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Benign Prostate Hypertrophy

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Leader in Holmium Laser Enucleation of Prostate

HoLEP (Holmium Laser Enucleation of Prostate) is the platinum standard for prostate surgery. It is a unique laser surgery for the prostate that removes the maximum amount of prostate tissue and takes a long time to learn how to do. It has excellent outcomes, short and long term. Patients from all over the world have travelled to have a consultation with Dr. Krambeck. 

No prostate is too large or too small for Dr. Krambeck to perform HoLEP. Dr. Krambeck was one of the first surgeons to adopt outpatient HoLEP and same-day catheter removal.  She works closely with Lumenis Ltd., the makers of the MOSES™ Holmium laser.  With state of the art technology, Dr. Krambeck is able to take her expertise to the next level to deliver the best possible outcome for you.  Read Dr. Krambeck's comments on MOSES here.

What is
Benign Prostatic Hyperplasia?

Benign prostatic hyperplasia (often referred to by its abbreviation, BPH) is enlargement of the prostate gland that commonly occurs as men age. BPH is not prostate cancer, and it will not spread. Many men are affected; in fact, approximately 80% of men have symptoms of BPH by the age of 80 years.

The urethra carries urine from the bladder to the tip of the penis. An enlarged prostate gland can limit your ability to pass urine because it affects the size of the urethra. If you imagine your prostate as a donut, the urethra would be the hole in the middle. If the donut increases in size, the donut hole gets smaller.

If left untreated, BPH can lead to:

  • Hematuria (blood in the urine)

  • Incontinence

  • Stones

  • Infection

  • Inability to urinate with damage to the bladder

  • Damage to the kidneys

Symptoms of
Benign Prostatic Hyperplasia

The symptoms of benign prostatic hyperplasia (BPH) can vary depending on the degree of obstruction of urine flow. Commonly, these symptoms include:​

Difficulty starting to urinate and possibly a stuttering stream
Frequent urination
Increased need to urinate, including waking at night to urinate
Inability to empty the bladder completely
Urine dribbling towards the end of urination
BPH can also cause nocturia (excessive urination at night).

Causes and Diagnoses
of Benign Prostatic Hyperplasia

Essentially every man will develop BPH if he lives long enough. Some may develop BPH at a young age (as young as 40), and some have more symptoms than others. The following can affect your risk:

  • Age. Symptoms become more common as you get older.

  • Lifestyle. A sedentary lifestyle can lead to increased symptoms, while increasing exercise can help improve symptoms. Alcohol and caffeine intake can worsen symptoms of BPH and should be avoided.

  • Medications. Certain medications, such as those used to treat allergies and beta-blockers used to treat hypertension, can worsen symptoms.

Diagnosis is usually made by evaluating symptoms and performing a physical exam to check for an enlarged prostate. This finding is usually established by a digital rectal exam.

Additional tests may include:

  • A flow test is when the patient urinates into a receptacle while the strength of the stream is recorded.

  • The urine may be analyzed for blood components, bacteria and stone crystals.

  • A noninvasive ultrasound of the bladder may be performed after urination to check for residual urine.

  • A prostate-specific antigen (PSA) blood test and urine analysis are recommended to exclude prostate cancer or other coexisting conditions that could require a different treatment plan.

  • If surgical treatment is pursued, an exam using a camera through the penis (cystoscopy) may be recommended to better define the anatomy of the enlarged prostate and determine the optimal treatment options. This exam is performed in the office with local anesthesia and usually takes just two to three minutes.

  • A bladder function test may be performed to check the bladder’s ability to contract with sufficient force. This requires the placement of a pressure-flow measuring catheter (a thin plastic tube inserted in the penis). The study takes approximately 20 minutes.

  • An ultrasound, computed tomography (CT) scan or magnetic resonance imaging (MRI) of the prostate may be performed to further evaluate the size and structures of the prostate.

Medical Consultation

Frequently Asked Questions:

​Q: I've been told my bladder doesn't work anymore, am I still a candidate for HoLEP?

A: Dr. Krambeck has performed thousands of HoLEP surgeries, even for patients who were told they have non-functioning bladders.  In most patients with underactive bladders, HoLEP is able to remove so much tissue, that patients will be able to void using abdominal pressure.

Q: Is my prostate too big? Or too small for HoLEP?

A: HoLEP can be performed for any size prostate and this is supported by the AUA guidelines.  There is no prostate too large or too small for HoLEP performed by Dr. Krambeck

Q:  I am on anticoagulation for a heart condition, can I have HoLEP done?

A: Dr. Krambeck can safely perform your surgery while you are on blood thinners. (e.g. Eliquis, Xarelto, Plavix, Coumadin, Aspirin, Brillinta, ect).  In other words, you do not need to stop your blood thinning medicine.

Q:  I have a bladder stone, should I get this treated first?

A:  Dr. Krambeck can treat your bladder stone at the time of HoLEP.

Q: I live out of state and would like to minimize the number of trips to see Dr. Krambeck.  Is that possible?

A: Yes. Dr. Krambeck's team is accustomed to working with patients from all over the world.  For example, we can schedule your consultation one day before your surgery so you only have to be away from home for 2-3 days.

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