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Benign Prostatic Hyperplasia

Benign Prostatic Hyperplasia

According to the National Institutes of Health, more than 50 percent of men over 60 and 90 percent of men over 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. 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)

Dr. Richard Heppe

Dr. Heppe was recognized as a 2016, 2017, 2018 and 2019 Top Doc by 5280 Magazine in the category of reproductive endocrinology and infertility. Click here to learn more.

Making a Diagnosis

BPH is typically diagnosed through a variety of tests, including: 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 Thermotherapy (TUMT) is a minimally invasive, in-office procedure. TUMT 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 is performed right here at TUCC. The procedure takes approximately 30 minutes to complete, however patients should allow for extra time including pre- and post-procedure activities. It is not surgery and there are no incisions.

How TUMT Works

The process will begin 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.

Within the first several weeks after the procedure, the body will be healing 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 time 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. Patients will find that their 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

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.

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.

 

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.

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.

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