Kings Mountain resident Robert Bolin, 62, has spent the past 20 years dealing with symptoms of benign prostatic hyperplasia. Benign prostatic hyperplasia (BPH) occurs when the prostate gland becomes enlarged, which blocks the urethra and therefore impacts a person’s ability to urinate.
This condition caused severe urinary issues and drastically affected Robert’s quality of life.
“The prostate will grow in all men as they get older, which causes the majority of men to experience problems with their ability to urinate by the time they reach their 80s,” says Dr. Rebecca Gerber, a urologist at Atrium Health Urology Kenilworth.
The condition can start in a man’s late 40s and onward, though sometimes it develops earlier, as it did in Robert’s case. Medical experts still aren’t sure what specifically causes benign prostatic hyperplasia.
“It is likely a combination of genetic and environmental factors, but we don’t know the specific genes or have a way to prevent it at this point,” says Dr. Gerber.
Robert’s life with benign prostatic hyperplasia
Robert’s symptoms began in his early 40s with the frequent urge to urinate and difficulty urinating. His doctor detected elevated prostate-specific antigen (PSA) levels in his blood and suspected prostate cancer. But after nearly a year of testing, Robert was diagnosed with BPH, which is not cancerous.
Unfortunately, various treatments led to little relief from the frequent urge to urinate.
“For nearly two decades, my life has been dictated by and scheduled around my bladder,” says Robert. “That’s a rough prospect for an active man who’d rather enjoy the outdoors than constantly scan for a place to run to the restroom.”
An avid traveler, Robert’s BPH symptoms made trips difficult.
“When I’d get on a plane, no matter where I flew, I could count on needing to go to the bathroom six to eight times per flight,” he says. “It’s embarrassing when you have to get up so many times.”
When he traveled with his motorhome, he’d have to pull over numerous times to use the restroom.
Even his sleep was impacted.
“I’d wake up six to 12 times a night with the urge to go to the bathroom,” he says.
Desperate for relief from his symptoms, Robert saw his doctor and began using a catheter to empty his bladder when he was around age 58. It got to the point where he was unable to urinate at all and therefore had to catheterize himself every time he needed to empty his bladder.
But using a catheter still presented challenges, especially when traveling because it required him to carry a host of supplies and try to keep them sterile in an airport bathroom.
Benign prostatic hyperplasia treatment options
Gerber says the first line of treatment for benign prostatic hyperplasia is medication to shrink the prostate or help with the flow of urine. However, these medications can come with side effects and while they may improve the symptoms, they don’t permanently fix the problem. Additionally, patients must remain on these medications for the rest of their lives. Some minimally invasive procedures can help, but they aren’t as thorough in treating the issue, she explains.
If more conservative treatments don’t alleviate symptoms, a patient wants a better chance at long-term improvement or a patient does not want to be dependent upon medications for the rest of their life, urologists often recommend surgical procedures, such as GreenLight laser therapy (PVP), transurethral resection of the prostate (TURP) or holmium laser enucleation of the prostate (HoLEP).
Gerber recommended HoLEP to treat Robert’s symptoms. HoLEP is a minimally invasive surgical procedure performed endoscopically through the urethra with no incisions. During this procedure, urologists use the same holmium laser that is used to treat kidney stones.
“HoLEP is different from other surgical BPH procedures because it allows you to remove all obstructive prostate tissue that has the potential to grow back,” says Gerber. “We can also perform the procedure on a prostate of any size, whereas you’re limited by size with TURP and GreenLight laser therapy.”
People who undergo the HoLEP procedure tend to have a better improvement in symptoms and a lower risk of needing another surgery in the future. There’s also a lower risk of bleeding post-surgery. In most cases, it’s an outpatient procedure.
“We have 18 years of data on the HoLEP procedure and less than 2% of patients need additional surgery after 18 years,” says Gerber. “In comparison, with TURP or GreenLight laser therapy, 10 to 30% of patients require another surgery at 10 years because the prostate tissue grows back.”
While not all urologists have been trained on the HoLEP procedure, Gerber believes it will be the gold standard for treating BPH in the future.
“If I had to recommend a BPH treatment to my father, I’d recommend HoLEP,” she says. “People tell me they are so grateful for HoLEP and how it’s changed their lives. Now they don’t have to carry catheters around or spend their life planning when they’ll go to the bathroom. They can go on long road trips and fly on a plane. It drastically changes their quality of life.”
Robert’s life-changing experience with HoLEP
“Three years ago, my prostate locked up several times to the point where I couldn’t urinate at all,” says Robert. “It was painful and frightening. I was told by multiple specialists I would need surgical intervention to deal with worsening symptoms of BPH. I became adept at self-catheterization, but still suffered through a urinary tract infection.”
He was given a list of four recommendations. One urologist recommended a UroLift® System, another suggested GreenLight laser therapy and another advised a total prostate removal could be necessary. Finally, a physician in the VA Asheville Health Care urology department suggested he research the HoLEP procedure.
Robert’s research led him to Gerber’s online bio, as she’s one of only a few physicians in the United States who perform the HoLEP procedure. He saw she was in residency at the University of Wisconsin, so he assumed he’d have to travel to meet with her.
“A week later, I learned she was in Charlotte at Atrium Health,” says Robert. “I met with her and it was ‘love at first sight’ when she told me how she could help me.”
He underwent surgery in March 2022 at age 61, nearly 20 years after his urinary symptoms began.
Since undergoing the HoLEP procedure, Robert’s life has drastically changed.
“The surgery totally changed my life,” he says. “After 20 years of planning trips around bathroom breaks, I’m about to go on a four-hour hot air balloon ride and a 21-day African safari. I’m going to stay in a treehouse in an African jungle. In the past, I wouldn’t have been able to do that. I’m also going to get back into scuba diving again.”
Robert’s advice to others dealing with BPH symptoms: “Considering the years of issues, problems and procedures I’ve dealt with, I would now recommend anyone considering treatment for BPH to seek solutions sooner rather than later, so they can enjoy a life that isn’t tethered to the status of their prostate. I believe I could have avoided years of worsening symptoms and enjoyed a faster recovery had I known this procedure was an option sooner.”
Gerber adds, “You don’t have to live with your urinary symptoms. The sooner you address it, the less likely it is to cause long-term bladder damage. If you’re bothered by urinary symptoms, talk to your primary care provider or urologist. You don’t have to spend your life thinking about the next time you have to use the bathroom.”
Learn more about urology care at Atrium Health.
