Benign Prostate Hyperplasia (BPH)

Benign Prostate Hyperplasia (BPH)

Benign Prostatic Hyperplasia (BPH) is a common urologic condition due to the non-cancerous enlargement of the prostate gland which usually affects men over the age of 50. Many men with BPH will never experience symptoms however, as one ages, symptoms become more likely. The prostate gland wraps around the upper part of the urethra, which carries urine out of the bladder. As the prostate gland enlarges, it can squeeze down on the urethra. This can lead to difficulty with urination and other lower urinary tract symptoms (LUTS).

Symptoms of Benign Prostatic Hyperplasia (BPH)

Common symptoms of BPH can include the following:

  • Frequent urination, especially at night
  • Difficulty initiating urination
  • Dribbling after urination
  • Weak or decreased urine stream
  • Urgency
  • Sensation that the bladder is not empty, even after urination
  • Starting and stopping during urination

Risk Factors of Benign Prostatic Hyperplasia (BPH)

Risk factors that can lead to the development of BPH include:

  • Aging
  • Erectile dysfunction
  • A family history of BPH
  • Lack of physical activity
  • Obesity

Diagnosing Benign Prostatic Hyperplasia (BPH)

There are a number of tools used in the evaluation of BPH. The American Urologic Association has developed one of these such tools. The BPH Symptom Score Index consists of a series of questions where the patient rates the seriousness of each symptom he is experiencing. This helps the physician to measure the seriousness of BPH. During the initial visit for the evaluation of BPH, a physician will typically complete a full medical history, a urinalysis, a PSA, and a full physical exam including a digital rectal exam. Based on the patient’s individual medical conditions, there a number of additional tests that the physician may perform.

Treatments for Benign Prostatic Hyperplasia (BPH)

There are a number of treatment items available for BPH. Your physician will work with you to determine the best treatment plan for you based on your individual symptoms and needs.

Treatment options include:

This treatment option is typically recommended for patients who have mild symptoms but are not bothered by them. Those patients with kidney problems, urinary retention, urinary incontinence or recurring urinary tract infections are not typically candidates for this option. Watchful Waiting involves close physician monitoring but no active treatment. In many cases, patients may simply make changes to their current medications or diet. Patients under this treatment option should receive yearly exams to check for increases in symptoms and reevaluate treatment if needed.

One option for the medical management of BPH symptoms is alpha blockers. These drugs cause relaxation of the muscle tissue of the prostate and bladder thus causing improved urine flow and reducing bladder outlet obstruction. These drugs mainly help with symptom relief and typically do not reduce the size of the prostate. Typically, they are taken orally twice daily. Typical side effects of these drugs include headaches, dizziness, light-headedness, fatigue, nasal congestion, and ejaculatory dysfunction.

Another option for medical management of BPH is 5-alpha reductase inhibitors. The two 5-alpha reductase inhibitors approved for BPH are finasteride and dutasteride. These medications will cause shrinking of the prostate thus increasing urinary flow rate. Patients with larger prostates tend to benefit the most from these drugs. These drugs reduce the incidents of urinary retention and can decrease the likelihood of future BPH surgery. Typical side effects include decreased libido, erectile dysfunction, and ejaculatory disorders.

In many cases, for men with larger prostates, combined use of both alpha blockers and 5-alpha reductase inhibitors show greater success than the use of a single drug. The alpha blockers work to provide quick symptom relief while the 5-alpha reductase inhibitors target the underlying disease process by shrinking the prostate. This therapy, however, can lead to more side effects including decreased libido, erectile dysfunction, ejaculatory disorders, headaches, dizziness, light-headedness, fatigue, and nasal congestion.

An additional medical management option for BPH is anticholinergics. This medical therapy is recommended by the AUA for patients with irritating lower urinary tract symptoms that do not have an elevated post void residual (PVR).

Another type of drug therapy is the use of a phosphodiesterase-5 inhibitors (PDE5). The most commonly used of these inhibitors for BPH is Cialis. Along with helping to improve BPH symptoms, Cialis provides the added benefit of improving erectile dysfunction. The final type of medical therapy is herbal therapies. The most commonly used of these self-treatment remedies is Saw Palmetto. Herbal therapies are a very popular self-treatment. While many patients receive benefit from these therapies, since these therapies are not FDA regulated, there are no set value and safety standards.

The UroLift System®is a minimally invasive outpatient procedure for treating BPH by lifting and holding the enlarged prostate so that it no longer blocks the urethra. This procedure requires no cutting, heating, or removal of prostate tissue. Using only local anesthesia, the physician inserts tiny implants to hold the prostate lobes apart, opening the urethra.

Patients typically can return home the day of the procedure without a catheter. Most patients start to feel symptom relief as early as two weeks post procedure. In addition, this procedure does not compromise sexual function.

For those patients that are found not to be candidates for medical management or a minimally invasive therapy, there are surgeries available to treat BPH. A transurethral resection of the prostate (TURP) is one of these surgical options. This procedure consists of inserting a scope into the urethra and excising a portion of the obstructing prostate tissue. Removal of this tissue relieves pressure on the urethra. A newer procedure known as a bipolar TURP or VLAP reduces surgical risk even further through vaporization of tissue rather than excision. This typically decreases bleeding, decreasing healing time.