Everything You Didn’t Know About BPH
January 10, 2020
When you’re receiving treatment for BPH, medical management doesn’t always work. However, that doesn’t mean you’re out of options. If medical management fails, the next conversation your Urologist will have with you will consider all the surgical treatment options for BPH.
Traditionally, Transurethral Resection of the Prostate (TURP) and more recently, the Urolift procedure, have been the most widely studied, effective and performed procedures to alleviate BPH symptoms. But what happens when your prostate is either too large to treat or if other prostate procedures and options fail? That is when HoLEP or one of the various surgical procedures for BPH are called upon.
But before we go on about the incredible capabilities of HoLEP and the various surgical treatments for BPH, let’s define what Benign Prostatic Hyperplasia actually is and how you can diagnose it.
What is BPH?
Most men, as they get older, begin to experience urinary problems. This is due to the benign growth of the prostate as men age, also called benign prostate hyperplasia or BPH. This is a common, progressive urological condition, typically beginning around age 50 with 50% of men exhibiting some signs of BPH and 90% by age 85.
BPH is normal prostate tissue growth which begins to obstruct the outlet of the bladder — squeezing down on the urethra. The good part is that it’s not a cancerous condition and does not predispose one to cancer.
Typical symptoms of BPH are urinary frequency, urgency, incomplete emptying, weak or slow urinary stream, getting up a lot at night to urinate, straining to start a urinary stream and frequent prostate or urinary tract infections. It’s a progressive disease and can lead to bladder damage, chronic infections, the inability to urinate, blood in the urine, and even kidney damage if left untreated. But before you treat BPH, you have to diagnose it.
How do you diagnose BPH?
In order to fully diagnose BPH and determine the best course of treatment for BPH (medical or surgical), a careful history and some in-office testing should be performed by a urologist. Prior to any surgical procedure, it is important to have some in-office urology testing done to ensure which type of surgery will be effective.
BPH Diagnosis Methods:
Urinalysis (UA): This is a quick dip of a urine sample to ensure there is no infection present which can oftentimes mimic the symptoms of BPH.
Prostate Exam (DRE): This exam not only is a screening tool for prostate cancer but helps generally gauge the size of the prostate as well.
Post-Void Residual (PVR): This is an in-office portable ultrasound that is placed on your abdomen where your bladder is and measures the amount of urine left in the bladder after urination.
Uroflow (UF): This is a simple in-office test where you urinate into a funnel. This measures how fast the urine flows and what the stream of urination looks like.
Prostate Ultrasound (TRUS): A painless procedure using an ultrasound to see an image of the prostate and gauge its size and level of obstruction very specifically.
Urodynamics (UDS) or UroCuff: This is a flow study that is useful to rule out bladder dysfunction vs. prostate obstruction and may be done if BPH medications fail. It may also be performed prior to surgery if there’s any suspicion of bladder dysfunction. The bladder is a muscle and over time, if it never properly empties and stays full, its ability to work effectively becomes irreversibly damaged.
Cystoscopy: A small instrument is inserted into the urethra after local anesthetization, allowing for visualization of the prostate tissue, size, obstruction, as well as examining the health of the bladder. This is typically performed prior to some surgical options and if there have been any episodes of blood in the urine.
Once you’ve been diagnosed with BPH, the next conversation your urologist will have with you will be about all the different BPH treatment options. And if your urologist is here at the Austin Urology Institute, the options are vast.
Treatment of BPH
The simplest way to start treating BPH is with lifestyle changes and prescription medications. However, this is rarely effective if the prostate has grown large enough.
If medical therapy fails either due to the severity of BPH or because of progressive BPH in which medical therapy is no longer working, surgery is required to remove the obstructing prostate tissue. The prostate stays intact, just the tissue obstructing the bladder is removed.
Surgical Procedures for BPH:
TURP (Transurethral Resection of the Prostate): A TURP is the most common surgery for BPH with approximately 150,000 performed each year in the U.S. It is a day surgery performed under general anesthesia and typically takes one hour. A resectoscope is inserted through the tip of the penis into the urethra. The resectoscope contains a light, valves for controlling irrigating fluid and an electrical loop that cuts tissue and seals blood vessels. The removed prostate tissue pieces are carried by the irrigating fluid into the bladder and then flushed out. There are no surgical incisions with this procedure. Typically, you go home the day of the surgery and a catheter temporarily stays in place for a few days before being removed in the office. Usually, the patient is able to resume most daily activities the next day, however, strenuous activities will be restricted for 2 weeks to prevent prostate bleeding. Dramatic changes in urination are seen about 2 weeks post-surgery which continues to improve within the next 3 months.
Urolift: Urolift is a minimally invasive approach to treating an enlarged prostate or BPH. The procedure uses a few small devices or implants that lift or hold the enlarged prostate tissue out of the way so it no longer blocks the urethra. There is no cutting, heating or removal of prostate tissue. It is often done in the office without the need for general anesthesia, only light sedation, in less than 30 minutes often with no catheter to go home with. Men begin to see results quickly within 2 weeks and results are proven to last for many years post-procedure. Eligibility for this procedure is dependent on prostate size.
Holmium Laser Enucleation of the Prostate (HoLEP): Since its introduction in the late 1990s, Holmium Laser Enucleation of the Prostate (HoLEP) has gained traction and popularity for the management of benign prostatic hyperplasia (BPH), or enlarged prostate. The principles behind the HoLEP procedure for BPH are to provide patients with the fastest relief coupled with the most optimal outcomes when it comes to prostate symptoms.
Get back to life
Living with BPH or enlarged prostate is hardly living at all. If your symptoms are bad enough, it can make life incredibly difficult and extremely stressful. At the Austin Urology Institute, we don’t just treat urologic conditions, we give people their lives back. Want to get yours back? Drop us a note or give us a call at 512-694-8888. We’ll get you back to the flow of things in no time.