About BPH
The prostate gland in adult males remains a constant size until approximately age 40, then begins to enlarge. When the prostate enlarges, this can cause trouble passing urine because the prostate is positioned directly underneath the bladder and encircles the same tube (urethra) that is used to pass urine. The bladder then has to push harder to overcome the prostate’s resistance to urine flow.
If the blockage continues by the prostate growing the bladder may be unable to empty, leading to a condition called urinary retention. If you’re having urinary problems, please contact us to make an appointment. Urinary problems can lead to obstruction of the urinary tract if untreated.
Symptoms of BPH
As the prostate gets larger, it can irritate and block the function of the bladder, which can cause other symptoms to appear.
- Feeling that the bladder is full, even right after urinating
- Urinating often
- Feeling that urinating “can’t wait”
- Weak urine flow
- Dribbling of urine
- The need to stop and start urinating several times
- Trouble starting to urinate
- The need to push or strain to urinate
- Getting up at night to urinate more than 2 times
Causes of BPH
Men naturally produce testosterone, a male hormone, and small amounts of estrogen, a female hormone. As men age, active testosterone in their blood decreases, which leaves a higher proportion of estrogen. Some scientific studies have shown that benign prostatic hyperplasia may occur because the higher proportion of estrogen inside the prostate, increases cell growth. Another hormone, dihydrotestosterone (DHT) has a well known role in prostate growth As men age, the testosterone levels drop, but they continue to produce and accumulate high levels of DHT in the prostate. DHT encourages prostate cells to grow.
Diagnosing BPH
- Urinalysis (urine test)
- PSA blood test to screen for prostate cancer
- Urinary blood test to screen for bladder cancer
- Post-void residual volume (PVR) to measure urine left in the bladder after urinating
- Uroflowmetry to measure how fast urine flows
- Cystoscopy to look at the urethra or bladder with a scope
- Urodynamic pressure to test pressure in the bladder during urinating
- Ultrasound of the prostate
Risk Factors and Prevention of BPH
- Aging
- Family history of BPH
Prevention Strategies
- Losing weight
- Eating a healthy diet, with fruits and vegetables
- Stay active helps weight and hormone levels
Treatment of BPH
Medication is the first line of treatment and usually these are used in combination. There are two classes of medications to treat BPH; Alpha-blockers, which relax the smooth muscle of the prostate gland and thus improve urinary symptoms, and 5-alpha-reductase inhibitors, which block the production of dihydrotestosterone (DHT)—a hormone that affects prostate growth.
Transurethral Resection of the Prostate (TURP) is the prostate treatment most commonly used to treat BPH and is technically a minimally invasive procedure. The surgeon uses a special tool that has an electric current (or laser) and camera to remove a small part of the prostate that is blocking the urethra. This is done through the urethral channel in the penis. By removing the tissue blocking the channel, urine can freely exit the bladder.
Risks and complications include:
- Bleeding
- Fluid absorption
- Hyponatremia (low sodium)
- Incontinence
- Erectile Dysfunction (very rarely)
There are a variety of other minimally invasive treatments used for BPH:
- UroLift® | FDA Cleared BPH Treatment for Enlarged Prostate
- Transurethral needle ablation (TUNA)
- Transurethral microwave therapy (TUMT)
- Interstitial laser coagulation of the prostate (ILC)
- Aquablation Therapy
Simple Prostatectomy is done for patients with urinary retention who have very large prostates over 80 grams. All surgeries require hospitalization and a drainage tube called Foley catheter that will remain from 2-7 days. This can be done a variety of ways:
Open Retropubic Simple Prostatectomy
Through an incision, the surgeon moves the bladder to one site and surgically remove the blocking core of the gland. The capsule or shell of the prostate is then closed.
Open Suprapubic Simple Prostatectomy
In this procedure, the surgeon makes a small incision in the lower abdomen then opens the bladder to remove prostate tissue through the bladder.
Robotic Simple Prostatectomy
The surgeon makes 5 small incisions in the abdomen so that cameras and surgical instruments can be inserted. This provides access to remove the enlarged prostate core that is blocking the urethra.
Aquablation Therapy
The surgeon utilizes a minimally invasive next-gen robotic device that maps the treatment area by identifying which portion of the tissue to preserve and to remove. It utilizes a waterjet according to the surgeons plan. It takes about an hour and is done under anesthesia.
Follow-up
- Medications
- Surgery
- Heat therapy to prostate
- Embolization of blood vessels to the prostate
If you have questions regarding treatments for Benign Prostatic Hyperplasia (BPH), please call today. Click here to request an appointment.
