Benign prostatic hypertropy, or BPH, occurs when the prostate gradually enlarges over one's lifetime. About 10% of men eventually require medical or surgical therapy for BPH.
Symptoms of BPH
The symptoms of BPH occur as a result of bladder outlet obstruction.and include decreased force of urinary stream, difficulty starting and stopping urination, a sensation of incomplete emptying of the bladder, and frequency of urination. Perhaps the most bothersome symptom to most men is nocturia (awakening at night to urinate) resulting in daytime fatigue. If left untreated BPH can lead to urinary tract infections, bladder diverticuli, bladder stones, or kidney failure.
Evaluation (tests the urologist may perform)
prostate exam - to rule-out prostate cancer, which occasionally causes bladder outlet obstruction
PSA level - blood test which is more sensitive than prostate exam in detecting prostate cancer
creatinine level - blood test to evaluate kidney function
urinalysis - to check for infection or blood in urine
cystoscopy - a telescope is passed through the prostate into the bladder to confirm obstruction from prostate
uroflow - patient voids into a funnel which measures urinary flow rate.
urodynamics - a tube is placed in the bladder to measure bladder pressure during filling with water and voiding. This study is used to confirm bladder outlet obstruction and rule-out bladder spasms (involuntary bladder contractions).
post-void residual - measures the amount of urine left in the bladder after voiding. May be measure by placing a tube into the bladder or by bladder ultrasound.
Non-Invasive Treatment Options
watchful waiting (observation) - often men with enlarged prostates have only mild symptoms which do not require treatment. There are some medications which can suddenly worsen BPH symptoms or even cause urinary retention (inability to void). The most common culprits are antihistamines and decongestants, such as those found in over-the-counter cold medications.
medical therapy - medications which are effective in treating BPH either work by relaxing the smooth muscle around the prostate (alpha-blockers such as Cardura, Hytrin, Flomax, or Uroxatral) or by shrinking the prostate (5 alpha-reductase inhibitors such as Proscar or Avodart). Cardura and Hytrin are the most successful medications, but may occasionally cause dizziness on standing by lowering blood pressure. Flomax and Uroxatral work in a similar fashion as Cardura and Hytrin with less chance of dizziness. Proscar and Avodart shrink the prostate and lower PSA levels, but usually are ineffective in improving BPH symptoms unless the patient has a very large prostate. In addition, Proscar take 6 - 12 months to show any benefit while Avodart takes 3 months to improve symptoms. Studies are beginning to show benefit in taking both an alpha-blocker and a 5 alpha reductase inhibitor together. We are currently enrolling patients for a study with Flomax and Avodart combination therapy.
Minimally Invasive Treatment Options
transurethral needle ablation (TUNA) of the prostate - The urologist uses radiofrequency energy to destroy prostate tissue causing obstruction.
microwave hyperthermia - Microwave energy is applied to the prostate through a catheter. It is performed in the office as an outpatient.
interstitial laser coagulation (ILC) - a small laser fiber is inserted into the prostate gland to heat the prostate tissue.
Surgical Therapy for BPH - indicated in patients who fail the treatments above or have one of the following - urinary retention, gross hematuria (visible blood in the urine), recurrent UTI's, hydronephrosis (kidney swelling seen on IVP or renal ultrasound), or kidney failure.
transurethral incision of the prostate (TUIP) - a incision is made through the prostate to open the prostatic urethra. This procedure is successful in smaller prostates and is less invasive than TURP.
transurethral resection of
the prostate (TURP) - this has been the gold
standard operation for BPH for years. Several years ago
it was one of the most commonly performed operations in
the U.S.. An opening is created in the prostatic urethra
by scraping out prostate tissue through a large cystoscope.
Greenlight PVP - a laser is used to
vaporize the prostate tissue creating a channel in the prostate similar to
a TURP. Most patients can go home the same day with no catheter.
West Florida Urology currently is a teaching center for this procedure. Click
here for a slide presentation of the Greenlight
procedure. (requires Power Point program - may take 10
seconds or longer to download)
Additional Information
There is an informative site by the National Institutes of Health (NIH) on the World Wide Web which provides an overview of the diagnosis and treatment of BPH.