Benign Prostatic Hyperplasia (BPH) Overview

Benign prostatic hyperplasia (BPH) at a glance

• BPH is an enlarged prostate gland in men.
• The prostate gland surrounds the urethra (a tube that carries urine out of the body) which, when squeezed by an enlarged prostate, causes bothersome urinary problems.
• BPH is not prostate cancer and it does not cause cancer.
• Many men over age 40 have a small amount of BPH, as the prostate naturally enlarges with age.
• The symptoms of BPH can be relieved by lifestyle changes, herbal medications, prescription medications, Rezūm therapy and surgery.

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What is a prostate gland?

The prostate gland is part of the male reproductive system. The prostate is a walnut-sized gland located between the bladder and the penis. The prostate is just in front of the rectum. The urethra runs through the center of the prostate, from the bladder to the penis, letting urine flow out of the body.

The prostate secretes fluid that nourishes and protects sperm. During ejaculation, the prostate squeezes this fluid into the urethra, and it is expelled with sperm as semen.

What is BPH?

Benign prostatic hyperplasia (BPH) is another name for prostate gland enlargement (it is also known as benign prostatic hypertrophy). BPH is one of the most common urological conditions among men. BPH is not prostate cancer.

As urine exits the bladder, it first passes through the prostate gland. An enlarged prostate can cause trouble with urination. As the prostate enlarges, it puts pressure on the bladder. This makes urinating more difficult. Common symptoms include: urinary frequency, urgency, slow flow, need to urinate at night, and difficulty starting the urine flow. When advanced, BPH can lead to serious side effects such as urinary tract infection, complete inability to urinate, and kidney failure. Although most symptoms are simply a nuisance, it can lead to much more serious medical problems.

The prospect of developing BPH increases with age. More than half of men age 50 years or older have some symptoms of BPH; more than 90 percent of men older than 80 have BPH symptoms.

Causes of BPH

No one knows exactly what causes BPH. It appears to be a normal part of aging, as changing hormone balance and cell growth causes the prostate to enlarge.

Most men’s prostates continue to grow throughout their lives. For many, this growth causes the prostate to become large enough to cause issues with urination. Men age 50 and above are more likely to develop symptoms from BPH.

Several risk factors may make BPH more likely:

• Age 40+. Approximately 30 percent of men notice BPH symptoms by the time they are 60. Half experience symptoms by age 75. Men under age 40 seldom have BPH.
• Family history. BPH is more common among men with a family history of prostate problems.
• Obesity increases the risk of BPH. Exercise can make BPH less likely.
• Heart disease and diabetes. Having diabetes, having heart disease and taking beta blocker medications might increase a man’s risk for BPH.
• Ethnic background. African-American men might experience BPH symptoms at a younger age than others. Asian men are less likely to experience BPH.

Symptoms of BPH

As the prostate grows, it squeezes or presses the urethra. Men might notice problems with urination as a result. Common symptoms include:

• A weak stream
• The need to urinate frequently
• Difficulty urinating
• Feeling the bladder is not empty after urination
• Dribbling after urination
• Needing to wake in the night to urinate
• Bloody urine and pain urinating may be signs of infection.

For some men, BPH causes few or no symptoms. What kind of symptoms a person has, or how severe they are isn’t necessarily related to how much the prostate is enlarged.

In severe cases untreated BPH can lead to inability to urinate (urinary retention), urinary tract infections or kidney problems.

Cold weather, stress (emotional or physical) and some medications can make symptoms worse. Sometimes, other conditions cause these symptoms. If symptoms come on suddenly or suddenly get worse, men should contact their doctor to discuss the cause. If a man can’t urinate at all, he should seek medical attention immediately.

Diagnosing BPH

Men who suspect they might have BPH should see their doctor.

If the doctor suspects BPH, he might order further tests to confirm the diagnosis. IPSS or AUA score questionnaires can help identify the severity of the symptoms. Digital rectal exam (DRE) will estimate the size of the prostate. Other tests may include: urine flow and bladder emptying assessment, cystoscopy, ultrasound, and urodynamic studies. An ultrasound and biopsy may be necessary if prostate cancer is suspected.

