Men's urinary care · Los Angeles
Enlarged prostate evaluation & treatment starts by measuring what is blocking the flow.
A weak stream, urgent trips, or waking repeatedly at night may be caused by benign prostatic hyperplasia—but prostate size is only part of the story. EVSLA reviews the urinary pattern, prior urology workup, prostate anatomy, and treatment goals before discussing whether prostate artery embolization belongs among your options.
- Urinary symptoms measured first
- Urology collaboration when needed
- Nonsurgical options discussed
A urinary pattern worth checking
Is your bladder running your day?
- Your stream is weak, slow, or starts and stops
- You strain, dribble, or still feel partly full
- Urgency or nighttime trips interrupt daily life
What is an enlarged prostate (BPH)?
Benign prostatic hyperplasia (BPH) is noncancerous growth of the prostate gland. Because the prostate surrounds the urethra just below the bladder, growth can narrow the urine channel and make the bladder work harder to empty.
BPH may cause frequency, urgency, nighttime urination, hesitancy, weak or interrupted stream, straining, dribbling, and a feeling of incomplete emptying. Symptom severity does not always match prostate size, and similar symptoms can come from other urinary conditions.
Clinical references: NIDDK and Mayo Clinic and American Urological Association
Enlarged prostate symptoms
The problem may be storage, emptying— or both
A symptom score can show how often each problem occurs and how much it affects sleep, travel, work, exercise, and quality of life.
Why BPH changes urine flow
The prostate grows around a narrow passage
The urethra passes through the prostate. As tissue enlarges, it can squeeze that channel. The bladder initially compensates by contracting harder; over time, incomplete emptying and bladder changes may develop.
Prostate tissue and bladder-neck tone may make it harder for urine to leave the bladder.
Stronger contractions may create urgency and frequency even when the flow remains weak.
Residual urine can contribute to retention, infection, stones, and—less commonly—kidney problems.
Clinical reference: NIDDK Enlarged Prostate (BPH).
When not to wait
Complete urinary blockage needs immediate care
BPH symptoms often change gradually. A sudden inability to pass urine is different: acute urinary retention is painful and requires urgent drainage and medical evaluation.
Urgent-care reference: NIDDK: Enlarged Prostate (BPH), Mayo Clinic, .
What causes BPH?
Age-related growth is common; symptoms are individual
Researchers do not attribute BPH to one cause. Aging and hormone-related changes are central, while family history and cardiometabolic health may influence risk. BPH is benign, but appropriate prostate evaluation still matters because BPH and prostate cancer can coexist.
01
Increasing age
Clinically meaningful prostate enlargement and urinary symptoms become more common after age 40.
- Age-related growth
- Hormone changes
- Gradual progression
- Individual symptoms
02
Family history
Having a close relative with prostate problems may increase the likelihood of BPH.
- Inherited susceptibility
- Family prostate history
- Earlier discussion
- Individual screening
03
Diabetes and heart disease
Metabolic and cardiovascular conditions have been associated with greater BPH risk.
- Diabetes
- Heart disease
- Metabolic health
- Medication review
04
Weight and activity
Obesity may increase risk, while regular physical activity may be protective.
- Weight
- Physical activity
- Cardiometabolic risk
- Healthy aging
How enlarged prostate is diagnosed
Measure the bother, the flow, and what remains
A useful workup does more than confirm that the prostate is enlarged. It determines whether symptoms are actually caused by bladder-outlet obstruction and identifies problems that change treatment choice.
BPH diagnostic pathway
Diagnostic references: NIDDK and Mayo Clinic.
Enlarged prostate treatment
Treatment should match symptoms, anatomy, and your priorities
Mild symptoms may need monitoring rather than a procedure. More bothersome or complicated BPH can be treated with medicines, office-based therapies, surgery, or prostate artery embolization after appropriate evaluation.
Path 1 · Monitor and modify
Start with symptom impact
For mild symptoms without complications, active surveillance and practical changes may be enough.
- Track symptom score
- Time evening fluids
- Limit alcohol and caffeine if helpful
- Review medicines that worsen retention
Path 2 · Medication
Match the prescription to the pattern
Choice depends on prostate size, symptom pattern, blood pressure, sexual priorities, and side effects.
