BPH

BPH is an enlarged prostate. While the prostate is usually the size of a walnut or golf ball in adult men, it can grow to be as large as an orange.

As the gland enlarges, it can squeeze the urethra. If you are not able to pass urine at all (called retention) or if you have renal failure, immediate attention is required. This means it is not cancer, nor does it lead to cancer. Still, BPH and cancer can happen at the same time. If you have symptoms, it is of great value to get a complete diagnosis and learn what you can do to get relief. As you age, your prostate may get larger. BPH is when it gets large enough to cause problems. As the prostate enlarges, it presses against the urethra. The bladder wall becomes thicker. Over time the bladder may weaken and lose the ability to empty fully. Urine then remains in the bladder. These problems cause many of the lower urinary tract symptoms (LUTS) of BPH.

  • Men over the age of 50 as the risk for BPH rises with age.
  • Men whose fathers had BPH.
  • Men who are overweight or obese.
  • Men who don’t stay active.

When the prostate is enlarged, it can bother or block the bladder. Needing to pass urine often is a common symptom of BPH. This might include the need to pass urine as often as every one to two hours, mainly at night. Other symptoms of BPH are listed below:

  • Incomplete emptying; the feeling your bladder is full, even after passing urine.
  • Frequency; the need to pass urine often, about every one to two hours.
  • Intermittency; the need to stop and start several times when passing urine.
  • Urgency; feeling the urgent need to pass urine as if you can’t wait.
  • Weak stream; a weak urine flow.
  • Straining; trouble starting to pass urine or the need to push or strain to pass urine.
  • Nocturia - the need to wake up at night more than two times to pass urine.

How is it diagnosed?

  • Physical Exam: A digital rectal exam (DRE) is often the next step. During a DRE, you lie on your side or bend over. The doctor inserts a gloved, lubricated finger into your rectum to feel the back wall of the prostate gland. The health care provider is looking for enlargement, tenderness, lumps or hard spots. This 10-15 second exam is an important way to find problems.
  • Urine tests: These tests are done to measure how well you release urine. This shows the doctor if the urethra is blocked or obstructed. There are several types:
  • Scans: These tests are done to measure how well you release urine. This shows the doctor if the urethra is blocked or obstructed. There are several types:

How is it treated?

Medical therapy is usually the first option for men with BPH. Types of drugs include: Alpha-blockers are pills used to relax the muscles of the prostate and bladder to reduce BPH symptoms. They do not shrink the prostate, but they may improve urine flow if there is a blockage. One benefit of alpha-blockers is they start to work right away. Side effects may include dizziness, lightheadedness, fatigue and difficulty ejaculating. Men with moderate to severe BPH and men who are bothered by their symptoms are good candidates. Alpha-blockers are not a good choice if you plan to have cataract surgery soon. Alpha-blocking drugs include alfuzosin, doxazosin, silodosin, tamsulosin, and terazosin. 5-Alpha reductase inhibitors are pills that can increase urine flow and shrink the prostate by blocking DHT. DHT is a male hormone that can build up in the prostate and may cause prostate growth. These drugs may lower the risk of BPH problems and the need for surgery. Side effects include erectile dysfunction and reduced libido (sex drive). You must keep taking the pills to prevent symptoms from coming back. These may be best for men with very large prostate glands. These prescription drugs may take many months to become fully effective and include dutasteride and finasteride. Combined therapy uses both an alpha-blocker and a 5-alpha reductase inhibitor. They may work better together than either drug does alone to stop BPH from getting worse.

Transurethral resection of the prostate (TURP) is a common surgery for BPH. TURP uses electric current or laser light to cut and remove tissue. This is done with anesthesia and a tool called a resectoscope inserted through the penis. The resectoscope provides light, irrigating fluid, and an electrical loop. The loop cuts tissue and seals blood vessels. The removed tissue is flushed into the bladder and out of the body with a catheter. Men who require surgery because of moderate to severe BPH symptoms may be good candidates for TURP. Holmium laser enucleation of prostate (HoLEP) is when a surgeon places a resectoscope through the penis into the urethra. A laser inserted into the resectoscope destroys excess prostate tissue. No incisions (cuts) are needed and there is very little bleeding. You may only need to stay one night in the hospital. A catheter is used, but it is usually removed the next day. Men with larger prostates who wish to avoid more invasive surgery may be good candidates for this treatment. Men with a higher risk of bleeding, such as those taking blood-thinning medications, may also be good candidates for HoLEP. Thulium laser enucleation of the prostate (ThuLEP) is similar to HoLEP but uses a different type of laser. As in HoLEP, the surgeon places a resectoscope through the penis into the urethra. A laser inserted into the resectoscope destroys excess prostate tissue. Men with larger prostates who wish to avoid more invasive surgery may be good candidates for this treatment. No incisions (cuts) are needed and there is very little bleeding. You may only need to stay one night in the hospital. A catheter is used, but it is usually removed the next day. Men with a higher risk of bleeding, such as those taking blood-thinning medications, may also be good candidates for ThuLEP.

For most men, symptoms of BPH improve after treatment. After surgery, it can take time for sexual function to return fully. Most experts believe that if you were able to have an erection shortly before surgery, you will be able to after surgery. Your orgasm is not expected to change. In some cases, men can experience an issue where semen enters the bladder rather than out the penis (retrograde ejaculation.) Infection, bleeding and incontinence may also occur after some BPH treatments. In some cases, scar tissue may form. Side effects vary with the type of treatment you choose and most side effects are temporary. Some men need further or new treatment for their BPH symptoms after initial treatment. It is of great value to tell your doctor about any side effect you may have to get help.

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