What is BPH?

Benign Prostatic Hyperplasia(BPH), or enlargement of the prostate gland, is a condition in which the prostate enlarges and blocks the urinary channel. The prostate surrounds the urethra(male urine channel), which is the tube that carries the urine from the bladder out of the body. As men get older the prostate grows and can cause urinary symptoms. This can negatively affect a man’s quality of life.

Its important to remember that BPH causes urinary symptoms. It is very rare for prostate cancer to cause urinary problems.

What Causes BPH?

The prostate continues to grow throughout a man’s life. Unfortunately, there is no known clear cause for prostate enlargement, although some research studies suggest that an imbalance in sex hormones as men get older may play a role. Enlargement of the prostate seems to run in families as well.

Common Symptoms of BPH

BPH may cause a series of symptoms which vary in severity as the prostate gland enlarges. However, these symptoms tend to gradually worsen over time. These symptoms include:

• Frequent Urination

• Weak or Slow Urinary Stream

• Sensation of Incomplete Bladder Emptying

• Increased Frequency of Urination During the Night

• Difficulty Starting Urination

• Urgent Feeling of Needing to Urinate

• Urinary Dribbling

• Urinary Stream That Stops and Starts

• Inability to Urinate

Complications of an Enlarged Prostate

Although not common, an enlarged prostate that goes untreated can increase the risk of these complications:

Urinary Retention or Inability to Urinate: This may cause the patient to have a catheter inserted into the bladder to drain the urine.

Bladder Stones: When someone is unable to drain the bladder, the urine does not flow and may predispose to stone formation. Bladder stones can increase the risk of developing an infection, blood in the urine, or the inability to urinate.

Urinary Tract Infections: Just like with bladder stones, the inability to fully empty the bladder can increase the risk of UTI. Men with recurrent urinary tract infections need to have their prostate evaluated to ensure surgery is not required.

Bladder Dysfunction: Chronic straining and inability to completely empty the bladder can cause the bladder’s surrounding muscle (detrusor) to stretch and weaken over time. This can cause a man to become catheter dependent.

Kidney Dysfunction: Inability to completely empty the bladder can increase the pressure within the bladder. This increased pressure can cause kidney damage and if the urine is infected, increase the risk of kidney infections. This can be checked with a simple blood test.

BPH Treatment Options

Treatment for BPH depends on the severity, or level of bother, of the symptoms and the presence of the previously mentioned complications. When the symptoms are mild or not bothersome, and there is no presence of complications, you may not need active treatment.

Medications

If the symptoms are bothersome Dr. Clavell may prescribe medications to manage your symptoms. These medications include:

Alpha blockers: These medications(like Tamsulosin or brand name Flomax) help relax the muscles around your bladder neck to make it easier for you to urinate.

Alpha Reductase Inhibitors: These medications help decrease the size of the prostate when it is enlarged.

Phophodiesterase 5-Inhibitors: Although originally prescribed for erectile dysfunction, low dose Cialis® has been found to help improve urinary symptoms in patients with BPH.

Endoscopic Procedures

Endoscopic procedures are those that require instrumentation through the urethra, or urinary channel, to treat the prostate from the inside. These include:

Rezūm Water Vapor Therapy: Rezūm is a treatment for BPH that uses thermal energy in water vapor (steam) to treat the prostate tissue blocking the urinary channel. The water vapor is injected into the prostate tissue through a hand-held device. The water vapor causes the cells to be damaged and ultimately leads to cell death.

UroLift® System UroLift®: is a minimally invasive treatment for BPH which “lifts” or holds the enlarged prostate tissue to maintain the urethra open. Clinical research data has shown the UroLift System treatment is safe and effective in relieving lower urinary tract symptoms without affecting sexual function.

Transurethral Resection of the Prostate: TURP is the most common surgery currently used for BPH treatment. This procedure is performed in the operating room and is considered the “gold standard” treatment. It involves removal of the prostate tissue blocking the urinary channel. Although rare, long-term side effects that can occur after TURP include retrograde ejaculation (dry orgasm), erectile dysfunction and urinary incontinence (leakage of urine)

Greenlight photovaporization of the prostate: in this procedure your surgeon will introduce a scope into the bladder. Then using a laser fiber they will vaporize the excess prostate tissue to create an open channel. This has some benefits over the traditional TURP. These include less bleeding and shorter catheterization times.

HOLEP(Holmium laser enucleation of the prostate): here once again your surgeon will introduce a scope into the bladder. Then using a laser fiber they will incise the excess prostate tissue and remove it in pieces that fall into the bladder. They will then use an instrument called a morcellator to break down this tissue and remove it from the body.

Other procedure:

Simple prostatectomy: this procedure is usually performed using a surgical robot. Your surgeon will make an incision over either the bladder or the prostate capsule. They will then remove the excess prostate issue in large pieces. After sewing the prostate capsule or bladder back together you will have a catheter for a few days afterwards.

Prostate Artery Embolization: here in interventional radiologist replace a catheter into an artery either in your groin or in your wrist. They will then use this catheter to plug up some of the blood vessels which are going to the excess prostate tissue. This causes the prostate to shrink and brings about improvement in urinary symptoms.