BPH

BPH Definition

BPH stands for Benign (non-cancerous) Prostate (affecting the prostate) Hyperplasia (having more cells than is normal). BPH can cause problems that impede urine flow and causes the bladder to not empty completely when you urinate.

From birth to young adulthood, your prostate gland grows from the size of a pea to about the size of a walnut. In your mid-to late 40s, the gland begins a second growth spurt which makes your prostate grow more rapidly in the central interior part of the gland.

As your prostate grows it can cause two main growth related problems. First, the prostate can compress the urethra and partially or completely block urine flow. Second, your prostate can cause the muscles around the urethra to contract making it difficult for the urethra to relax and allow urine to flow.

BPH Symptoms

  • Nocturia: Waking up many times throughout the night to urinate
  • Urgency: Feeling that you cannot wait to urinate
  • Frequency: Needing to urinate often
  • Incomplete emptying: Feeling that your bladder is not completely empty after urinating
  • Decreased force of stream: Slow or weak urine stream. Also described as a dribbling stream, or a stream that stops and starts
  • Straining to void: Straining during urination

Diagnosing BPH

Digital Rectal Examination (DRE)

The prostate is an internal organ, so the physician cannot look at it directly. Because the prostate lies in front of the rectum, however, the doctor can feel it by inserting a gloved, lubricated finger into the spectrum and easily locate and examine the prostate gland.

The examination allows the physician to determine whether the prostate is enlarged or has lumps or other areas of abnormal texture.

Laboratory Testing

Prostatic-Specific Antigen (PSA)
PSA is a substance produced by the prostate. A blood test is used to measure PSA levels. When the gland is inflamed, it may produce high levels of PSA indicating the possibility of prostatitis. PSA is also very useful in screening for prostate cancer and can help the physician decide what other tests may be needed.

Diagnostic Testing

Urine flow test and a bladder scan indicating post-void residual may be done. A post-void residual indicates how well you are emptying your bladder. Radiological imaging such as ultrasound can also show whether you have an enlarged prostate.

Treatment Options

There are many treatment options available for BPH. Your urologist will discuss your treatment options with you. Generally, different treatments provide different degrees of relief. The severity or your symptoms are key in deciding the best option for you.

Medications

There are a variety of medications on the market today that can alleviate the symptoms you experience with BPH. If you choose this option, your doctor may prescribe one or more of the following:

  • Alpha Blockers: Relax the channel in the prostate and can help relieve pressure on the urethra. Examples of alpha blockers include Uroxatrol, Flomax, Cardura, Hytrin and Rapaflo.
  • 5-alpha reductase inhibitors: Block hormones that encourage prostate growth. With time, this can help in shrinking the prostate. Examples include Avodart and Proscar.
  • Anticholinergics: Relax the bladder muscle and may help relieve the urgent need to urinate. Examples include Detrol LA, Vesicare, Sanctura, Ditropan, Enablex and Toviaz.
  • B3-agonist: New medical treatment that also helps relax the bladder muscle. Examples include Myrbetriq.

Surgical Intervention

  • Laser Ablation of the Prostate (PVP, Holmium)
  • Microwave Treatment of the Prostate Gland
  • Open Prostatectomy
  • Transurethral Resection of Prostate (TURP)