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Benign Prostatic Hyperplasia (BPH)

What is a Prostate?

The prostate is a walnut sized gland located between the bladder and the penis. The urethra runs through the center of the prostate from the bladder to the penis.

Prostate Visualization

What is the function of the prostate?

The prostate produces seminal fluid that protects and nourishes the sperm.

What is an enlarged prostate?

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. A normal prostate volume is approximately 20 cc. An enlarged prostate is >20 cc and may or may not cause urinary symptoms. If it does not cause any symptoms, then it does not need to be treated. Enlarged prostate is not life threatening.

Enlarged Prostate

Symptoms of an enlarged prostate

  • Urinary urgency – The sudden, urgent need to urinate, owing to the sensation of imminent loss of urine without control
  • Hesitancy – Difficulty initiating the urinary stream; interrupted, weak stream
  • Incomplete bladder emptying – The feeling of persistent residual urine, regardless of the frequency of urination
  • Straining – The need strain or push (Valsalva maneuver) to initiate and maintain urination in order to more fully evacuate the bladder
  • Decreased force of stream – The subjective loss of force of the urinary stream over time
  • Dribbling – The loss of small amounts of urine due to a poor urinary stream

The difference between Prostate Cancer and Enlarged Prostate

Enlarged prostate is a distinct diagnosis from prostate cancer. Enlarged prostate is not life threatening. It is benign prostatic tissue that has grown into the bladder and is obstructing urinary flow. Whereas, prostate cancer affects the outer shell of the prostate and may need to be treated.

How is enlarged prostate diagnosed and worked up?

There are several ways that enlarged prostate can be diagnosed. 

  • American Urological Association Symptom Score(AUASS)
    • The severity of BPH can be determined with the American Urological Association Symptom Score (AUASS) plus a disease-specific quality of life (QOL) question. Questions on the AUASS for BPH concern the following:
      • incomplete emptying
      • frequency
      • intermittency
      • urgency
      • weak stream
      • straining
      • nocturia
  • Urinalysis and culture
    • A urine culture may be useful to exclude infectious causes of irritative voiding.
  • DRE(Digital Rectal Exam)
    • Also known as a prostate exam, a DRE can checks if a prostate is hard or has a nodule that might indicate a prostate cancer. It can also determine if there is any enlargement of the prostate.
  • Prostate Specific Antigen(PSA) test
    • Blood test that helps assess the risk of prostate cancer.
    • A normal PSA is <4.0 ng/ml.
    • PSA screening is sensitive but not specific. There are many things that may elevate one’s PSA other than prostate cancer, including a UTI or enlarged prostate. A PSA above 4.0 ng/ml does not indicate a prostate cancer. However, most people with prostate cancer will have an elevated PSA.
  • Uroflow/PVR
    • Uroflow measures the rate of urine flow. Normal urine flow is approximately 15 ml/s. A slower stream or a strained urine pattern may indicate an obstruction.
    • Post-void residual(PVR)- measures how much urine is left in the bladder after voiding.  A PVR >100 ml indicates a risk of urinary retention(being unable to void).
  • Medical therapy
    • Alpha blockers
    • PDE5 inhibitors
    • 5-alpha reductase inhibitors
    • If you fail medical therapy, the indications to progress to outlet procedures are namely urge incontinence, progressive urinary retention (acute or chronic), unhappiness with daily mediation, or bothersome symptoms.
  • Surgical Workup
    • Cystoscopy/TRUS(transrectal ultrasound)
      • A Cystoscopy and TRUS are used to obtain the size and shape of the prostate. This information helps determine which procedures the patient is a good candidate for.
      • Cystoscopy- a camera is used to view inside the urethra and bladder. It helps obtain the shape of the prostate and rule out other causes for urinary symptoms.
      • TRUS- similar to a prostate exam, in which a probe is inserted in the rectum to measure the size of the prostate.
    • Urocuff/urodynamics
      • To help distinguish poor bladder contraction ability (detrusor underactivity) from bladder outlet obstruction
  • Medical Treatment Options
    • 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
    • Phosphodiesterase-5 inhibitors = daily Cialis
      • Works to relax muscle cells in the bladder and prostate
      • May cause a drop in blood pressure. It is unsafe to use with nitrates or alpha blockers.
    • 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
  • Surgical Treatment Options
    • Rezum
    • UroLift
    • Protouch/Holmium Laser Enucleation of the Prostate(ProLEP/HoLEP)
    • Transurethral Resection of the Prostate(TURP)
    • Aquablation
    • Microwave/TUNA

If you are experiencing the symptoms of enlarged prostate, it may be time to see a medical professional.

For more information on treatment options for BPH in the Alexandria, VA area call Potomac Urology at (703) 680-2111 today!