Benign Prostate Hyperplasia

Benign Prostatic Hyperplasia (BPH) is a non-cancerous enlargement of the prostate, which affects a majority of men over age 50. The symptoms of Benign Prostatic Hyperplasia usually begins with urinary frequency, having to get up at night, and other minor inconveniences. Many men who have enlarged prostates never experience any symptoms, but the likelihood of developing symptoms increases as men age.

The prostate is an internal gland of the male reproductive system that is located in front of the rectum and below the bladder. The prostate gland wraps around the upper part of the urethra, the tube that carries urine out of the bladder. Benign Prostatic Hyperplasia affects the innermost part of the prostate first, so the enlargement frequently results in a gradual squeezing of the urethra where it runs through the prostate, sometimes causing difficulty urinating or other urinary problems.

Benign Prostate Hyperplasia Symptoms

Many men with BPH may have no significant symptoms, but the most common symptom that men first notice as prostate enlargement progresses is difficulty in urination. Characteristic symptoms of BPH include:

  • A weak urinary stream
  • A feeling that the bladder is not completely emptied after urination
  • Difficulty starting urination
  • Urgency (difficulty postponing urination)
  • Frequent urination
  • Nocturia (getting up at night to urinate)
  • Dribbling at the end of urination
  • Interruption of the stream (stopping and starting)

As the prostate gland enlarges, the urethra is squeezed more tightly and it becomes difficult for the bladder to empty completely. In a small percentage of men, this leads to urinary tract infections or gradual bladder and/or kidney damage.

Diagnosing Benign Prostate Hyperplasia

If you are experiencing any of the symptoms listed above or burning or pain on urination you should see your doctor. Your doctor may ask you questions about how you void or want you to fill out a questionnaire to help evaluate the severity of your symptoms. Depending on the symptoms, some additional tests may be ordered to see if you have an obstruction. A rectal examination and a blood test to check for prostate cancer (PSA test) will most likely be done on the initial visit to the urologist. The American Urological Association recommends that men age 50 and over have a prostate exam with PSA every year.

We now have an online version of the BPH Symptoms Questionnaire. Click on the link below to complete the online questionnaire.

Benign Prostatic Hyperplasia Treatments

Benign Prostatic Hyperplasia requires treatment only if the symptoms are bothersome or urinary function is seriously affected. If your symptoms are not bothersome enough, you and your doctor may decide on a course of “watchful waiting” – involving yearly or more frequent checkups. If your symptoms are more bothersome, there are several methods of treatment available to men affected by BPH. Your doctor can discuss these treatments with you to determine which is most appropriate for your condition. Medication: Four types of medication are currently being used in the treatment of BPH.

4 Types of Medications

Alpha-blockers are medications that can relax the muscle tissue in the prostate and, in this way, may relieve part of the blockage. The second type of medication, 5-alpha-reductase inhibitors, partially shrinks the enlarged prostate by blocking the effect on the prostate of the major male hormone, testosterone. The third medicine is a specific phosphodiesterase inhibitor called Cialis (and actually it is the daily, low-dose form of this medication indicated for the treatment of BPH). The exact mechanism of action is not clear but it has the added benefit of also potentially improving the patient’s erectile function. The final category of “medication” is herbal products, the most commonly used being saw palmetto. Many men get significant symptom relief with these over the counter “supplements.” One drawback to herbal products is the lack of standardization of their content and labelling since they are not regulated closely by the FDA. Trans-Urethral Microwave Thermotherapy (TUMT): Microwave therapy gives an alternative to surgery or a lifetime of medication for certain patients. The procedure involves placing a special catheter in the urethra that delivers heat to the prostate via microwaves, causing shrinkage of the prostate gland. It takes approximately one hour to perform the procedure and the patient is placed under local anesthesia. Because of the simplicity of the procedure, it is usually done on an outpatient basis or in the office and it can offer a significant improvement in urine flow and symptoms for most patients. Many men are good candidates for this procedure, but your doctor will take under consideration certain criteria like overall health and the severity of the symptoms. It is generally the only procedure that is completely safe for men who must remain on blood thinners at all times. For more information: www.Prolieve.com Transurethral Resection of the Prostate (TURP or “standard” TURP): Transurethral resection of the prostate is a surgical procedure, which has been done for decades. It involves inserting a scope into the urethra (the tube inside of the penis) and surgically removing a portion of the obstructing prostate tissue. This procedure reduces pressure on the urethra, which is being “pinched” by the enlargement of the surrounding prostate. No external incisions are made, it is all done through the scope inside the urethra. TURP remains an excellent treatment for BPH although it does introduce some surgical risk. A newer technology which decreases bleeding and speeds healing is called a “bipolar TURP.” What makes this different is the electrical energy source used to cut through the tissue being removed. Both forms of the TURP have the slight advantage of providing tissue to examine under the microscope. In uncommon instances where the possibility of prostate cancer is an unanswered question, this can be desired. Visual Laser Ablation of Prostate (VLAP) also called a “laser TURP”: Like a TURP as described above, the VLAP eliminates the obstructing prostate tissue. This is achieved by vaporizing the tissue with high energy from a laser inserted and directed through the scope. It generally involves less bleeding, less pain and a shorter recovery time than a standard TURP, although it still requires an anesthetic. Its disadvantage is that a very large prostate may not be adequately treated with this procedure. The two most commonly used lasers for this procedure are the “Green Light” and the holmium lasers. TransUrethral Vaporization of Prostate (TUVP): This is basically the same as the VLAP, except that the energy source used to vaporize the obstructing prostate tissue is electrical instead of laser. Subtotal prostatectomy: If the prostate is really large, the above options are less successful than desired. For such prostates a “subtotal” is a better choice. If you think of the prostate like an orange with the urethra running through its middle, it is the pulp that blocks the flow of urine. All of the above procedures remove the “pulp” while leaving the “peel” intact. A subtotal prostatectomy utilizes a laparoscopic approach requiring several small (1/2 – 1”) lower abdominal incisions. The surgeon uses lighted instruments to open the “peeling” and remove the “pulp.” The peeling is then sewn back together. This is very effective for very large prostates.

Could you benefit from treatment for BPH? Please pick the answer that best describes your response to each of the following questions.

0=Not at All

1=Less than 1 time in 5

2=Less than half the time

3=About half the time

4=More than half the time

5=Almost Always

Incomplete emptying over the past month, how often have you had a sensation of not emptying your bladder completely after you have finished urinating?

0 1 2 3 4 5

Frequency over the past month, how often have you had to urinate again less than 2 hours after you have finished urinating?

0 1 2 3 4 5

Intermittency over the past month, how often have you found you stopped and started again several times when you urinated?

0 1 2 3 4 5

Urgency over the past month, how often have you had a weak urinary stream?

0 1 2 3 4 5

Weak Stream over the past month, how often have you had a weak urinary stream?

0 1 2 3 4 5

Straining over the past month, how often have you had to push or strain to begin urination?

0 1 2 3 4 5

Nocturia over the past month, how many times did you most typically get up to urinate from the time you went to bed at night until the time you got up in the morning?

0 1 2 3 4 5

Score ___________
Add the numbers from your answers to questions 1 through 7. The maximum possible score is 35. Remember: This information is not intended as a substitute for medical treatment.

Note: This test is used to measure the severity of your symptoms. This is not a diagnostic test. In other words, it will not tell you whether or not you have BPH. Talk to your doctor to determine if your symptoms are due to BPH.

Adapted from Barry MJ, et al. The American Urological Association symptom index for benign prostatic hyperplasia. J Urol. 1992; 148: 1549-1557.

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