The prostate is one of the glands of the male reproductive system. Benign prostate hyperplasia means enlarged prostate gland.

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

Normal and Enlarged prostate gland (BPH)
An enlarged prostate gland (BPH) restricts the flow of urine through the urethra.

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

cyctoscopy - blocked urethra
Using a cystoscope, the physician can verify how much urine flow is impaired.
  • 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:

Transurethral microwave therapy (TUMT)
Transurethral microwave therapy (TUMT) is one of several, minimally invasive treatments used for BPH.
  • 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)

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.

Multidisciplinary Urology Team - Surgery Medical Oncology and Radiation
The multidisciplinary urology team at Saint John’s Health Center is ready to support you.

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.

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.