A Urology Team Center of Excellence

BPH - Enlarged Prostate

Benign Prostatic Hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland that causes progressive difficulty with urination. The enlargement process begins between the ages of 30-40, but typically develops so slowly that manifestations of BPH do not generally become noticeable until after 50. Enlargement of the prostate can result in a blockage of the urethra creating a difficulty in emptying the bladder, as well as other symptoms. The size of the prostate does not always determine how severe the blockage or symptoms will be. Treatment for BPH is recommended when the voiding dysfunction is significant enough to affect quality of life.

 

Lower Urinary Tract Symptoms (LUTS)

Symptoms of BPH most often begin around age 50 but can be seen much earlier. Often the first symptom is a noticeable decrease in the strength of the urinary stream. However, other symptoms can include:

  • A decrease in the force of the urinary stream
  • A urinary stream that starts and stops throughout the flow
  • A delay in starting the urinary stream
  • Frequent urination (having to urinate more often than every 3 hours)
  • A feeling that the bladder has not completely emptied
  • Waking up at night to urinate (Nocturia)
  • Dribbling urine at the end of the stream
  • Inability to urinate (Retention)

 

Although many men believe these symptoms are just a part of getting older, the truth is, these symptoms are not normal at any age. Left untreated, the symptoms may be harmful to the bladder and kidneys. Incomplete emptying of the bladder, as well as overworking the bladder muscle, can lead to urinary tract infections (UTI), bladder or kidney damage, bladder stones, or urinary incontinence. Therefore, it is important to seek treatment as early as possible to avoid the possibility of permanent bladder damage. When BPH is diagnosed and treated in the early stages, there is a lower risk of developing such complications.

Evaluation

The first step in diagnosing BPH is sharing your symptoms with a doctor. Fortunately, there are several options available for successfully treating BPH after diagnosis. First, the physician will use evaluation tools to rule our infection and cancer. They will also need to evaluate the severity of the blockage in order to determine the best and most effective treatment option.

Basic Evaluation Procedures

  • The symptom score sheet index – your physician may ask you to complete a questionnaire to determine the variety and seriousness of your symptoms.
  • A complete medical history will be obtained to include the symptoms that you are experiencing.
  • A physical examination will be performed which included a digital rectal exam to evaluate the prostate.
  • A urinalysis is done to check urine for the presence of bacteria or blood cells, as well as to screen for potential infections.

Additional Screening Tools

A Prostate Specific Antigen (PSA) blood test is often obtained. PSA is a specific substance produced only by the cells of the prostate gland. Patients with BPH, Prostatitis, or prostate cancer can have higher than normal levels of PSA in their blood. If the PSA is higher than normal ranges and an infection is not detected, the physician may perform a prostate biopsy to further rule out the presence of prostate cancer.

A Bladder Scan is an ultrasound test that can be used to measure your post void residual (PVR) or the amount of urine that remains in the bladder after urination.

Uroflowmetry is a test that measures urine flow and is often lower than normal in men with BPH.

A Prostate Ultrasound takes a picture of the prostate using sound waves. The doctor will perform this test with a special ultrasound that is placed in the rectum to evaluate the size and shape of the prostate.

Urodynamics is a comprehensive test used to measure the pressure in your bladder during bladder filling and urination. This test determines where the urinary problems are linked to the weakening of the bladder muscle or from the blockage of an enlarged prostate.

A Cystoscopy may be performed to allow the physician to view the length of the prostate and to evaluate for any abnormalities of the urinary channel (urethra).

Treatment Considerations

Proper treatment is determined based on the diagnosis, a patient’s overall health, severity of the symptoms, and the patient’s preference.

Watchful Waiting, or simply observing the patient to make sure no kidney or bladder problems develop, is a reasonable and safe choice for patients with minimal symptoms, or additional medical conditions that make treatment too risky.

Medications are often used for those who have bothersome symptoms, but have bladders that are still emptying fairly well, and have good kidney function. They are also administered for those who do not want to undergo procedures or surgery. There are several medications that work well. Alpha blockers are drugs that help relax the muscles in and around the prostate gland which can relieve mild to moderate symptoms. Newer drugs such as Flomax and Uroxatral often relieve symptoms after only a few doses, and do not have the same side effects as older drugs such as Hytrin and Cardura. Proscar and Avodart are another category of drugs that relieve symptoms by shrinking the prostate.  These drugs are very effective but can take from 9 to 18 months to create enough shrinkage for symptom improvement. Oftentimes patients may turn to vitamins, herbs or other natural remedies for BPH. Because these alternatives are not regulated or approved by the FDA, they are not recommended as proper or reliable substitutes.

Minimally Invasive Treatment Options

The right treatment for each patient is determined by the patient’s overall health, the severity of their symptoms, and the patient’s preference. For patients who do not want to take medications, do not want to take them long-term, or who have tried medication without success, there are minimally invasive procedures available that may provide an effective alternative to surgery.

Prostiva Radio Frequency (RF) Therapy

Prostiva is an in-office procedure that takes less than an hour (with some additional preparation and recovery time required). The procedure requires placing a small tube through the urethra to the prostate gland. At the tip of this tube are small electrodes that deliver low-level radio frequency (RF) energy used to reduce excess prostate tissue through a heating process. After this tissue is removed, urination flow is improved and BPH symptoms are either eliminated or minimized.

This procedure is generally conducted with local anesthesia only, and allows patients to return to many of their normal activities within 24 to 48 hours. There are also fewer side effects and adverse events compared to traditional surgical treatments, as well as fewer reports of incontinence or impotence. After the procedure, a catheter will be placed in the urethra for up to two days while swelling is reduced. Improvement in BPH symptoms should be taken between two to six weeks depending on the severity, duration and size of the prostate treated. The Prostiva procedure has a durability rate of up to 5 years.

Bipolar Transurethral Resection of Prostate/ Olympus Button / Green Light Laser

Surgical treatment may be indicated based on the severity of the symptoms. As with Prostiva, the goal of surgery is to remove excess prostate tissue that is blocking the flow of urine and hindering quality of life. A transurethral resection of the prostate or TURP is a surgical method which the inner core of the prostate is carefully resected to open the urine channel. It is typically performed as an outpatient and requires the patient to have a catheter for several days.  The Green Light Laser and Olympus button ablation of the prostate are surgical procedures that vaporize excess prostate tissue that is blocking flow. Patients are also able to go home the same day, and often experience an instant relief of symptoms.  All the surgical options are used for patients experiencing severe symptoms, and for those who have failed more conservative therapies. However, it can also be indicated for patients with any degree of symptoms who want instant relief without taking medications. The physician will discuss each option with the patient and help guide on the best therapy for that individual patient.

Although BPH is a common problem in men, it does not have to define their life. With medications, minimally invasive therapies, or outpatient surgery, men can experience improved urinary function and health.