Throughout a man’s life, his prostate may become larger and start to cause problems as he ages. But what are some of those problems? How do I know if I have BPH (Benign Prostatic Hyperplasia)? When should I see a doctor? What kinds of tests will my doctor perform? The following should help answer these questions as well as others.
Dr. Shaw starts off with a simple questionnaire to understand your symptoms. Sometimes, the solution is simple, with a few dietary and lifestyle adjustments.
For others with more moderate symptoms, it still may be as easy as taking a small tablet in the evening to shrink or relax the prostate. Symptomatic relief can be as fast as overnight for some.
For others with a significantly enlarged prostate that squeezes the urine tube, much like stepping on a garden hose, surgery may be required. But rest easy, the surgery is much easier than it was just a few years ago! The advance of lasers and other techniques often makes this an outpatient surgery.
BPH Enlarged Prostate Information
What is the prostate?
What is BPH?
What are some of the risk factors for BPH?
What are some of the symptoms associated with BPH?
How is BPH diagnosed?
When a doctor evaluates someone for possible BPH, the evaluation will typically consist of a thorough medical history, a physical examination (including a digital rectal exam or DRE), and use of the AUA BPH Symptom Score Index. In addition, the doctor will generally do a urine test called a urinalysis. There are a series of other studies that may or may not be offered to a patient being evaluated for BPH depending on the clinical situation. These include:
- prostate specific antigen (PSA), a blood test to screen for prostate cancer
- urinary cytology, a urine test to screen for bladder cancer
- a measurement of post-void residual volume (PVR), the amount of urine left in the bladder after urinating
- uroflowmetry, or urine flow study, a measure of how fast urine flows when a man urinates
- cystoscopy, a direct look in the urethra and/or bladder using a small flexible scope
- urodynamic pressure-flow study that tests the pressures inside the bladder during urination
- ultrasound of the kidney or the prostate
When should I see a doctor about BPH?
Is BPH a rare condition?
Does BPH lead to prostate cancer?
Are there risks in not seeking treatment for BPH?
Which type of drugs are the best?
How do I know if oral medications are the best treatment for me?
How are the urinating symptoms secondary to BPH diagnosed?
There are a number of diagnostic test procedures that can be used to confirm BPH. The tests vary from patient to patient, but the following are the most common: digital rectal examination (DRE), PSA test, transrectal ultrasound (this measures the size of the prostate), urine flow study (this measures the speed and strength of the urinary stream), measurement of how much urine is left after urinating (post-void residual urine) and cystoscopy (a fiber-optic instrument inserted into the urethra to examine both the prostate and the urinary bladder).
What are some of the medical treatments available for BPH?
5-alpha-reductase inhibitors: Finasteride and dutasteride are oral medications that work completely different then alpha blockers. In select men, finasteride and dutasteride can relieve BPH symptoms, increase urinary flow rate and actually shrink the prostate though it must be used indefinitely to prevent recurrence of symptoms. Studies suggest that these medications may be best suited for men with relatively large prostate glands. It may take as long as six months to a year, however, to achieve maximum benefits from this drug. . These drugs reduce the risk of BPH complications such as acute urinary retention (suddenly being unable to urinate) and the eventual need for BPH surgery. Side effects can include impotence, decreased libido and reduced semen release during ejaculation.
Combination Therapy: The use of both alpha blockers and 5-alpha-reductase inhibitors result in better amelioration of symptoms and long term benefits than using only one type of drug. However, this improved benefit may be associated with more side effects (possible side effects from both medications).
Phytotherapies: These compounds, also know as herbal therapies, are very popular self treatment remedies. However their effectiveness is not really known but if they provide benefit, it is much less than other medical therapies.
When is surgical treatment suggested as a form of treatment?
What are the different surgical treatments available?
Transurethral resection of the prostate (TURP): Transurethral resection is the most common surgery for BPH. In the United States, approximately 150,000 people have TURPs performed each year. This can be done using electric current or with laser light. After the patient receives anesthesia, the surgeon inserts an instrument called a resectoscope 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 tissue pieces are carried by the irrigating fluid into the bladder and then flushed out and sent to a pathologist for examination under a microscope. At the end of the procedure, a catheter is placed in the bladder through the penis. The bladder is continuously irrigated with fluid through the catheter in order to monitor bleeding and prevent blood from clotting and obstructing the catheter. Since there are no surgical incisions with this procedure, patients normally stay in the hospital only one to two days. Depending on surgeon preference, the catheter may be removed while the patient is still in the hospital or the patient may be sent home with the catheter in place, attached to a leg bag for convenience and removed several days later as an outpatient procedure.
Minimally Invasive Surgical Treatments
Newer surgical modalities for the treatment of BPH have been aimed at providing a one-time minimally invasive therapy that is associated with fewer complications than TURP.
Transurethral microwave thermotherapy (TUMT): Transurethral microwave thermotherapy is a minimally invasive surgical treatment which uses a device to apply heat to the prostatic tissue causing necrosis and relief of bladder outlet obstruction. While the improvements in some outcomes following TUMT have not quite reached those associated with TURP, significant improvements in urinary symptoms have been reported for long time periods. In addition, re-treatment rate for recurrent lower urinary tract symptoms occurring secondary to BPH during a 3 year follow up period has been reported to be close to 25%. Another study reported that by two years after treatment with TUMT, 46.9% of patients were using medical therapy with an alpha-adrenergic antagonist and 17.6% of patients elected for re-treatment with TURP. Overall, it is still unclear as to the long term effectiveness in the relief of lower urinary symptoms after treatment with TUMT. One of the major advantages of TUMT is that it can be performed in a single 1-hour session as an outpatient procedure without any general or spinal anesthesia. Reports of complications vary, and range from 0 to 38%, based on the study and the investigators? criteria for complications.
Urolift is an FDA approved device that is implanted within the prostate to help relieve the symptoms of BPH. Typical symptoms include weak stream, straining to urinate, frequency, and urgency. The device itself is about 3-4 cm in size, and contains two vertical ends (made of nickel/titanium, and stainless steel) connected by a suture. The standard number of devices placed during a procedure is four, however this may depend on the prostate size.
How does Urolift work?
Urolift works by pulling apart the lobes of the prostate to allow the bladder to empty more efficiently through the prostatic urethra. Urolift is implanted into the prostate through the urethra by a device that is connected to a camera. To see this in action, click on the video link below.
Is it surgery?
Urolift may be done as an outpatient procedure in the operating room or in the clinic under mild sedation. This depends on the patient’s health status, comfort, and doctor’s preference. The actual process of implantation takes about 10 minutes; some additional time is added on for the preparation. Recovery relatively quick compared to traditional prostate surgery for BPH and does not require a catheter.
What are the side effects?
The most common side effects of Urolift are blood in the urine, burning with urination, urgency, pelvic pain, and leakage of urine.
How does Urolift compare to TURP (transurethral resection of prostate)?
TURP is always done as a surgical procedure in the operating room , under general anesthesia. It also requires a catheter afterwards for a few days. With Urolift, the patient also has much less (if any) bleeding afterwards . . TURP may be done if necessary after Urolift is implanted. Urolift may not be used in patients with a median lobe (prostate grows into bladder).
What can be expected after treatment?
Table 1: Overall improvement in patient symptoms
Table 2: Immediate post-operative complications
Table 3: Late post-operative complications