Benign Prostatic Hyperplasia (BPH)

According to the National Institutes of Health, more than 50 percent of men over the age of 60 and 90 percent of men over the age of 70 are living with benign prostatic hyperplasia (BPH). It is the most common disorder of the prostate. This condition is caused by changing hormonal levels that increase the size of the prostate. The prostate may grow by cells multiplying around the urethra and squeezing it or by cells growing into the urethra and lower bladder. The male hormone testosterone is responsible for stimulating prostate growth. BPH is not typically associated with a cancerous prostate gland.

Patients suffering from BPH may experience the following symptoms:

• Blood in the urine
• Frequent urination
• Urine leakage
• Recurrent, sudden or urgent need to urinate
• Straining to begin urination
• Weak or interrupted urination
• Dribbling urinary stream
• Incomplete emptying of the bladder
• Acute inability to urinate (in severe cases)

Diagnosis:

BPH is typically diagnosed through a digital rectal examination, American Urological Association (AUA) Symptom Index, PSA test, urodynamic testing, uroflowmetry, pressure flow studies or a post-void residual test.

Digital Rectal Examination
This exam involves a urologist assessing the patient's prostate gland through the rectal wall to determine its size, shape and consistency.

AUA Symptom Index
This questionnaire is given to patients to assess their urinary problems and help diagnosis BPH.

PSA Testing
PSA (prostate specific antigen) is a protein produced by prostate cells, which can be detected in the blood. A simple blood test can indicate if further evaluation for prostate cancer is necessary. Elevated PSA levels can also be associated with BPH.

Urodynamic Testing
Urodynamic tests are office procedures used to evaluate urine flow and measure the volume and pressure of urine.

Uroflowmetry
Patients undergo this test with a full bladder and urinate into a device measuring the amount of urine, time it takes for urination and the rate of urine flow. A reduced flow rate may indicate BPH.

Pressure Flow Study
This is the most accurate test used to determine urine blockage. A catheter is inserted through the urethra in the penis into the bladder to measure pressure in the bladder during urination and detect a flow blockage.

Post-void Residual (PVR)
This test measures the amount of urine left in the bladder following urination by ultrasound or catheterization.

Treatments:

Men suffering from BPH have several treatment options. Depending on symptoms, some may be instructed to simply come in for an annual visit. Others may be given medication to prevent the conversion of testosterone to dihydrotestosterone in order to decrease prostate size. Alpha blockers may relax the bladder and prostate to increase urine flow. Patients with severe medical problems may undergo a procedure to insert prostatic stents into the urethra to push back surrounding tissue and widen the opening. Other minimally invasive treatments for BPH may include laser or microwave treatment to reduce or eliminate symptoms. TUCC is one of the few urologic centers in the country to utilize a 180 watt greenlight laser as a prostate vaporization treatment for BPH patients.

In instances where medical or minimally invasive treatments have no effect on a patient's condition or when a patient experiences severe complications, the following surgical treatments may be administered:

Transurethral Microwave Therapy (TUMT)
A microwave procedure, TUMT, can be done in the office to alleviate blockage from BPH. This is done under local anesthesia and takes roughly 30-60 minutes to complete. A catheter with a microwave unit is placed in the urethra to heat up the prostate and alleviate any blockage. A temperature sensor is also placed in the rectum. Following the procedure, a patient is typically sent home with a drainage catheter which remains in place for a few days.

Transurethral Resection of the Prostate (TURP)
This procedure, which takes less than 90 minutes to complete, removes obstructing tissue from the prostate through a special scope in the urethra. Patients undergoing this procedure typically have a hospital stay during which a catheter is used to drain urine. Complications of TURP may include, blood in the urine, scar tissue formation, initial urinary discomfort or difficulty controlling urination or problems with sexual function.

Prostatectomy
For a BPH patient, removal of the prostate may be necessary if it is greatly enlarged, if the bladder has been damaged or if complications prohibit transurethral surgery. After surgery, a urinary catheter is inserted to ensure bladder emptying. Potential side effects of prostatectomies may include incontinence or impotence. A robotic prostatectomy via the da Vinci robot may also be used in select patients. For more information about daVinci procedures, please click here.

Transurethral Incision of the Prostate (TUIP)
Patients who do not have greatly enlarged prostates may undergo transuretheral incision of the prostate (TUIP) to make cuts in the bladder neck. The cuts reduce pressure on the prostate and make urination easier.

Click here to learn more about the symptoms and treatment options for BPH.