Benign prostatic hyperplasia (BPH) is a common urological condition caused by the non-cancerous enlargement of the prostate gland in aging men, commonly those over fifty years old. As the prostate enlarges, it can squeeze down on the urethra. This can cause men to have trouble urinating leading to the symptoms of BPH.
A common symptom is the need to frequently empty the bladder, sometimes as often as every one to two hours, especially at night. Other symptoms include the sensation that the bladder is not empty, even after a man is done urinating, or that a man cannot postpone urination once the urge to urinate arises. BPH can cause a weak urinary stream, dribbling of urine, or the need to stop and start urinating several times when the bladder is emptied. BPH can cause trouble in starting to urinate, often requiring a man to push or strain in order to urinate. In extreme cases, a man might not be able to urinate at all, which is an emergency that requires prompt attention. In a small percentage of men, blockage from BPH may lead to stone formation, repeated infections and blood in the urine.
If the symptoms of BPH are affecting the quality of your life, it is time to seek treatment. For example, if you are losing sleep because you need to constantly urinate during the night. In addition, you should see a doctor immediately if you have blood in the urine, pain with urination, burning with urination or is unable to urinate
Your doctor will first take your medical history and listen to the complaints you are having with urination. The doctor then continues with a physical examination of the prostate which lies in front of the rectum. The doctor can feel it by inserting a gloved finger into the rectum. This examination allows the physician to estimate whether the prostate is enlarged, has lumps, or other areas of abnormal texture. In addition, the doctor will generally do a urine test called a urinalysis. There are a series of other studies that may or may not be offered to a patient being evaluated for BPH depending on the clinical situation.
You may be referred to a urologist for further consultation. Once serious conditions like cancer of the prostate or bladder are ruled out, treatment would depend on the severity of the BPH. In mild BPH, there is no significant blockage of the bladder and the symptoms are not bothersome. Most of these patients can be managed with an adjustment in their fluid intake, regular exercise, and a proper diet with less red meat, more fruits and vegetables. In moderate BPH, the blockage of the bladder is not severe but the symptoms are bothersome. Medication can be used to treat these cases to either relax the bladder outlet or help shrink the prostate, to improve the flow of urine. In severe BPH, the blockage is severe and person is unable to empty the bladder completely. This results in frequent urination but small amounts. In severe BPH, an operation may be necessary.
Benign enlargement of the prostate gland may be managed through the use of selective medications. Urologists generally use two classes of medications to treat this condition those being the alpha-blockers and the 5-alpha-reductase inhibitors. The alpha-blockers are used to relax the smooth muscle of the prostate gland and thus improve urinary symptoms. The 5-alpha reductase inhibitors block the production of dihydrotestosterone (DHT), which is felt to play a pivotal role in prostatic growth. Urologists at the prostate center currently participate in clinical studies of the latest available types of these medications.
Transurethral Resection of the Prostate (TURP)
Transurethral Resection of the Prostate is a surgical procedure commonly used to treat BPH. This has been considered the “gold standard” of surgical care for the last few decades. In this cystoscopic procedure the Urologist uses a wire loop, which has been charged with an electrical current to remove the prostate tissue. This effectively is able to remove the obstructive prostatic tissue blocking the urine from exiting the bladder. TURP is performed under regional or general anesthesia. The average in hospital stay is 1 to 2 days and potential complications may include bleeding, fluid absorption, hyponatremia, incontinence, and potentially erectile dysfunction.
Photoselective Vaporization of the Prostate (PVP)
Vaporization of the Prostate is a new minimally invasive procedure which was F.D.A. approved in March of 2002. The procedure is performed using the GreenLight Laser™ produced by Laserscope. It uses a fiber that emits a laser energy wavelength that is absorbed by oxyhemoglobin. Because of this physical principle, the vaporization of the prostatic tissue can be accomplished in a much more bloodless fashion. The risks of blood transfusion, fluid absorption, hyponatremia, incontinence, and impotence are low.