BPH

BPH Evaluation at Southland Urology

Benign prostatic hyperplasia (BPH) is a very common, non-cancerous enlargement of the prostate gland that occurs in many aging men. As the prostate grows, it can press on the urethra, leading to a variety of urinary symptoms such as frequent or urgent urination, a weak stream, and the feeling of incomplete bladder emptying. While not life-threatening, BPH can significantly impact a man’s quality of life, and a number of effective treatment options are available.

Understanding Incontinence

What is Benign Prostatic Hyperplasia (BPH)?

Benign prostatic hyperplasia, or BPH, is a condition where the prostate gland grows in size. The prostate is a small, walnut-shaped gland located just below the bladder and surrounds the urethra. As a man ages, it’s very common for the cells in the prostate to begin to multiply, causing the gland to enlarge. This growth is non-cancerous, but as the prostate gets bigger, it can compress the urethra, making it difficult for urine to flow out of the bladder. This is the root cause of the bothersome urinary symptoms that define BPH.

Symptoms of BPH

The symptoms of BPH are often referred to as Lower Urinary Tract Symptoms (LUTS). These symptoms can range from mild to severe and can vary from man to man. The most common symptoms include a frequent or urgent need to urinate, a weak or slow urinary stream, the need to strain to urinate, and a feeling that the bladder is not completely empty after urination. Many men also experience nocturia, which is the frequent need to wake up at night to urinate. While these symptoms are rarely life-threatening, they can significantly disrupt sleep, social activities, and overall quality of life.

Diagnosis

Diagnosing BPH typically involves a multi-step process. A urologist will start by taking a detailed medical history and asking about your symptoms. They may use a symptom score sheet to gauge the severity of your BPH. A physical exam, including a digital rectal exam (DRE), is performed to feel the size, shape, and consistency of the prostate. Other diagnostic tests may include a urinalysis to rule out an infection, a PSA blood test to check for prostate cancer, and a urinary flow study to measure the speed and volume of urine flow. An ultrasound may also be used to measure the prostate size and to check for residual urine in the bladder after urination.

Non-Surgical Management

For men with mild to moderate symptoms, non-surgical options are often the first line of treatment. These include lifestyle modifications, such as limiting fluids before bedtime, reducing caffeine and alcohol intake, and bladder training. Oral medications are a common and effective treatment. Alpha-blockers work by relaxing the muscles in the prostate and bladder neck, improving urine flow. 5-alpha reductase inhibitors work by shrinking the prostate gland itself. For some men, a combination of these medications is recommended.

Minimally Invasive Procedures

For men who are not getting enough relief from medications or who are looking for a more permanent solution, several minimally invasive procedures are available. Rezum therapy uses targeted bursts of steam to shrink the prostate tissue. UroLift uses tiny implants to hold the enlarged prostate lobes apart, opening the urethra. Both of these procedures are performed in a doctor’s office or surgical center and typically have a very fast recovery time with a low risk of sexual side effects. These options provide a middle ground between medication and more traditional surgery.

Surgical Treatment

For men with severe BPH symptoms or a very large prostate, surgery may be the best option for long-lasting relief. The most common surgical procedure is a Transurethral Resection of the Prostate (TURP). During a TURP, a surgeon uses a resectoscope to trim away excess prostate tissue from the inside. More recently, Aquablation is being used to treat both medium and large sized prostates using a high-pressure water jet to remove prostate tissue without heat. Other surgical options include laser procedures that vaporize prostate tissue, such as photoselective vaporization (PVP), and robotic or open surgery for extremely large prostates. While surgery offers the most durable results, it comes with a longer recovery time and a higher risk of side effects, including retrograde ejaculation.