Benign prostatic hyperplasia (BPH) is a non-cancerous increase in the size of the prostate gland and surrounding tissue. As the gland enlarges, it squeezes the urethra and causes the bladder wall to become thicker. Over time, the bladder muscles weaken and the bladder loses the ability to empty fully, resulting in urinary symptoms.
The most common complaints in people with BPH include:
- Difficulty starting urination
- Having to strain or push in order to pass urine
- Weak stream due to a weak urine flow
- Dribbling at the end of urination
- Urgent or frequent need to urinate
- Nocturia—increased urinary frequency at night
- Intermittency—the need to stop and start many times when passing urine
In some men, rare symptoms may occur, including:
- Inability to urinate
- Blood in urine
- Urinary tract infections
The size of the enlarged prostate gland does not determine the severity of the symptoms. Actually, some men with only a slightly enlarged prostate have significant symptoms while others with a massive enlargement have only minor urinary symptoms. Plus, in some men, symptoms tend to stabilize and even improve with time.
Besides, an enlarged prostate shares urinary symptoms with a number of conditions, including:
- Inflammation of the prostate (prostatitis)
- Narrowing of the urethra (urethral stricture)
- Urinary tract infection
- Kidney or bladder stones
- Problems with nerves controlling the bladder
- Scarred bladder neck after surgery
- Bladder or prostate cancer
Therefore, it is advisable that you see a urologist as soon as possible if you are having persistent urinary symptoms. Regardless of whether the urinary symptoms are bothersome or not, seeing a doctor will help to identify or rule out any underlying causes.
How is benign prostatic hyperplasia treated?
When your urologist is certain that you have benign prostatic hyperplasia, you’re typically started on an alpha blocker—a medication that relaxes your bladder neck muscles and the muscle fibers in the prostate, making urination easier.
Commonly prescribed alpha blockers include alfuzosin (Uroxatral), tamsulosin (Flomax), doxazosin (Cardura), and silodosin (Rapaflo). For men with only slightly enlarged prostates, alpha blockers work really quickly and relieve urinary symptoms effectively.
Another option is to prescribe medication that can shrink the prostate by preventing hormonal changes behind prostate enlargement. The medications, called 5-alpha reductase inhibitors, such as Finasteride (Proscar) and Dutasteride (Avodart), can shrink the prostate by as much as 50-percent over a period of six months. You can rely on these drugs to relieve urinary symptoms within a few weeks of usage.
In some cases, your doctor may opt for a combined therapy using an alpha blocker together with a 5-alpha reductase inhibitor. This is done if either medication isn’t effective when used alone.
If your symptoms fail to respond to these medications, your doctor may recommend a minimally invasive surgical procedure. Such a procedure may also be necessary if your symptoms are severe or if you have a urinary obstruction, bladder stones or kidney problem.
Some procedures your doctor may consider include:
- Transurethral resection of the prostate (TURP)
This is a minimally invasive procedure that involves inserting a lighted scope into the urethra and using it to guide the removal of all but the outer part of the prostate.
- Transurethral incision of the prostate (TUIP)
Just like TURP, this procedure involves inserting a lighted scope into the prostate. The difference is that during TUIP, the surgeon makes 1-2 small incisions in the prostate gland, which enable urine to pass through the urethra.
- Transurethral microwave thermotherapy (TUMT)
As opposed to using a lighted scope, this procedure uses a special electrode inserted through the urethra into the prostate. The electrode provides microwave energy that is directed to the inner portion of the enlarged prostate. As a result, the prostate shrinks and urine flow improves.
- Transurethral needle ablation (TUNA)
This is another minimally invasive procedure that involves passing a scope into the urethra to allow the surgeon to place needles into the prostate gland. Radio waves are directed through the needles, which help to heat up and destroy excess prostate tissue.
- Laser therapy
During this procedure, high-energy laser is used to remove or destroy overgrown prostate tissue. It is preferred in men who are taking blood-thinning medications and who shouldn’t undergo the other minimally-invasive prostate procedures stated above.
- Prostate urethral lift (PUL)
This is a minimally invasive procedure that involves using special tags to compress the sides of the prostate in order to enhance urine flow. It is recommended in men who are wary about the impact of treatment on erectile and ejaculatory function. Prostate urethral lift causes minimal adverse effects on ejaculation and sexual function compared with TURP, TUIP, TUMT, and TUNA.
- Robot assisted prostatectomy
As a last resort or in cases where the prostate is too much enlarged, the bladder is damaged or there are other complicating factors, the surgeon may opt for da Vinci robot-assisted prostatectomy. The procedure involves making an incision in the lower abdomen to reach the prostate gland, which is then removed.
Reliable, unbeatable care
Are you 50 years or above and are having a frequent urge to urinate, a weak urine stream, leakage or dribbling of urine, or trouble beginning urination? You may be having benign prostatic hyperplasia.
At Advanced Urology Institute, we offer safe, timely and reliable diagnosis and treatment of BPH. Our urologists are skilled in doing physical examination, patient history, symptom evaluation, and ordering tests that form the basis for diagnosing the condition and ruling out other problems, including prostate cancer.
We also make sure that our patients understand the full range of treatment options available to them, and guide them on making an informed decision and on pursuing the treatment that is best for their individual medical situation. For more information on benign prostatic hyperplasia diagnosis and treatment, visit the site “Advanced Urology Institute.”
