BPH is the most common problem we see in our male patients today. BPH stands for Benign (non-cancerous) Prostatic (affecting the prostate) Hyperplasia (having more cells than is normal). The prostate is a walnut-sized gland that is part of the male reproductive system. It is located just below the bladder and surrounds the uppermost portion of the urethra (the tube that carries urine from the bladder, through the penis, and out of the body). BPH can cause problems that impede urine flow and cause the bladder to not empty completely when you urinate.
From birth to young adulthood, your prostate gland grows from the size of a pea to about the size of a walnut. For many men from their mid-to-late 40s, the prostate begins a second growth spurt, which makes it grow more rapidly in the central inferior part of the gland, which is the area where the prostate surrounds the urethra.
As your prostate grows it can cause you two growth related problems. First, the prostate can compress the urethra and partially or completely block urine flow. Second, your prostate can cause the muscles around the urethra to contract making it difficult for the urethra to relax and allow urine to flow.
Common BPH Symptoms
Nocturia: Getting up in the middle of the night to urinate.
Urgency: Feeling that you cannot wait to urinate.
Frequency: Urinating often.
Incomplete emptying: Feeling that your bladder is not completely empty after urinating.
Decreased force of stream: Slow or weak urine stream. Also described as a dribbling stream, or a stream that stops and starts.
Straining to void: Straining during urination.
Pain in the suprabubic area.
Digital Rectal Examination
The prostate is an internal organ, so the urologist cannot look at it directly. Since the prostate lies in front of the rectum, the doctor can feel it by inserting a gloved, lubricated finger into the rectum and easily locate and examine the prostate gland. The examination allows the physician to estimate whether the prostate is enlarged, has nodules (lumps) or other areas of abnormal texture.
Prostate-Specific Antigen (PSA)
PSA is a substance produced by the prostate. This is measured using blood tests for PSA levels. When the prostate is inflamed, it may produce high levels of PSA, indicating the possibility of prostatitis. PSA is also very useful in screening for prostate cancer, and can help the urologist decide what other tests may be needed such as a biopsy of the prostate for definitive prostate cancer diagnosis.
Urine flow test and a bladder scan indicating post-void residual may be done. A post-void residual indicates how well you are emptying your bladder. Radiological imaging such as a ultrasound and computerized tomography (CT scan) can also show whether you have an enlarged prostate.
The treatment options for BPH include observation, medical therapy, or for patients with symptoms that affect your quality of life, surgical intervention. Generally speaking, different treatments provide difference degrees of relief. The severity and effect of your symptoms on your are key in deciding the best option.
For patients that are asymptomatic, or for symptoms that are not very bothersome, observation may be the best treatment choice for you. You would come into our office every 3-6 months for digital rectal examinations, and regular PSA checks. Once your symptoms become bothersome, then we can decide on the other treatments available.
There are a variety of medications on the market today that can alleviate the symptoms you experience with BPH. If you choose this option, your doctor may prescribe one or more of the following types of medications.
- Alpha Blockers: Relax the muscles in the bladder neck and prostate so that urine can flow more easily. Examples of this type of drug include Flomax (Tamsulosin), Rapaflo, Uroxatrol, Cardura, and Hytrin.
- 5-Alpha Reductase Inhibitors: Block hormones that encourage prostate growth. Over time, this can help in shrinking the prostate. Examples include Avodart and Proscar (Finasteride).
- Anticholinergics: Relax the bladder muscle and may help relieve the urgent need to urinate. Examples include Detrol LA, Vesicare, Sanctura, Ditropan, Oxybutynin, Gelnique, and Enablex.
Most of the urologists do all of the surgeries mentioned in this section. If you suffer from the symptoms of BPH, you must be evaluated first before a treatment course is recommended. A cystoscopy evaluation to evaluate the inside of your bladder and prostate is a necessity before proceeding with any of these therapies. In some circumstances, a transrectal ultrasound of your prostate is necessary to evaluate the volume and size of the prostate.
Transurethral Resection of the Prostate (TURP)
TURP is a minimally invasive surgery where instruments are inserted in through your urethra to remove prostate tissue. An incision is not made during this procedure, and an electrical loop cuts away excess prostate tissue to improve urine flow. For additional information on TURP, click here.
Laser Ablation of the Prostate
This procedure involves using a laser to vaporize obstructive prostatic tissue. Potential advantages of laser ablation of the prostate include less bleeding, shorter catheterization, and recovery times. Laser ablation is done on an outpatient basis.
Transurethral Microwave Therapy (TUMT)
TUMT involves the utilization of heat to reduce the prostate tissue from impeding urine flow. It also utilizes pressure to compress the tissue, which will also reduce the narrowing caused by excessive prostate tissue. During the procedure, local anesthetic will be introduced and a flexible catheter will be passed through the urethra by your urologist. The catheter contains a microwave coil that delivers heat from a machine to the prostate. It also contains a pressure balloon that will be inflated following insertion of the catheter to apply pressure to the prostatic urethra and dilate the urethral opening. This procedure is done in our office under a local anesthetic, so you would not be hospitalized. The procedure takes about two hours. For additional information on TUMT, click here.