Condition - BPH Benign Prostatic Hyperplasia/Enlarged Prostate

Benign Prostatic Hyperplasia (BPH) is a common, non-cancerous condition in men in which the prostate gland enlarges. The prostate is located below the bladder and surrounding the urethra - the tube carrying urine out of the body. A growing prostate can squeeze the urethra and cause difficulty with urination, also known as lower urinary tract symptoms (LUTS). These symptoms can include a weakened stream, frequency, sudden urge to urinate, and nighttime urination. In more severe cases, patients may lose the ability to urinate at all and may need a catheter.

Causes

Benign Prostatic Hyperplasia (BPH) is related to the aging process and the presence of the male hormone testosterone. More than half of men age 50 and older and 90 percent of men age 80 and older have BPH. Caffeine, alcohol, spicy or acidic foods, certain cold medications, and constipation can make symptoms worse. Left untreated, symptoms may worsen over time and can cause complications that may include inability to urinate (urinary retention), bladder or kidney damage, bladder stones or urinary tract infections.

Symptoms

An enlarged prostate can cause a variety of urinary symptoms including:

  • Recurring, sudden need to urinate
  • Increasingly frequent urination, especially at night
  • Weak or interrupted urine stream
  • Difficulty starting urination
  • Urine leakage
  • Inability to completely empty the bladder
  • Blood in the urine

Diagnosis

While a careful review of symptoms may suggest BPH, additional workup may include:

  • Digital Rectal Exam (DRE) – to assess size and contour of the prostate
  • PSA (prostate specific antigen) – blood test important for prostate cancer screening
  • Urinalysis
  • Urinary symptom score questionnaire
  • Urodynamics and urine flow studies
  • Ultrasound or CT scan
  • Cystoscopy

It is important to note that urinary symptoms or elevated levels of PSA can indicate BPH but may also be caused by prostatitis (prostate inflammation) or prostate cancer. Referral to a urologist for either of the above is an important first step for an appropriate diagnosis and treatment.

Treatment

The treatment for BPH / enlarged prostate will depend on the severity of your symptoms and how much they interfere with your lifestyle. Men with minimal symptoms may only need to make lifestyle changes; those with more pronounced symptoms or complications may require medication or a procedure. Your doctor can help you determine which treatment is most appropriate for you.

Lifestyle Changes

Avoid caffeine, acidic drinks such as colas, tomato and orange juice, and alcohol as these can irritate the bladder and worsen symptoms. Constipation and cold medications (especially containing antihistamines or pseudoephedrine) can make it more difficult to urinate. Limit evening beverages and urinate prior to going to sleep. Be sure to urinate when you first feel the urge rather than trying to “hold it” as this can lead to leakage of urine.

Medications

There are a variety of medications that may improve urinary symptoms and combination therapy may work the best.

Medications may include:

Minimally Invasive Therapy

These procedures seek to open a passage through the prostate to allow urine to flow with less effort. Our urologists perform the most advanced treatments available using the least invasive technique appropriate to resolve your problem.

  • Laser vaporization - a laser heats and vaporizes the obstructing prostate tissue
  • TURP (Transurethral resection of the prostate) - obstructing tissue is removed by either traditional approach or Plasma Button
  • Transurethral microwave therapy (TUMT) - microwave energy heats and destroys obstructing prostate tissue
  • Transurethral needle ablation (TUNA) - radiowaves heat and destroy obstructing prostate tissue
  • Transurethral incision of the prostate (TUIP) using electrocautery or laser
  • Prostatectomy - open procedure to remove the obstructing prostate; a less common option reserved for those with very large prostates
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