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Benign Prostatic Hyperplasia (BPH)
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Frequently Asked Questions
BPH is another term for benign enlargement of the prostate gland. It is very common in older males, affecting approximately half of men in their 50’s, and the majority of men in their 70’s and 80’s. The prostate gland surrounds the urethra like a doughnut, and often enlargement of the gland can cause compression leading to difficulty with urination. At Comprehensive Urology, we offer a variety of treatments to help men with BPH, tailored to their specific situation.
 Prostate with BPH
Symptoms of BPH
Symptoms of BPH vary from person to person, and can include one or many of the following:
- Difficulty starting urination (urinary hesitancy)
- Slow urinary flow
- Intermittent urinary flow
- Sense of incomplete bladder emptying
- Urinary frequency
- Nocturia (nighttime urinary frequency interrupting sleep)
- Urinary urgency
- Urinary incontinence (leakage of urine)
When left untreated, BPH can lead to bladder dysfunction, recurrent urinary tract infections, and even obstruction of the kidneys and subsequent kidney failure.
Diagnosis
A proper diagnosis is essential to developing the optimal treatment plan for each patient with BPH. Our physicians first begin with a thorough history. Men can complain of a multitude of symptoms, and therefore it is essential that a treatment plan is based upon how BPH is specifically affecting each of their lives.
Physical Examination - A thorough physical examination is paramount in the diagnosis of BPH. Specifically the digital rectal examination is performed by inserting a gloved finger into the rectum in order to help determine if the prostate gland is enlarged. It is also used to help screen for prostate cancer.
Other tests to assist in the diagnosis and subsequent treatment of BPH include:
Urinalysis - An evaluation of the urine can help detect abnormalities such as inflammation or infection.
Urine Flow Test - This test is performed in order to evaluate the flow rate and amount of urine during a normal void. Our team often uses this test to monitor changes over time with treatment.
Post Void Residual - Often used to detect how much urine is left over in the bladder after voiding. This can often be performed with a noninvasive ultrasound of the bladder.
Prostate Specific Antigen (PSA) Test - PSA is sometimes elevated with BPH, cancer, and infection. It can be used to monitor risk of prostate cancer over time.
Ultrasound - Ultrasound can aid with measurement of prostate gland size. It can also help detect anatomic variations in the prostate gland or even prostate tumors. Ultrasound can also help determine the effects of BPH on its surrounding structures such as the bladder or kidneys.
Cystoscopy - A thin tube with a lens and camera attached, called a cystoscope can be inserted into the urethra to help visualize the internal urethra and bladder. This scope, which is smaller than a standard urinary catheter, can help evaluate compression from the enlarged prostate gland.
Urodynamic Studies - This specialized study precisely characterizes pressures within the urinary tract, and helps characterize the bladder’s response to filling and ability to empty with normal contraction.
Our team at Comprehensive Urology will help determine which of these evaluations may assist in the diagnosis of BPH. They may also be used to help monitor progress once treatment has been initiated.
Treatment of BPH
At Comprehensive Urology, there are a multitude of treatments available for BPH. The specific treatment options are tailored to each patient in order to provide the best possible outcome.
Medications
There are two main classes of medications available to help manage urinary symptoms due to BPH:
Alpha Blockers
Targets the smooth muscle fibers in prostatic tissue causing them to relax.
5 Alpha Reductase Inhibitors
Works to block the hormones that stimulate prostate growth.
Both types of medication are designed to help improve urinary symptoms and can be very effective either alone or in combination. At Comprehensive Urology, your health care provider will discuss which treatment option is best for your particular situation.
In-Office Non Pharmaceutical Treatment
There are options available for those men for whom medications may not be suitable or sufficient, or for those who need further therapy.
One of these options for BPH is a non-surgical technique called Trans-Urethral Microwave Therapy (TUMT). Using microwave energy, the prostate can be targeted with heat which will cause the prostate to shrink and the urinary channel to enlarge. This procedure is performed in the office, is well-tolerated with minimal to no discomfort, and takes approximately 30 minutes. Urinary symptoms will gradually improve with the average maximum improvement seen between 8 and 12 weeks after the procedure. Many men are able to discontinue their use of medications for BPH after the procedure. At Comprehensive Urology, our physicians will help determine if this treatment may be suitable for you.
Another non pharmaceutical option for some symptoms related to BPH is pelvic floor rehabilitation. This therapy combines a personalized home program that is developed from an office evaluation. The office evaluation consists of measurements of the pelvic floor muscles to establish a plan of care to strengthen them, and electrostimulation of the pelvic floor nerve and muscle tissues. It is relatively non-invasive and painless and has no significant side effects. (click here to read more about pelvic floor rehabilitation and stimulation.
Some men experience acute urinary retention due to BPH, in which traditionally an indwelling catheter is placed into the bladder which drains into an external drainage bag. This is often required to stay indwelling until medications can take effect or until the patient is ready for a surgical procedure to relieve the obstruction. A newer option eliminates the need for an indwelling catheter during that time interval. Our physicians often place a temporizing SpannerTM intraprostatic stent instead which allows our patients to void normally and freely without the need for an external drainage bag until they are able to proceed with definitive treatment. This treatment allows us to satisfy our goal of trying to optimize the management of the urinary obstruction while at the same time optimizing our patient’s quality of life.
Surgical Options
The are multiple surgical treatment options for those men in whom medications may not be a suitable option. The concept of all treatments is essentially the same- to create a larger urinary channel through the prostate gland in order to allow easier urinary flow. The most effective options include transurethral resection of the prostate (TURP) and laser photovaporization of the prostate.
TURP is considered the gold standard surgical treatment because of its durability and efficacy as a procedure. By using an endoscopic camera, our surgeons can shave away the prostatic blockage and seal blood vessels with an electrical blade until a larger urinary channel is created. No incision is made on the skin. A urinary catheter is left to drain the bladder until the channel is healed (usually 24 to 48 hours). Upon catheter removal, In most cases, the improvement in urinary symptoms is dramatic.
A newer surgical option, called transurethral plasma vaporization and resection of the prostate (TURiP), allows our surgeons to perform a procedure almost identical to the TURP, but with several advantages. It allows vaporization of the prostate tissue as well as resection with bipolar electrical current. This current allows treatment to be performed in the setting of saline, a fluid found normally in our bodies. This in turn allows less risk of developing mineral abnormalities in the blood during the procedure, a problem found (although rarely) with TURP. This makes TURiP an even safer and more precise treatment of the prostate gland than the traditional TURP.
Another newer minimally invasive surgical option is laser photovaporization of the prostate (PVP). The procedure is performed by using an endoscopic camera though the urethra as well, but instead of treating the tissue with an electric knife, the tissue is vaporized by utilizing a laser. The advantages of this procedure include less risk of complications and indwelling catheter duration.
In some patients in whom the gland is markedly enlarged (>100gm), the most definitive therapy to treat their obstruction may be a simple prostatectomy. In this procedure, a small incision is made on the lower abdomen (similar to that of a caesarean section for women). The interior tissue of the prostate is removed, leaving the exterior “shell” of the prostate intact. This procedure is highly successful in resolving the obstructive process and requires a hospital stay of a few days.
At Comprehensive Urology Medical Group, our Physicians have the extensive knowledge and expertise with all of these therapies in order to help you find which may be most suitable for you.
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