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Benign Prostatic Hyperplasia

Benign Prostatic Hyperplasia

Men often delay visiting their doctor for a prostate checkup. However, regular prostate exams can help you and your physicians stay ahead of common prostate conditions. Enlarged prostate, or benign prostatic hyperplasia (BPH), is a condition that regular urology visits can monitor.

Prostate Enlargement

For men of a certain age, BPH is the most common disorder of the prostate, and it’s important to know the facts. According to studies, around 50 percent of men aged 51-60 have an enlarged prostate, or BPH. For men between the ages 60 and 69, that number increases to 70 percent of men. And once they get past the age of 70, the number of men with BPH climbs to more than 80 percent. 

Dr. Richard Heppe

Greenlight Laser for BPH

Richard Heppe, MD, was recognized as a 2016, 2017, 2018 and 2019 Top Doc by 5280 Magazine in the category of reproductive endocrinology and infertility.

What Is Benign Prostatic Hyperplasia?

An enlarged prostate is typically caused by a benign growth, which means it is not cancerous. However, the condition still causes many health problems in men. Most prevalently, BPH physically presses against the urethra, obstructing the flow or urine. That obstruction prompts changes to the bladder muscles, resulting in a collection of symptoms that can disrupt a man’s everyday life.

Is Benign Prostatic Hyperplasia Serious?

An enlarged prostate is typically caused by a benign growth, which means it is not cancerous. However, the condition still causes many health problems in men. Most prevalently, BPH physically presses against the urethra, obstructing the flow or urine. That obstruction prompts changes to the bladder muscles, resulting in a collection of symptoms that can disrupt a man’s everyday life.

Benign prostatic hyperplasia, illustration showing normal and enlarged prostate gland

Symptoms

Symptoms associated with BPH typically manifest as conditions of the lower urinary tract. Patients suffering from BPH may experience the following symptoms:

  • Blood in urine (hematuria)
  • 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

In some cases, BPH causes damage to the kidney, along with bladder stones, urinary tract infections (UTI), and acute urinary retention—the inability to urinate, along with pain and swelling of the lower abdomen. 

BPH Risk Factors

While BPH is common among men, there are some risk factors that increase the chances of developing the condition. 

Age

Beginning at the age of 50, the risk of developing BPH increases as a man gets older.

Family history

Men with a family history of BPH are more likely to develop an enlarged prostate than men without a family history of the disorder.

Obesity

Men who are obese or who suffer from metabolic syndrome—a group of risk factors for cardiovascular disease and diabetes, such as high blood pressure, insulin resistance, and low HDL cholesterol levels—are at increased risk for developing BPH.

Making a Diagnosis

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 diagnose 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, as elevated PSA levels can 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 could 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

Depending on the symptoms, there are several treatment options for men suffering from BPH. While some men will simply be instructed to monitor the condition with annual visits to the physician, others will be presented with medications or surgical treatments.

Medication

Some men may be given medication to prevent the conversion of testosterone to dihydrotestosterone, which can decrease prostate size. Meanwhile, alpha blockers may relax the bladder and prostate to increase urine flow.

Minimally Invasive Treatments

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 urology centers in the country to utilize a 180-watt Greenlight Laser as a prostate vaporization treatment for BPH patients.

Transurethral Microwave Therapy (TUMT)

One of the groundbreaking procedures performed at TUCC is transurethral microwave therapy (TUMT). While the procedure takes approximately 30 minutes to complete, patients should allow additional time for pre- and post-procedure activities. It is not surgery and there are no incisions.

  • TUMT is a minimally invasive, in-office procedure that uses high-energy, microwave-generated heat to reduce excess tissue in the prostate gland. It offers significant and long-lasting relief from the symptoms of BPH. TUMT is also effective at enhancing patient comfort by protecting the urethra from the heat generated during the procedure through a proprietary circulatory cooling system.

TUMT begins with a pre-procedure local anesthetic or pain medication to minimize any potential discomfort. During the procedure a catheter will be inserted through the urethra and placed near the area of prostatic growth. An antenna within the catheter deploys microwaves that generate heat in the prostate, in turn reducing the amount of excess tissue. Throughout the procedure, cooled fluid is circulated through specially made tubes, protecting the urethra and surrounding healthy prostatic tissue from the heat.

Recovery from TUMT is relatively short and patients are able to return home once the procedure is complete. However, patients should not drive themselves. A temporary catheter is typically required for a few days after the procedure.

During the first several weeks after the procedure, the body will heal itself by reabsorbing the treated prostatic tissue. Patients will have progressively greater relief from the procedure over the course of 6-12 weeks, after which the full degree of relief should be felt.

Benefits of TUMT

While every patient is different, TUMT is a safe and durable procedure that comes with relatively few sexual side effects when compared to BPH medicines such as 5-alpha-reductase inhibitors and alpha-blockers. The procedure is covered by Medicare in all 50 states, and most private insurance plans cover the procedure as well.

Risks of TUMT

As with any medical procedure, there are some potential risks and considerations with TUMT. These may include:

  • Blood (sometimes clotted) in urine (Hematuria)
  • Painful or difficult urination (Dysuria)
  • Rectal irritation
  • Temporary inability to control urination
  • Possible temporary inability to achieve or maintain an erection
  • Retrograde ejaculation

Surgical Treatments

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 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 urine, scar tissue formation, or initial urinary discomfort, 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 a prostatectomy 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 be used in select patients.

Transurethral Incision of the Prostate (TUIP)

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

After BPH Treatment

Depending on the type of treatment you receive and the severity of your BPH, it is common to feel tired for a week or two following your procedure. During that time, do not lift or move any heavy objects and abstain from any strenuous exercise or similar activity.

Your TUCC physician will schedule a follow-up exam to monitor your prostate and ensure no abnormal growth returns. 

How Can You Prevent a Recurrence of BPH?

Once men reach the age of 50, there is no surefire way to prevent BPH from occurring or recurring. Regular visits to your urologist are your first line of defense against incidents of BPH. However, there are some lifestyle chances you can make that could potentially help to lower your risk of BPH. This includes:

  • Losing weight
  • Eating a well-balanced diet
  • Avoiding saturated fats

An overabundance of body fat could increase hormone levels and other factors in the blood that stimulate the growth of prostate cells. Keeping yourself active while eating plenty of fruits and vegetables helps control weight and hormone levels.

The Best Benign Prostatic Hyperplasia Doctors

The doctors at TUCC are professionals when it comes to problems related to the prostate. Highly skilled and deeply compassionate, TUCC physicians are with you through every step of BPH.

FAQ

Benign prostatic hyperplasia (BPH) is when the prostate and surrounding tissue expands, causing health problems related to the lower urinary tract.

While the main causes are unclear, incidents of BPH tend to increase as a man gets older. One theory states that as men age, the amount of active testosterone in the blood declines, and this shift in hormones triggers prostate cell growth.

The urgent need to pass urine is a common symptom of BPH, especially when that urgent need happens at night. Other common symptoms of BPH include:

  • The feeling that the bladder is always full
  • Starting and stopping several times while urinating
  • Weak flow of urine
  • Straining during urination

 

BPH is benign, not cancerous. However, the condition can cause several health concerns and disrupt the patient’s quality of life. As such, it should be monitored and treated when detected.

While there is no cure, there are several treatment paths that your physician can recommend. Mild symptoms could be addressed with lifestyle changes, and certain medications can be prescribed to relieve urinary symptoms. For more advanced cases, TUCC physicians are experienced in innovatie, minimally invasive procedures that utilize laser technology.

We’re here to help.

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