- Alpha blockers
- 5-alpha-reductase inhibitors
- PDE-5 inhibitor in selected patients
- Combination therapy when appropriate
Path 3 · Procedure
Compare reasonable options
When symptoms remain bothersome or complications develop, compare options rather than assuming one fits every prostate.
- Transurethral or robotic surgery
- Office-based minimally invasive therapies
- Laser or water-based procedures
- Prostate artery embolization
Prostate artery embolization
Reduce prostate blood flow through a small artery access
During PAE, an interventional radiologist guides a catheter from the wrist or groin into the prostate arteries and delivers tiny particles to selected branches. Reduced blood flow causes prostate tissue to shrink over time, which may improve urinary symptoms.
Important tradeoff: PAE can improve symptoms with a less invasive recovery profile for selected patients, but long-term randomized evidence shows transurethral surgery may improve maximum flow and bladder emptying more.
- Image-guided catheter procedure
- No transurethral tissue removal
- Often performed as an outpatient
- Local anesthesia and sedation may be used
- Symptoms improve gradually
- Retreatment remains possible
Confirm candidacy
Review symptoms, prostate anatomy, flow and residual urine, prior treatments, medications, and reasons to choose another therapy.
Map the arteries
Angiography and cone-beam imaging identify prostate branches and help protect nearby vessels.
Selective embolization
Tiny particles are delivered into selected prostate arteries to reduce blood supply to enlarged tissue.
Gradual response
Inflammation settles, prostate tissue shrinks, and symptom improvement is measured over weeks to months.
Procedure and evidence: Society of Interventional Radiology.
After prostate artery embolization
The artery access heals first; urinary improvement is gradual
Recovery varies with access site, prostate size, baseline retention, medications, and other health conditions. Follow the treating team’s instructions rather than a generic timeline.
Procedure day
Observation and discharge
The team monitors access-site bleeding, pain, nausea, urination, and walking before same-day discharge when appropriate.
First days
Urinary irritation may flare
Frequency, urgency, burning, pelvic pressure, fatigue, or mild blood in urine or semen may occur. Use the prescribed plan.
Early weeks
Symptoms begin to change
Some patients notice easier urination within weeks; others improve more gradually as tissue shrinks.
Follow-up
Measure the result
Repeat symptom score, medication review, flow or residual testing, and decide whether further urologic care is needed.
Who may be a PAE candidate?
Candidacy depends on more than prostate size
PAE may be considered for appropriately evaluated patients with bothersome urinary symptoms attributed to BPH—particularly when anatomy, bleeding risk, recovery goals, or treatment preferences make it reasonable.
Questions that shape candidacy
- Are symptoms moderate to severe and clearly affecting quality of life?
- Does the workup support BPH-related obstruction rather than another cause?
- What are the prostate volume, shape, median lobe, and arterial anatomy?
- Have medicines or prior procedures failed, caused side effects, or become undesirable?
- Are bladder function, infection, retention, kidney function, and PSA concerns addressed?
- Do you understand the alternatives, tradeoffs, and possibility of retreatment?
What to bring
A consultation built around measurable symptoms
Bring urology notes, medication history, PSA trend if available, prostate imaging, cystoscopy or urodynamic reports, urine-flow and residual results, prior biopsy reports, and records of catheterization or prostate procedures.
- Score the symptoms Complete an IPSS and identify the urinary symptoms that matter most.
- Confirm the diagnosis Review urinalysis, exam, PSA context, prostate anatomy, and competing bladder or urethral causes.
- Measure emptying Review flow rate, post-void residual, retention history, infection, stones, and kidney effects.
- Compare options Discuss monitoring, medicines, office-based therapies, surgery, and PAE with realistic tradeoffs.
- Plan the artery route If PAE remains appropriate, review vascular anatomy, contrast, access site, and medications.
- Set outcome goals Define symptom, flow, residual, medication, and quality-of-life targets before treatment.
Your care team
Who evaluates PAE at EVSLA
This concept positions EVSLA’s physicians around BPH imaging review, PAE candidacy, image-guided treatment, and follow-up in coordination with urology. Physician credentials, exact services, and location availability must be confirmed before publication.
