Definition of BPH, symptoms and treatment strategies
Benign Prostatic Hyperplasia (BPH) is the non-cancerous enlargement of the prostate. The prostate gland encircles the urethra in males and produces a fluid that makes up most of the volume of the semen. As the prostate enlarges, it can put pressure on the urethra causing a slowing of the urinary stream, hesitancy, frequency and dribbling. It can also cause urinary retention- the inability to urinate.
Complications from BPH may include:
- urinary tract infections
- weakening of the bladder muscle
- hematuria (blood in the urine)
- renal failure
- impaired sexual function
- bladder stones
The type and severity of symptoms experienced will vary from person to person and may change over time. For many men, BPH never progresses beyond a minor to moderate annoyance; for others, it may greatly impair their quality of life.
A diagnosis of BPH involves a physical exam, a digital rectal examination (DRE) and an evaluation of the patient’s symptoms. Laboratory tests may include:
- PSA (prostate specific antigen)- to help screen for prostate cancer.
- Urinalysis and culture- to rule out kidney disorders and urinary tract infections
- Blood urea nitrogen (BUN and Creatinine- blood tests to evaluate kidney function) which may be compromised if the prostate is causing urinary obstruction.
Non- Laboratory tests may include:
- Bladder and Prostate ultrasound- To help measure the size of the prostate and evaluate the volume of urine retained in the bladder
- Cystoscopy- To evaluate the urethra and bladder with a small flexible scope
- Prostate biopsy- To rule out prostate cancer
Treatment decisions are based upon each patient’s condition. The pros and cons of each option are discussed in detail during treatment planning.
Examples include reducing fluid intake in the evening and eliminating bladder irritants from the diet.
In patients who have moderate symptoms, medications are used to control BPH.
- Alpha blockers- relax the muscles around the prostate and bladder neck. Work quickly to relieve symptoms
- 5-alpha reductase inhibitors- shrinks the prostate gland in men whose prostate volume is over 40 cc. May take months to work.
- Anticholinergics- used to delay the urge to urinate, inhibits involuntary contractions.
Minimally Invasive Therapies
- Laser Therapy (Photoselective vaporization of the prostate (PVP, Greenlight)- uses laser energy to destroy prostate tissue.
- TUNA-transurethral needle ablation..uncommonly used at the present time
- Thermotherapy-destroys prostate cells by intense heat administered through a catheter
Transurethral resection of the prostate (TURP) is a procedure frequently used to treat moderate to severe BPH. It is one of the most common major surgeries performed on symptomatic men .
- Transurethral incision of the prostate (TUIP) uses special cutting instruments inserted through the urethra. TUIP differs from TURP in that no prostate tissue is removed. Instead, your surgeon makes one or two small cuts or grooves in your prostate gland where your prostate meets your bladder. The cuts allow the urethra to expand, making it easier to urinate
- Open prostatectomy is usually done in men who have a greatly enlarged prostate gland, bladder damage or other complicating factors, such as bladder stones or urethral narrowing (strictures).