Benign Prostatic Hyperplasia (BPH)

Enlarged Prostate

Benign prostatic hyperplasia (BPH) is an enlarged prostate that often occurs as we age. As the prostate enlarges, it may squeeze down on the urethra and cause the bladder wall to become thicker. Eventually, the bladder may weaken and lose its ability to empty completely, which is known as urinary retention. This, along with the narrowing of the urethra, typically causes many of the problems associated with BPH.

What are the Symptoms of BPH?

As the prostate enlarges, it can irritate or block the bladder. This often results in:

• Frequent need or urge to urinate (even immediately after urinating)
• Increased frequency of urination, especially at night
• Difficulty starting urination
• Weak urine flow or a stream that stops and starts
• Dribbling of urine
• Inability to completely empty the bladder
• Waking up at night to urinate (nocturia)

While BPH is benign and does not cause nor lead to cancer, the two can happen at the same time. Please seek immediate treatment if you may have blood in your urine, feel pain or burning when you urinate, or cannot urinate at all. It may be an emergency.

How is BPH Diagnosed?

If you have urinary concerns, discuss them with your urologist. Your doctor will ask detailed questions about your symptoms and conduct a physical exam, which may include a:

• Digital rectal exam (DRE)
• Urinalysis (urine test)
• Prostate-specific antigen (PSA) blood test
• Post-void residual volume (PVR)
• Uroflowmetry
• Cystoscopy
• Urodynamic pressure test
• Ultrasound of prostate

BPH Treatments

There is a variety of effective treatments for enlarged prostate. Ideal treatment options depend on personal factors including age, overall health, prostate size, and amount of discomfort. If symptoms are tolerable, you and your doctor may just monitor your symptoms. For some men, symptoms may ease without treatment. If they do not, your doctor may recommend:

Medication

Medication, the most common treatment for mild to moderate prostate enlargement, includes alpha blockers, 5-alpha reductase inhibitors, a combination drug therapy and Tadalafil. Each works differently in the body, and has its own side effects.

Minimally Invasive Procedures

If symptoms are moderate to severe, and medication has not relieved symptoms, there are minimally invasive options available: 

• Aquablation Therapy Treatment for BPH uses the power of water delivered with robotic precision to provide long-lasting BPH relief without compromise. It is precise, consistent, and predictable, and provides long-term relief no matter how large your prostate.
• Laser therapy uses high-energy lasers to remove overgrown prostate tissue. This can immediately relieve symptoms and has a lower risk of side effects. It is typically recommended for those taking blood-thinning medications.
• Transurethral resection of the prostate (TURP) involves removing all but the outer part of the prostate. TURP generally relieves symptoms quickly, returning a stronger urine flow soon after the procedure.
• UroLift^® (Prostatic Urethral Lift) uses special tags to compress the sides of the prostate to increase urine flow. This is a quick outpatient procedure with a very fast recovery.

Robotic surgery, using the daVinci^® Xi robotic system, is an option for men with very large prostates. Robotic surgery results in less postoperative pain, reduced blood loss during surgery, a shorter hospital stay, less risk of infection, minimal scarring, and a faster return to normal activity compared to open surgery.

The best treatment for an enlarged prostate varies, so talk to your doctor about the risks and benefits of each one. Or make an appointment with a Summa Health urologist to discuss.