Harout Dermendjian, MD
Endovascular Specialist
Featured for BPH imaging review, PAE candidacy, and minimally invasive treatment planning. Confirm approved credentials and scope.
Kartik Kansagra, MD
Endovascular Specialist
Featured for prostate arterial anatomy, embolization planning, and image-guided care. Confirm current services.
Sipan Mathevosian, MD
Endovascular Specialist
Featured for PAE evaluation, treatment, and urinary-symptom follow-up. Confirm specialty description and availability.
Where to request an evaluation
Three clinics across Los Angeles County
Call before traveling to confirm where BPH consultation, imaging review, prostate artery embolization, and follow-up are performed. Services may differ by location.
Glendale
445 W Broadway
Glendale, CA 91204
Simi Valley
2750 Sycamore Dr, Ste 200
Simi Valley, CA 93065
La Cañada Flintridge
1407 Foothill Blvd
La Cañada, CA 91011
Questions patients ask
Enlarged prostate, answered plainly
What is an enlarged prostate (BPH)?
Benign prostatic hyperplasia is noncancerous growth of the prostate gland. Because the urethra runs through the prostate, enlargement can narrow the urine channel and make the bladder work harder to empty.
BPH becomes more common with age, but not every enlarged prostate causes symptoms.
What are the symptoms of an enlarged prostate?
Common symptoms include frequency, urgency, waking at night to urinate, trouble starting, weak or interrupted stream, straining, dribbling, and feeling that the bladder has not emptied.
Other conditions can produce the same symptoms, so evaluation matters.
Does an enlarged prostate mean prostate cancer?
No. BPH is benign and is not believed to increase prostate-cancer risk. However, BPH and prostate cancer can coexist and may cause overlapping urinary symptoms.
Why do I urinate so often at night?
Nocturia can occur with BPH, but it can also reflect evening fluids, sleep apnea, diabetes, swelling, overactive bladder, medicines, or other conditions. A bladder diary can help identify the pattern.
When is urinary retention an emergency?
If you cannot pass any urine, seek immediate medical care. Also get prompt care for blood in the urine, severe lower-abdominal or urinary pain, or painful frequent urination with fever and chills.
How is BPH diagnosed?
Evaluation usually includes a symptom history, medication review, examination, urinalysis, and symptom score. PSA discussion, flow testing, post-void residual, imaging, cystoscopy, or urodynamics may be used selectively.
What is the best treatment for an enlarged prostate?
There is no single best treatment for every patient. Options include monitoring, lifestyle changes, medicines, office-based therapies, surgery, and prostate artery embolization.
Can an enlarged prostate be treated without surgery?
Yes. Many patients can use monitoring, lifestyle changes, or medication. PAE is a nonsurgical catheter-based option for selected patients, while some complications or anatomy may still make surgery safer or more effective.
What is prostate artery embolization?
PAE is an image-guided procedure in which a catheter is directed into the prostate arteries and tiny particles reduce blood flow to selected prostate tissue so it can shrink over time.
Is PAE better than TURP or another prostate procedure?
PAE may offer a less invasive recovery profile, while randomized long-term evidence shows TURP can improve urine flow and residual emptying more. The better option depends on anatomy, goals, complications, medical risk, and retreatment tolerance.
What are the side effects and recovery after PAE?
Temporary frequency, urgency, burning, pelvic pressure, fatigue, nausea, bruising, or mild blood in urine or semen may occur. Less common complications require individualized discussion and follow-up.
Do home remedies or the “Vicks trick” shrink an enlarged prostate?
There is no reliable evidence that applying Vicks or another topical home remedy shrinks the prostate or safely treats urinary obstruction. Supplements and home remedies should not replace medical evaluation.
Urinary symptoms deserve a measured treatment decision.
Bring urology notes, medication history, PSA trend if available, prostate imaging, flow and residual results, cystoscopy or urodynamic reports, and records of prior catheterization or prostate procedures. EVSLA can review whether PAE is appropriate to discuss alongside urologic alternatives.
If you cannot urinate, have severe lower-abdominal pain, or have painful frequent urination with fever and chills, seek urgent medical care.