Benign Prostatic Hyperplasia (BPH)
What is BPH?
Benign prostatic hyperplasia (BPH) is an enlarged prostate. As you age, your prostate may get larger. This may lead to difficulty urinating. About half of all men between the ages of 51 and 60 have BPH.
What is The Prostate and What Does it Do?
The prostate the size of a walnut and goes all the way around a tube called the urethra. The main job of the prostate is to make fluid for semen.
What Are The Symptoms of BPH?
- Incomplete Emptying – Feeling the bladder is full even after urinating
- Urgency – Feeling that urinating “can’t wait”
- Frequency – Urinating more often than usual
- Weak Urine Stream
- Nocturia – Waking up at night to urinate
- Intermittency – The need to stop and start urinating several times
- Hesitancy – Trouble starting to urinate
- Straining – The need to push or strain to urinate
How is it Diagnosed?
The American Urological Association (AUA) developed a BPH Symptom Score Index. It asks how often urinary symptoms happen. The score rates BPH as mild to severe.
Your health care provider will review your Symptom Score and take a medical history. There will be a physical exam with a digital rectal exam (DRE). You may also have:
- Urinalysis (urine test)
- PSA blood test to screen for prostate cancer
- Urinary blood test to screen for bladder cancer
- Post-void residual volume (PVR) to measure urine left in the bladder after urinating
- Uroflowmetry to measure how fast urine flows
- Cystoscopy to look at the urethra or bladder with a scope
- Urodynamic pressure to test pressure in the bladder during urinating
- Ultrasound of the prostate
There are many treatments for BPH. Mild cases of BPH may need no treatment at all. In some cases, minimally invasive procedures that do not require anesthesia are good choices. And sometimes a combination of medical treatments works best.
The main treatments for BPH are:
Watchful Waiting/Active Surveillance
- Men with mild/moderate symptoms who are not bothered by the symptoms
(1) Alpha blockers = alfuzosin (Uroxatral), terazosin (Hytrin), doxazosin (Cadura), silodosin (Rapaflo), tamsulosin (Flomax)
- Immediately work to relax the prostate and bladder neck
- May cause dizziness and/or retrograde ejaculation
(2) 5-alpha reductase inhibitors= finasteride (Proscar) and dutasteride (Avodart)
- Works over 3-6 months to shrink the prostate
- May cause erectile dysfunction or decreased libido
(3) Phytotherapies = saw palmetto and other herbal supplements
- Not proven to work and not recommended
(1) Transurethral resection of the prostate (TURP)
- Most common surgery for BPH
- A scope is inserted via the penis to allow for resection of the prostate (Roto-rooter procedure)
- A catheter is placed after the procedure and you may stay a night in the hospital
(2) Simple prostatectomy
- This is used for patients with extremely large prostates
- May be done open or robotically
- Requires hospitalization