- Benign Prostatic Hyperplasia -
Benign prostatic hyperplasia is commonly known by the acronym "BPH." It is the gradual, non-cancerous enlargement of the inner portion of the prostate gland and the lower urinary tract symptoms that result. These symptoms have been referred to in the past as "prostatism." This common problem affects an increasing percentage of men as they age, often beginning in a man's 40s. Note that there is no direct relationship between prostate cancer and BPH, although some of the urinary symptoms can be the same.
| Symptoms of BPH are due to obstruction of the flow of urine out of the bladder. The common early symptoms are weakening or intermittency of the urinary stream, frequency, urgency, sensation of incomplete bladder emptying, and awakening during the night mutiple times to urinate (nocturia). As time passes, worsening obstruction may lead to bladder injury, bladder stones, urinary tract infections, kidney failure, overflow urinary incontinence, and urinary retention, which is often a painful emergency. |
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- Evaluation of BPH -
The evaluation of BPH includes a thorough history, physical exam, symptom score questionnaire, PSA check, bladder ultrasound after voiding to check for incomplete emptying, flow rate determination, and in some instances a somewhat more involved bladder evaluation called urodynamics. This last test can be thought of as an "EKG for the baldder." It measures the ability of the bladder muscle to squeeze and evaluates the degree of urethral obstruction, in an effort to determine the most effective treatment for a particular individual.
- Medications for BPH -
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Treatment options include two different kinds of medication. The first type is the alpha-blockers, which includes alfuzosin (Uroxatral), tamsulosin (Flomax), and terazosin. These drugs act by relaxing the smooth muscle of the prostate and bladder neck, decreasing resistance to the flow of urine from the bladder. These drugs typically work within a few days. |
The second class of BPH drugs, known as 5-ARIs, works in an entirely different manner. These drugs includes dutasteride (Avodart) and finasteride (Proscar), which inhibit the conversion of testosterone to its most potent form (DHT), thereby decreasing stimulation of prostate growth. These drugs work slowly, gradually shrinking the prostate over 6-12 months.
- Minimally Invasive Treatments for BPH -
Minimally invasive procedures to open up the bladder outlet are increasingly becoming first-line treatment for BPH. Many people do not want to be on a medication (or two) for many years, preferring to undergo a procedure, which often restores their ability to void normally.
TUMT
One of the most commonly performed procedures for BPH treatment is transurethral microwave therapy (TUMT). This is an in-office procedure in which a special catheter used to heat the prostate adenoma. Some of the obstructing tissue dies and is reabsorbed over a few weeks. This results in opening up of the prostate to enlarge the urethra. |
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Prostate Laser Vaporization
Another procedure, which can be performed either in the the clinic under local anesthesia or in the hospital as an outpatient, is laser ablation of the inside of the prostate. Focused laser energy is used to vaporize the inside of the prostate, enlarging the channel substantially, thereby improving urinary flow rates and bladder emptying. While this procedure is more invasive than tumt, it is also more effective. Two different laser systems are available for this procedure, each with its own advantages.
The video below is an animation of prostate enlargement, followed by transurethral vaporization of the prostate (TUVP) using the BioLitec Evolve 150 watt laser. This procedure can be performed either in the clinic with mild sedation or in the operating room with general or spinal anesthesia.
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- Surgery for BPH -
For very large prostates (over 100 grams), minimally invasive techniques are generally not the most effective means of opening up the urinary channel. The problem is that enough tissue can not be reliably removed in these circumstances. Surgical removal of the entire benign center (adenoma) of the prostate, leaving the prostatic capsule and erectile nerves undisturbed, is a very effective treatment, first performed in 1895! Known as "suprapubic prostatectomy" or "simple prostatectomy," this operation remains the most effective means of unobstructing very large prostates. Simple prostatectomy has been traditionally performed via open surgery, but can now be performed laparosocpically, or utilizing the da Vinci robot. An excellent video about robotic-assisted simple prostatectomy can be viewed By Clicking HERE. Unlike treatment for smaller glands, this operation typically requires a one or two day hospital in-patient stay. |
