Benign Prostatic Hyperplasia
Benign Prostatic Hyperplasia: What You Need to Know
Benign prostatic hyperplasia, a noncancerous enlargement of the prostate gland, is the most common benign tumor found in men. Not long ago, a study found a possible genetic link for BPH in men younger than age 65 who have a very enlarged prostate: Their male relatives were four times more likely than other men to need BPH surgery at some point in their lives, and their brothers had a sixfold increase in risk.
BPH produces symptoms by obstructing the flow of urine through the urethra. Symptoms related to BPH are present in about one in four men by age 55, and in half of 75-year-old men. However, treatment is only necessary if symptoms become bothersome. By age 80, some 20% to 30% of men experience BPH symptoms severe enough to require treatment. Surgery was the only option until the recent approval of minimally invasive procedures that open the prostatic urethra, and drugs that can relieve symptoms either by shrinking the prostate or by relaxing the prostate muscle tissue that constricts the urethra.
Symptoms
BPH symptoms can be divided into those caused directly by urethral obstruction and those due to secondary changes in the bladder.
Typical obstructive symptoms are:
Difficulty starting to urinate despite pushing and straining
A weak stream of urine; several interruptions in the stream
Dribbling at the end of urination
Bladder changes cause:
A sudden strong desire to urinate (urgency)
Frequent urination
The sensation that the bladder is not empty after urination is completed
Frequent awakening at night to urinate (nocturia)
As the bladder becomes more sensitive to retained urine, a man may become incontinent (unable to control the bladder, causing bed wetting at night or inability to respond quickly enough to urinary urgency).
Burning or pain during urination can occur if a bladder tumor, infection or stone is present. Blood in the urine (hematuria) may herald BPH, but most men with BPH do not have hematuria.
Treatment options for BPH
Medication.
An obstructing prostate can be treated with two types of medication either alone or in combination.
Alpha-blockers are the most commonly used and work by relaxing the prostate to improve the urine flow. Most men will also experience a loss of semen ejaculation but no effect on libido or errections. Occasionally side effects from low blood pressure can lead to cessation. Tamsulosin (FLOMAXTRA) and Silodosin (UROREC) are the most commonly prescribed.
The second group, 5 alpha reductase inhibitors, are mostly used in combination with alpha-blockers. These medicines alter testosterone metabolism leading to a shrinking of the prostate over several months. They commonly interfere with libido and errctions and as such are not used much in younger patients. DUODART is the combination medication available in Australia.
Minimally invasive.
These treatments are usually undertaken as day case procedures and are an alternative to ongoing medication in men who are not ready for surgery. As they do not remove any prostate tissue symptoms will usually progress over a 3 to 5 year period.
My preference is the UROLIFT which involves small staples to pin back the prostate lobes to improve urine flow.
Surgery.
Surgical treatments work by removing the central prostate tissue to open up the channel to improve flow and bladder emptying.
Commonly known as a “Rebore” the TURP was pioneered in the 1920s and became the main treatment for BPH from the 1960s . It remains an excellent treatment option but usually requires a two night stay in hospital.
Since 2010 I have predominantly been using the GreenLight laser to remove the central prostate tissue. The main advantage is less bleeding with the majority of patients only staying one night in hospital.