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How to shrink your prostate

Benign prostatic hyperplasia (BPH) – a condition in which most prostate tissue causes unpleasant symptoms for many older men – is the most common reason men visit a urologist. Half of all men aged 51-60 develop BPH and the incidence increases with each decade of life. Approximately 30-50 million men in the United States have BPH.

This causes symptoms of poor quality of life, such as difficulty in urinating, they cannot empty the bladder completely and often want to urinate. On top of that, these symptoms — which can lead to multiple night trips to the bathroom — can affect sleep.

What options are available for BPH treatment and which ones are right for you?

“There are a variety of treatments available to address the prostate that extend from drug to surgery,” says Michael Stiefelman, president of urology at Hackensack University Medical Center. “Your doctor will work with you to identify the best method, based on a number of factors, including your age, the size of your prostate, and how much discomfort or pain you are experiencing.”

Wait and See Approach

If you can live with your symptoms, you may decide to postpone treatment and adopt some lifestyle changes to find a solution. Those changes may include:

  • Drink less fluid before bedtime.
  • Usually consuming less alcohol and caffeine.
  • Avoid over-the-counter medications that contain decongestants or certain antihistamines that can exacerbate prostate problems.

“If you decide to postpone treatment, it’s important to periodically communicate with your doctor to monitor your condition,” says Ravi Munwar, MD, vice president of urology and director of minimally invasive and robotic urology surgery at Hackensack.


Most men with BPH actively manage their condition with medication. These include:

  • Alpha blockers: Although alpha blockers do not change the size of the prostate, they loosen muscles within the bladder and the prostate, which facilitates urination.
  • 5-alpha reductase inhibitors: These drugs stop the body from creating certain hormones that cause prostate enlargement.
  • Medications used to treat erectile dysfunction: Some medications affect smooth muscle in the bladder and prostate, which can help alleviate BPH symptoms.


The most common surgical procedures are transurethral resection of the prostate (TURP), in which the prostate tissue is removed by the urethra and the greenlight laser treatment evaporates the prostate tissue. Both treatments can result in reverse ejaculation, in which the sperm return to the bladder when a man ejaculates. During laser treatment, 90% of patients experience this side effect.

Urologists at Hackensack are the first to offer innovative treatment for BPH in northern New Jersey, which uses a high-intensity waterjet to remove excess prostate tissue (ablate) that causes unpleasant symptoms. Called Aquablation®, this treatment is an option for men who cannot effectively treat prostate enlargement using prostate-lowering medications. Acquisition is performed using a robotic surgical platform, guided by real-time imaging to provide treatment with exceptional accuracy.

Acquisition is prescribed for any person who causes disturbances of the prostate gland and is unable to achieve relief with medication or does not wish to take these medications. “Acquisition is just as effective as these other treatments but with fewer side effects, involving about 10 percent risk of reverse ejaculation,” says Dr. Says Munwar. “Using a surgical robotic system with ultrasound guidance, it can be completed much faster and with a higher level of accuracy that can be reproduced by the surgeon.”

Here’s how it works:

  • The patient undergoes anesthesia.
  • An ultrasound probe is inserted into the patient’s rectum to produce clear real-time images of the prostate. Adding ultrasound imaging enables the surgeon to map out the areas of the prostate to exclude and exclude parts.
  • The extent of aquablation is inserted into the urethra.
  • When ready to start, the surgeon presses the pedal and the aquablation system proceeds to the prostate, removing the mapped prostate tissue.
  • Depending on the size of the prostate, the procedure may take 15 minutes. The patient is usually in the hospital overnight with a urinary catheter and can return home the next day. Patients will soon experience a reduction in BPH symptoms and will be able to discontinue their BPH medication. Occupation achieves prostate relief for years.

Next steps and resources:

The material provided by HealthU is intended to be used as general information only and should not be changed by your physician’s advice. Always consult your doctor for personal care.

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