Benign prostatic hyperplasia (BPH), also called enlarged prostate, is a common condition that affects millions of men worldwide. As men age, their prostate gland often grows in size, leading to symptoms such as weak urinary stream, urgent or frequent urination, getting up to pee at night, and incontinence. BPH can significantly impact a man's quality of life and lead to serious complications if left untreated. In this article, we will explore the symptoms, diagnosis, and treatment options for BPH.
Overview What is BPH? Benign prostatic hyperplasia (BPH) is a condition in which the prostate grows in size.
The prostate is a gland that rests below the bladder and in front of the rectum. It’s about the size of a walnut, and it surrounds part of the urethra, which is the tube that carries urine and sperm (ejaculate) out of the body.
When your prostate grows in size, it can prevent urine and ejaculate from passing through your urethra.
BPH is not prostate cancer. However, some urinary symptoms can be a result of either BPH or prostate cancer, so it is important to consult a healthcare provider if you experience any symptoms.
Who does BPH affect? Benign prostatic hyperplasia (BPH) is a common condition that affects men, particularly those over the age of 50.
It is estimated that about 50% of men over the age of 50 and up to 90% of men over the age of 80 have BPH.
There are certain factors that may increase a man's risk of developing BPH, such as family history, obesity, lack of physical activity, and certain medical conditions such as diabetes and heart disease. While BPH is a common condition, it is important to talk to your doctor if you are experiencing any urinary symptoms, as they may be caused by other conditions that require prompt medical attention.
What are the symptoms of BPH? When the prostate is enlarged, it can compress the urethra, the tube that empties urine from the bladder out of your body. The severity of symptoms can vary from person to person. Common symptoms of BPH include:
Incomplete emptying : the feeling your bladder is full, even after passing urine.Frequency : the need to pass urine often, about every one to two hours.Intermittency : the need to stop and start several times when passing urine.Urgency : feeling the urgent need to pass urine, as if you can’t wait.Weak stream : a weak urine flow.Straining : trouble starting to pass urine or the need to push or strain to pass urine.Nocturia : the need to wake up at night more than two times to pass urine.Incontinence : leaking urine by accident.Severe BPH may lead to urinary retention , a condition where your bladder doesn’t empty all the way or at all when you urinate. This is an emergency that must be treated right away.
Diagnosis How is BPH diagnosed? Your healthcare provider will review your medical history, ask you questions about your symptoms, and perform a physical examination.
Other tests your healthcare provider may order to aid in diagnosis or screen for other diseases include:
A survey called the International Prostate Symptom Score (IPSS) or AUA Symptom Score Questionnaire to evaluate the severity of your symptoms. A digital rectal exam to feel the prostate for enlargement or abnormalities. A prostate-specific antigen (PSA) blood test to check for prostate cancer. Urinalysis (urine test) to assist in distinguishing other conditions such as diabetes, UTIs, and bladder cancer from BPH. Post-void residual (PVR) to determine the amount of urine that remains in your bladder after you urinate. A voiding diary, or bladder diary, to track the frequency of your urinations across multiple days. Urine flow tests (uroflowmetry) to measure the speed and volume of your urine stream. A cystoscopy to look into your bladder with a small camera. Urodynamic tests to evaluate how well the bladder and urethra are functioning and detect how much urine remains in your bladder after you’ve finished peeing.
Treatment How is BPH treated? There are many treatment options available for managing BPH, and your healthcare provider will help find the best fit for you.
The four main categories of treatments are:
Behavioral and Lifestyle Changes Medication Minimally Invasive Surgical Therapy (MIST) Surgery
Active Surveillance or Watchful Waiting If you have mild symptoms of BPH, you and your healthcare provider may decide on an “active surveillance” or “watchful waiting” approach in which you schedule regular appointments, often yearly, to monitor the progression of your BPH.
Lifestyle changes may also be recommended. Lifestyle changes include avoiding drinking fluids prior to bedtime or before going out, as well as reducing consumption of mild diuretics such as caffeine and alcohol. Pelvic floor muscle training may be particularly helpful for patients with urgency symptoms.
In the case your BPH worsens or begins to bother you more, your provider will help you decide on an appropriate course of action.
Medication Prescription medication is a common way to treat men with mild to moderate BPH. There are several types of drugs used to treat BPH and your healthcare provider will help find the best option for you.
Alpha Blockers Alpha Blockers are the most commonly prescribed medications to treat BPH. They work by relaxing the muscle in the prostate which reduces tension on the urethra.
Alpha-blocking drugs include alfuzosin (Uroxatral®), doxazosin (Cardura®), silodosin (Rapaflo®), tamsulosin (Flomax®) and terazosin (Hytrin®)
5-Alpha Reducatase Inhibitors 5-Alpha Reducatase Inhibitors can increase urine flow and shrink the prostate by blocking the hormone DHT. DHT is a male hormone that can build up in the prostate and may cause prostate growth.
