About Benign Prostate Hypertrophy
WHAT IS BPH?
A normal prostate gland is approximately the size of a walnut. Located just below your bladder, your prostate surrounds your urethra, the tube that carries urine out of your bladder and out of your body. The prostate makes some of the fluid (semen) which is part of the ejaculate.
Benign prostatic hyperplasia (BPH) is an enlarged prostate gland. Normally the size of a walnut the prostate gland sits below the bladder and surrounds the urethra (the tube that drains the bladder). Enlargement of the prostate may contribute to BOO (bladder outlet obstruction). The likelihood of developing an enlarged prostate increases with age. More than half of all men in their 60s and as many as 90% aged 70-89 years have some symptoms of BPH.
​
As the prostate gets bigger, it may constrict or partly block the urethra, causing BOO and lower urinary tract symptoms (LUTS) such as:
-
Urinary frequency
-
Drippling at the end of urinating
-
Inability to urinate
-
Incomplete emptying of bladder
-
Incontinence
-
Difficulty starting urination
-
Straining to urinate or weak urine stream
​
For some patients, these symptoms interfere with sleep, further reducing their quality of life.
​
If BPH/BOO becomes severe, you might not be able to urinate at all. This is an emergency that must be treated right away.
​
In most men, BPH/BOO gets worse with age. It can lead to bladder damage and infection. It can cause blood in the urine and cause kidney damage. To learn more check out the Blog
​
​
​
​
​
Is BPH related to cancer?
BPH is not cancer. It does not cause or lead to cancer. However, BPH and cancer can occur at the same time. Because of this, a screening exam is often performed as part of your workup. Learn more about BPH here
Diagnosis and Workup
If you think you might have symptoms of BPH, talk to your doctor or press here to contact a CIC physician. However, if you have blood in your urine, pain or burning when your urinate, or if you cannot urinate, call your doctor right away.
​
If some of the symptoms listed at the top of this page are familiar to you, you may have BPH. The best way to assess symptom severity is by using a validated symptoms score. The most common and widely used is the International Prostate Symptom Score (IPSS). It's a series of questions about how often urinary symptoms happen. The score rates BPH from mild to severe.
​
Click here to take the IPSS questionnaire. Then talk to your doctor or a CiC specialist about your results. Click here to learn more about BOO and your treatment options.
​
The doctor will review your results and take a medical history. Your doctor may also want you to have some or all of these tests:
​
-
Cystoscopy to look at the urethra or bladder with a scope
-
Post-void residual volume to measure urine left in the bladder after urinating
-
PSA blood test to screen for prostate cancer
-
Imaging of the prostate to evaluate size and anatomy. This may be either an Ultrasound, CT scan, or MRI.
-
Urinalysis which is a urine test for infection or blood.
-
Uroflowmetry to measure how fast the urine flows.
-
Urodynamic pressure to test pressure in the bladder during urination.
​
​
Transurethral Water-Jet Ablation (TWJA)
Also known as Aquablation therapy, TWJA uses high-pressure water jets to destroy excess prostate tissue. The surgeon uses ultrasound to identify the prostate then the water jets are directed to that area using special hand-piece is inserted into the bladder. An overnight stay in the hospital is required for continuous bladder irrigation to prevent blood clot formation. TWJA requires general anesthesia and you may require a bladder catheter for several days afterward. This procedure is fairly new and not much is known regarding the long-term effectiveness or whether patients eventually need to have additional treatments.
Treatment Options
Medical Therapy
Alpha Blockers
Alpha blockers are pills that relax the muscles of the prostate and bladder. They improve urine flow, reduce blockage of the urethra, and reduce BPH symptoms. They do not reduce the size of the prostate. Alpha-blocking drugs include alfuzosin (Uroxatral), terazosin (Hytrin), doxazosin (Cadura), and tamsulosin (Flowmax). Men with moderate to severe BPH may be good candidates. Side effects may include dizziness, lightheadedness, fatigue, and trouble ejaculating. Some patients may take these drugs in combination with other drugs, including 5-Alpha reductase inhibitors.
5-Alpha Reductase Inhibitors
5-alpha reductase inhibitors are pills that block the production of DHT, a male hormone that can build up in the prostate and cause prostate growth. These drugs, including finasteride (Proscar) and dutasteride (Avodart) shrink the prostate and may increase urine flow. Older men with very large prostates may be good candidates and the drugs may decrease the need for surgery. Side-effects include erectile dysfunction and reduced libido (sex drive).
