Enlarged Prostate-BPH

An enlarged prostate/BPH can disrupt daily life because it affects the urethra and bladder.

Although the enlarged prostate may cause no problems at all, about one third of men with BPH eventually will develop lower urinary tract symptoms

The prostate gland is part of the male reproductive system. It is about the same size and shape as a walnut and weighs about an ounce. The prostate surrounds a tube called the urethra that carries urine from the bladder out through the penis. The main function of the prostate is to produce fluid for semen.

Benign prostatic hyperplasia, or BPH, refers to abnormal growth within the prostate. The abnormal growth of BPH usually becomes evident after the age of 40. It is found in 60% of men over 60, and in up to 80% of men over 80 years of age. BPH is not cancer, nor does it lead to cancer.

As the prostate grows, it squeezes the urethra, sometimes causing difficulty in urinating. In the early stages of BPH, the bladder muscle can force urine through the narrowed urethra. As the narrowing continues, the bladder muscle gets thicker and more sensitive resulting in a stronger need to urinate. In some cases, you may have trouble passing urine through the urethra leading to a build up of retained urine. This can lead to dribbling or incontinence. Over time, some men may develop bladder or kidney problems, urinary tract infections, bleeding or stone formation.

Some men suddenly cannot urinate (a condition called acute urinary retention). If this occurs, you should see your doctor immediately.

Although the enlarged prostate may cause no problems at all, about one third of men with BPH eventually will develop lower urinary tract symptoms including:

  • Dribbling after urinating
  • Incomplete emptying of your bladder
  • Incontinence
  • Urinating frequently in the day or night
  • Straining to urinate
  • Strong and sudden urge to urinate
  • Weak urine stream

As you get older, these problems may become more bothersome. You should realize that these symptoms are not unavoidable effects of aging, but instead, they are treatable conditions found in many older men.

Check out the AUA Symptom Score, WebMD

EVALUATION

After taking a complete medical history, your doctor may perform a digital rectal exam to feel the prostate gland. A urinalysis to check for blood or infection will be done at the time of your visit. The following tests may also be recommended:

  • Urine culture to check for infection
  • Prostate-specific antigen (PSA) blood test to screen for prostate cancer
  • Urine flow rate
  • Post-void residual urine test to see how much urine is left in your bladder after urination
  • Urinary tract xray or ultrasound look for stones or blockage
  • Cystoscopy (look into the bladder with a soft flexible scope)
  • Pressure flow studies to measure the pressure in the bladder as you urinate

TREATMENT

The choice of a treatment is based on the severity of your symptoms, the extent to which they affect your daily life, and the presence of any other medical conditions. Treatment options include:

  • watchful waiting
  • medication
  • minimally invasive procedures
  • surgery.

At Orange Coast Urology, we offer a full range of options for patients with BPH. Our doctors are skilled in the diagnosis and available treatments. We will guide you to a plan that best suits your individual situation.

Watchful Waiting

If you have no symptoms, or are not bothered by your symptoms, you may choose to visit your doctor once a year. You can always come in sooner if your condition changes. If your symptoms become worse, talk to your doctor about other treatments.

Medical Treatment

Two types of medications may help relieve the symptoms of BPH. In some cases, these medications may be taken in combination. These drugs have side effects that affect some patients, but will generally go away when you stop taking them.

  • Drugs that help relax the muscles of the prostate. These drugs are called alpha blockers. They include alfuzosin, doxazosin, tamsulosin and terazosin. Although all four drugs work well, there are slight differences in the side effects of each one. Talk to your doctor about which one is best for you. After you start the drug treatment, your doctor will monitor you for the first few weeks, and will check your BPH symptoms to make sure that the dosage of medicine is correct for you.

    You may have side effects that can be different depending on the drug used. Side effects can or include stuffy nose, headache, decreased semen production, dizziness and tiredness. A smaller number of patients may have low blood pressure. You may need to stop these medications if you are going to have cataract surgery.

  • Drugs that help the prostate to shrink. These drugs are inhibitors of the 5 alpha-reductase enzyme, and include finasteride and dutasteride. You will need to see your doctor on a regular basis if you take this drug. Because these drugs change the result of your PSA test by lowering it about 50%, this test may need to be repeated while you are taking this drug. Your BPH symptoms may not begin to be relieved until you have taken the medication for 3 to 6 months.

    You may have a few side effects from taking these drugs such as an inability to achieve an erection, decreased sexual desire and a reduced amount of semen.
  • A word on Phytotherapeutics. Phytotherapies are plant-based or herbal substances that are found in certain foods and dietary supplements. Examples are saw palmetto or Pygeum africanum. Many of these agents have been used in other parts of the world to treat symptoms of BPH. The potency and safety of these agents have not been well studied and they have not been approved by the Food and Drug Administration for the treatment of BPH. Before using these products you should speak with your doctor.

Minimally Invasive Treatments

These heat based treatments are performed as outpatient procedures in the office or at an out patient center. Since no tissue is immediately removed, they can typically be performed with a local anesthetic. After the treatment, a catheter is placed in the bladder and remains for a few days while you are at home. In general, these treatments are better at relieving symptoms than medication but are less effective than surgical procedures.

  • Transurethral microwave heat treatment (TUMT) treats the prostate with microwave heat. A small microwave antenna attached to the end of a flexible tube is inserted into the bladder through the urethra and prostate.
  • Transurethral needle ablation (TUNA) uses heat to treat the prostate. A small needle attached to the end of a scope is inserted into the prostate through the urethra. Radio waves are used to heat the needle.
Surgery

Surgery may be selected as an initial treatment if your symptoms are particularly bothersome or you have developed other serious problems because of the BPH. You may also select surgery if you have tried medical or minimally invasive treatments and they have not been successful. The choice of surgery should be decided based on your level of discomfort, your medical test results, and your doctor's suggestions.

  • Transurethral resection of the prostate (TURP). This is the traditional, standard, surgical procedure to treat symptoms of BPH. This is an inpatient surgery. Under anesthesia, .the surgeon uses a scope with instruments through the urethra to surgically remove the inner portion of the prostate. Bleeding after surgery can be a problem so a catheter is left in place and you will stay in the hospital for 1-2 days.
  • To minimize the possible bleeding and hospital stay, improvements to the TURP procedure are available.
  • Transurethral incision of the prostate (TUIP). Through the scope, an incision is made allowing the prostate to spring open without removing any tissue. This is an option for some patients if the size and configuration of the prostate is favorable.
  • Transurethral vaporization of the prostate (TUVP). Through the scope, tissue is removed by vaporizing instead of cutting. This minimizes bleeding and can be done as an outpatient.
  • Laser therapy which includes the following procedures: transurethral laser coagulation; transurethral laser vaporization; transurethral holmium laser resection/enucleation.
  • Surgery of the prostate requiring incision of the skin (open prostatectomy). In contrast to the procedures described above which are done internally with a scope, this is reserved for patients with very large prostates


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