Benign Prostatic Hyperplasia (BPH)
What is BPH?
Benign prostatic hyperplasia (BPH) is an enlargement of the prostate gland that commonly occurs as men age. It can contribute to bothersome lower urinary tract symptoms (LUTS)
What are the symptoms of BPH?
BPH can cause a variety of bothersome urinary symptoms including urinary frequency, urinary urgency, waking up at night to urinate (nocturia), incomplete bladder emptying, weak urinary stream, and occasionally urinary dribbling or incontinence.
How is BPH diagnosed?
A detailed medical history including surveys such as the American Urological Association (AUA) Symptom Score are the most important diagnostic tool. A digital rectal exam to feel the size and texture of the prostate is also important. In addition, a urinary flow rate and the amount of urine left in the bladder after urinating (post-void residual) can be useful diagnostic tools. A urinalysis to rule out infection or possible bladder tumor as the cause of symptoms is performed and in men over 50, a prostate specific antigen (PSA) should be checked to screen for prostate cancer. If these tests are non-conclusive or if surgery is planned to treat BPH, urodynamics, cystoscopy, or prostate ultrasound may be utilized.
How is BPH treated?
There are multiple medical treatments for BPH. One class of medications are referred to as alpha-blockers. These medications help to relax the smooth muscle in the prostate and bladder neck to allow the urine to flow better. The most common medications in this class include terazosin (Flomax), alfuzosin (Uroxatral), doxazosin (Cardura), and terazosin (Hytrin). The most common side effects of these drugs is occasional lightheadedness and retrograde ejaculation.
Another class of medications for BPH are called 5-alpha reductase inhibitors and include finasteride (Proscar) and dutasteride (Avodart). These medications decrease the levels of dihydrotestosterone (DHT) in the prostate which causes the prostate to shrink.
A third class of medications used to treat urinary symptoms related to BPH is called anti-muscarinics. These medications help to relax the bladder muscle which can reduce urinary frequency, urgency, nocturia, and incontinence. The common medications in this class include tolterodine (Detrol), oxybutynin (Ditropan), darifenacin (Enablex), trospium chloride (Sanctura0, and solifenacin (Vesicare). The primary side effects of these drugs include dry mouth, dry eyes, and constipation.
There are multiple surgical options that we offer for the management of BPH. Almost all of the current surgical treatments for BPH are minimally invasive.
One of these treatments is called transurethral microwave therapy (TUMT) and we offer the Prolieve system in our office. This treatment is performed in the office, does not require anesthesia, and in the majority of the cases, does not even require a catheter after the procedure. It uses a special catheter with a balloon that helps to expand the prostate and then utilizes microwave energy to help shrink the enlarged prostate.
We also offer several types of laser prostate ablation. These are outpatient surgical procedures that are performed endoscopically with no incisions and minimal blood loss. During all of these procedures, a scope is placed into the urethra and the prostate is visualized directly and a laser is utilized to vaporize the enlarged prostate tissue.
At Specialized Urologic Consultants, we offer the following laser procedures:
- Holmium laser vaporization of the prostate or HoLAP.
- Photoselective vaporization of the prostate also known as the GreenLight laser.
- The EVOLVE® procedure.
Occasionally, the prostate is too enlarged for these minimally invasive procedures and a simple prostatectomy must be performed. This is an open procedure with a small, lower abdominal incision, where the majority of the large, overgrown prostate is removed.