20result%20in,most%20often%20in%20older%20men
- https://www.bloodpressureuk.org/your-blood-pressure/how-to-lower-your-blood-pressure/medications-for-high-blood-pressure/alpha-blockers/
- https://www.webmd.com/men/prostate-enlargement-bph/what-to-know-5-alpha-reductase-inhibitors
- https://www.sciencedirect.com/science/article/abs/pii/S2050052115300615#:~:text=Reported%20AEs%20with%205ARIs%20include,and%20clinical%20significance%20remain%20unclear.
- https://www.urologyhealth.org/urology-a-z/b/benign-prostatic-hyperplasia-(bph)/minimally-invasive-surgeries
- https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/transurethral-resection-of-the-prostate-turp
- https://effectivehealthcare.ahrq.gov/products/chronic-urinary-retention/research-protocol#:~:text=Acute%20urinary%20retention%20typically%20is,failure%2C%20and%2For%20death.
All surgical treatments have inherent and associated side effects. Individual’s outcomes may depend on a number of factors, including but not limited to patient characteristics, disease characteristics and/or surgeon experience. The most common side effects are mild and transient and may include mild pain or difficulty when urinating, discomfort in the pelvis, blood in the urine, inability to empty the bladder or a frequent and/or urgent need to urinate, and bladder or urinary tract infection. Other risks include ejaculatory dysfunction and a low risk of injury to the urethra or rectum where the devices gain access to the body for treatment. Further, there may be other risks as in other urological surgery, such as anesthesia risk or the risk of infection, including the potential transmission of blood borne pathogens. For more information about potential side effects and risks associated with Aquablation therapy for Benign Prostatic Hyperplasia (BPH) treatment, speak with your urologist or surgeon. Prior to using our products, please review the Instructions for Use, Operator’s Manual or User Manual, as applicable, and any accompanying documentation for a complete listing of indications, contraindications, warnings, precautions and potential adverse events. No claim is made that the AquaBeam Robotic System will cure any medical condition, or entirely eliminate the diseased entity. Repeated treatment or alternative therapies may sometimes be required.
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