Alternative Therapies
Phytotherapies
Phyto (plant) therapies are herbal treatments. Generally purchased as over-the-counter supplements, these forms of treatments have not gone through the same testing process as traditional prescribed medications nor do they follow the same manufacturing regulation that drugs do as mandated by the FDA. As a result, the quality, purity, and dosage can vary. Popular herbs such as saw palmetto are not recommended by physicians for treating BPH.
Minimally Invasive Surgical Therapies
Prostatic Urethral Lift (UroLift)
UroLift uses a needle to place implants into the prostate to hold open the obstructed urethra. Typically performed in a doctors office, the UroLift delivery device is advanced through the obstructed urethra and the implants permanently placed to lift and hold the prostate tissue out of the way of the urethra. Most men see symptom relief within about 2 weeks, however, reduction of symptoms and improvement in urinary flow may be less than with transurethral resection of the prostate (TURP). UroLift side-effects include pain or burning with urination, blood in the urine, or a strong urge to urinate but there are fewer sexual side-effects when compared to TURP. Men with a large middle lobe, or those with prostates larger than 60-80 grams may not be good candidates for UroLift. Furthermore, 30-40% of patients may require additional therapy although this is not precluded by the UroLift device.
Convective Water Vapor Ablation (Rezum)
Rezum uses heated water vapor (steam) to destroy prostate tissue. Like UroLift, Rezum may be performed in your doctor's office. The device is advanced into the obstructed urethra and a needle inserted into the prostate. Sterile water is then heated to the boiling point and a precise amount of steam is injected into the prostate to cause rapid tissue death and shrinkage. Symptom improvement may last up to 4 years. Side effects may be minimal and include painful or frequent urination. Again, men with large prostates greater than 30-80 grams may not be good candidates for this therapy.
Transurethral Microwave Therapy (TUMT)
TUMT uses microwaves to destroy prostate tissue. The urologist inserts the device through the urethra to the prostate. The device then emits microwaves to heat and destroy the excessive parts of the prostate. There is a low risk of urinary tract infections, urinary incontinence, and scarring of the urethra. Some patients may have to have a catheter or stent placed in the urethra temporarily to allow the urine to drain until swelling subsides. Despite the fact that this therapy has been available for more than 20 years, the long-term effectiveness remains unclear.
Prostate Artery Embolization
Prostatic artery embolization (PAE) is a minimally invasive treatment approved by the FDA for treatment of men with LUTS caused by an enlarged prostate. The procedure has a lower risk of the sexual side-effects such as retrograde ejaculation or erectile dysfunction, which can occur from surgery. The procedure is performed as an outpatient and is generally very well tolerated. Click here to learn more.
Surgery
Surgery has been the historical "gold-standard" for treatment of BPH. Surgery may be performed when medical or other therapies have failed or when BPH symptoms are severe. There are many different types of surgery, some of which are listed below:
Transurethral Incision of the Prostate (TUIP)
TUIP may be used if you have a smaller prostate but major blockage of the urethra. The surgeon uses a laser or electric current to create small cuts in the prostate to widen the urethra. A catheter is left in the bladder for 1-3 days and hospital stay is generally 1-3 days. Temporary urine retention, urinary tract infection, erectile dysfunction, and incontinence are possible side-effects.
Transurethral resection of the Prostate (TURP)
TURP is a very common surgery for BPH. The procedure is performed in the hospital under general anesthesia. The surgeon inserts a scope through the tip of the penis into the urethra. The surgeon then uses an electric wire to cut away prostate tissue that is blocking the urethra. It is common to require a bladder catheter for several days following the procedure. The hospital stay is 1-2 days. This treatment has well known long-term outcomes and most other therapies are compared to it. Side-effects of TURP may include retrograde ejaculation, erectile dysfunction, urinary tract infections and urinary incontinence. Full recovery takes about 4-6 weeks.
Holmium Laser Enucleation of Prostate (HoLEP)
HoLEP requires the surgeon to insert a tube under general anesthesia through the penis into the urethra. A laser is then inserted into the prostate to destroy the excess tissue. The procedure requires an overnight stay in the hospital as well as a bladder catheter which can usually be removed after 1-2 days. Recovery is relatively rapid, however, most patients have more post-operative stress incontinence compared to other surgeries which may improve after about 1 year.