Benign Prostatic Hyperplasia

Risk Factors

To date, the exact causes of BPH are not known, however, several factors can increase your risk.

• Being over the age of 45
• Producing testosterone
• Family history of BPH
• Obesity

Signs & Symptoms

Someone suffering from this problem will notice:

• A weak, hesitant urine stream
• A need to strain when urinating
• A sense that the bladder is not empty
• Dribbling or leaking after urination
• An inability to completely empty the bladder
• Frequent urination, including several times during the night
• Blood in urine

 Left untreated, Benign Prostatic Hyperplasia worsens and is sometimes referred to as “prostatism” or lower urinary tract symptoms (LUTS).

Diagnosis

For the majority of patients, urinary symptoms are the first sign of BPH. A doctor will conduct a digital rectal exam (DRE) to check for changes to the size and surface of the prostate, and a blood test to determine if the prostate is inflamed.

The doctor may also check the amount of urine left in the bladder after urinating using an ultrasound bladder scanner or a catheter. In some cases a flow measurement or even urodynamics may be required to diagnose BPH properly.

If there is concern about kidney function or abnormalities in the urine, an ultrasound of the kidneys and/or a cystoscopic examination of the bladder may be required to rule out more serious problems.

Treatment

There are several treatment options depending on the degree of discomfort associated with BPH, lifestyle factors, and complications from the enlarged prostate or the blockage of urine. Treatment options include the following:

• No Treatment or Watchful Waiting: Treatment may not be necessary for those with mild cases of BPH, where symptoms are tolerable. In these cases, the patient must still be monitored to ensure their problem does not worsen. Limiting fluids in the evening and avoiding caffeinated drinks, alcohol, and spicy foods may minimize symptoms.
• Herbal / Plant Therapy Treatment: For men with mild to moderate symptoms, over-the-counter herbal/plant therapy may be recommended. It should be noted that manufacturers have found it difficult to ensure potency and product-to-product consistency, given the nature of herbal/plant therapies.
• Prescription Medication: Two types of prescription medications are available to treat BPH symptoms. Combination therapy involves using both an alpha-blocker and a 5-alpha reductase inhibitor.
  • Alpha-blockers relax the muscles in the prostate gland and the bladder opening, which is like “taking the clamp off of a hose.” If this treatment option works, symptoms associated with BPH usually improve within one to two weeks. 
  • 5-alpha reductase inhibitors are a “mild form” of hormone treatment that reduces the size of the prostate gland by blocking a male hormone from stimulating prostate growth. It may take three to six months for symptoms associated with BPH to improve. This drug is most useful in men with larger prostates.
• Surgical Treatment: Surgery is typically used in men with moderate to severe symptoms when drug treatment fails, or those with complications such as frequent infections, bleeding, or episodes of retention.
  • Heat-based treatments include microwave thermotherapy, radiofrequency needle waves, laser coagulation, water-induced thermal therapy, and high-intensity ultrasound. 
  • Transurethral Resection of the Prostate (TURP) is considered by many urologists to be the gold standard procedure for Benign Prostatic Hyperplasia. TURP involves the removal of the inner portion of the prostate in small pieces using a small camera that is guided through the urethra in the penis. Approximately 75% of men will experience retrograde ejaculation following a TURP. Some men require a repeat of this procedure several years later as the benign growth can reform.
  • Retropubic Prostatectomy involves the removal of most of the inner prostate via a cut in the abdomen. It is required for very large prostate glands.

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