Additionally, the doctor might take a blood sample for a prostate-specific antigen (PSA) test. The PSA test will help evaluate for the presence of prostate cancer. Prostate cancer has some of the same symptoms, although BPH and prostate cancer are not related.

Treatment for BPH

Many men benefit from simple home treatment of BPH, which involves lifestyle changes and herbal remedies. Others require medication or minimally invasive therapies. Some need surgery to correct the problem. We also offer a new, natural treatment called Rezūm that is an in-office procedure.

Learn About Rezum Treatment

Lifestyle changes

Daily or home treatment doesn’t prevent the prostate from getting larger, but it can relieve the annoying symptoms.

Doctors often suggest that men:

• Limit beverages within an hour or two of bedtime.
• Do not wait too long to urinate. Making a point of urinating at regular times through the day can calm urinary frequency and urgency.
• “Double void” means urinating as normal, relaxing briefly, then urinating again.
• Avoidcaffeine and alcohol, which are diuretics (increase urine output). These can also irritate the bladder, causing more frequent urination.
• Avoid antihistamines and decongestants. These medications constrict the prostate and can make it harder to urinate.
• Stay active and eat healthily. Even light exercise can help reduce the urinary problems BPH causes. Keeping a healthy weight can minimize BPH-related issues.

Medications

Doctors commonly prescribe medication to treat mild to moderate symptoms of BPH. Medication options include:

• Alpha blockers. These medications relax muscles in the prostate. As a result, urination is easier. If the prostate is not very large, alpha-blockers work quickly.
• 5-alpha reductase inhibitors. These medications shrink the prostate but can take six months to two years before results are seen.
• Combination drug therapy. Combination medication is used at times to treat both the symptoms and the cause of BPH simultaneously.
• Tadalafil (Cialis). Daily treatment with this medication can alleviate the symptoms of BPH in addition to treating erectile dysfunction.

Rezūm

Urology Associates recently became the first practice in Colorado to offer Rezūm, a new proprietary therapy offered by NxThera that uses stored energy that occurs in water vapor to shrink prostate tissue in men with BPH. UA’s Dr. Barret Cowan served as one of the lead investigators in the clinical trials of Rezūm, and has performed many of the procedures with good results.

The nonsurgical, nonmedicinal procedure is done in-office and takes 5-10 minutes. The urologist inserts a small device through the man’s urethra that delivers water vapor directly into the prostate tissue enlarged by BPH. The thermal energy from the water vapor kills the enlarged cells and the reduction in tissue relieves most of the symptoms of BPH.

GreenLight™

GreenLight™ Laser Therapy is a minimally invasive procedure designed to treat BPH. This procedure uses a laser to rapidly heat and vaporize excess prostate tissue. Removing the extra tissue quickly restores natural urine flow in most individuals.

GreenLight™ Laser Therapy is typically performed in an outpatient setting with most patients being able go home within a few hours.

Surgery

The surgeon will help the patient choose the most effective option. Some surgical treatment options for BPH include:

• Transurethral resection of the prostate (TURP). The surgeon inserts a lighted scope into the urethra and removes only the obstructing portion of the prostate. Most men have a stronger urine flow soon after the procedure.
• Transurethral incision of the prostate (TUIP). Using a lighted scope inserted into the urethra, the surgeon makes one or two small cuts in the prostate gland. These incisions make more room so that urine can pass through the urethra more easily.
• Transurethral microwave thermotherapy (TUMT). A special catheter, inserted through the urethra into the prostate region, uses microwave energy to destroy the inner part of the enlarged prostate gland. The procedure shrinks the prostate and makes urine flow easier. This procedure is performed in the urologist’s office.
• Laser ablation. Using laser energy the surgeon can open the urinary channel by removing the obstructing portion of the gland. The majority of patients go home within 2 hours of the procedure.
• Transurethral needle ablation (TUNA). A scope allows the surgeon to place needles in the prostate gland via the urethra. The needles carry radio waves that heat excess prostate tissue and destroy it.
• Urolift. This new procedure uses special tags to compress the sides of the prostate, which results in increased urine flow.
• Open or robot-assisted prostatectomy. For patients with a very large prostate conventional surgery may be the best choice. The surgery removes prostate tissue via an incision in the lower abdomen. Patients usually require a short hospital stay afterward.