5-Alpha Reducatase Inhibitors include: finasteride (Proscar®) and dutasteride (Avodart®).
Minimally Invasive Surgical Therapy (MIST) Minimally invasive surgical therapy (MIST) can often be done as an outpatient, without a stay in the hospital, and have quicker recovery times than more invasive surgeries.
There are several types of less minimally invasive surgical treatments from which to choose. The option will depend on the size of your prostate, your overall health, and your personal choice.
Examples of minimally invasive surgical treatments include:
Prostatic Urethral Lift (PUL) or UroLift® A prostatic urethral lift (PUL) separates an enlarged prostate so it no longer blocks the urethra. A urologist inserts an instrument (UroLift®) into the urethra and moves it to the prostate. The UroLift ejects small implants that pull the prostate lobes apart, relieving pressure on the urethra.
This treatment option is not permanent. Studies have shown that this procedure is durable for five years.
Water Vapor Thermal Therapy or Rezūm™ This treatment uses water vapor (steam) to destroy prostate cells squeezing the urethra.
A urologist inserts an instrument into the urethra and up to the prostate. A needle is then ejected into the prostate which emits steam vapor. The water’s thermal energy destroys prostate cells, causing the prostate to shrink. Another name for this procedure is the Rezūm™ System.
Transurethral Microwave Therapy (TUMT) Transurethral Microwave Therapy uses microwaves to destroy prostate tissue. A urologist inserts a catheter through the urethra to the prostate. An antenna then sends microwaves through the catheter to heat parts of the prostate, destroying enlarged tissue.
Temporary implant (iTind™) Temporary implants, such as the iTind™ treatment, involve a device placed in the prostatic urethra. During the 5 to 7-day treatment, it slowly expands and exerts gentle pressure at three precise points to widen the opening through which urine flows through the prostatic urethra and then out of the body. After 5 to 7 days, the device is completely removed.
Surgery There are also several types of more invasive surgery options from which to choose. The best option will depend on your health, your doctor’s expertise, and your personal choice. Examples of more invasive surgeries include:
Transurethral Incision of the Prostate (TUIP) During a TUIP, prostate tissue is not removed but the urethra is widened with transurethral incisions of the prostate. A surgeon inserts a lighted scope into the urethra and makes one or two small cuts in the prostate gland, making it easier for urine to pass through the urethra.
Transurethral Resection of the Prostate (TURP) TURP is a common surgery for BPH. A surgeon inserts a thin instrument into the end of the penis and through the urethra. This instrument, called a resectoscope, contains a lighted camera and an electrical wire loop that cuts tissue. The wire loop is guided by the surgeon to remove the tissue blocking the urethra.
Laser therapy
During prostate laser surgery, a thin scope is inserted into the urethra up to the prostate. A laser is guided through the scope and delivers energy that shrinks or removes excess tissue from the prostate that is preventing urine flow. There are several different types of laser surgery, including GreenLight™ or Photoselective Vaporization (PVP) , Holmium Laser Enucleation of Prostate (HoLEP) , and Thulium Laser Enucleation of the Prostate (ThuLEP) . Your healthcare provider will help determine the best option for you.
Transurethral Vaporization of the Prostate (TUVP)
TUVP uses electrical current to destroy prostate tissue. The surgeon inserts an instrument into the urethra with a lighted camera and a tool that sends out an electrical current to vaporize prostate tissue.
Transurethral Water–Jet Ablation (TWJA) or Aquablation® TWJA uses high-pressure water jets to destroy excess prostate tissue. Tiny, powerful water jets are directed to the precise area of excess tissue to remove extra prostate tissue.
Simple prostatectomy A simple prostatectomy is the surgical removal of the prostate gland. A surgeon will make a cut in the lower belly and the prostate gland is removed through the bladder.
Monitoring How is BPH monitored? Routine symptom evaluation is crucial for managing BPH effectively and detecting complications early. Remote patient monitoring techniques, such as uroflowmetry, which measures urine flow rate and volume, and its home-based counterpart, remote uroflowmetry, play a key role in assessing intervention and treatment efficacy. Additionally, bladder or voiding diaries, where patients record their urinary habits over a set period, further aid healthcare providers in monitoring BPH progression. These approaches empower patients to actively participate in managing their condition, ensuring a better quality of life.
Conclusion In summary, benign prostatic hyperplasia (BPH) is a common condition affecting millions of men, particularly as they age. Recognizing the symptoms of BPH, seeking appropriate diagnosis, and exploring various treatment options are crucial to managing this condition and maintaining a good quality of life. Treatment options range from lifestyle changes and medications to minimally invasive surgical therapies and more invasive surgeries, depending on the individual's needs and preferences. It is essential for men to be proactive in discussing their symptoms and concerns with healthcare providers to find the best approach to managing BPH and mitigating any potential complications.
