Prostate Enlargment (aka BPH)
The prostate is a male gland that is around the urethra (urinary channel), near the bladder. Its main role is during the fertility years, since it makes much of the fluid that come out during ejaculation. It grows as men age and may start to cause partial or complete blockage of the urinary stream. This can cause a variety of symptoms (see below), ranging from “obstructive” (slow stream, incomplete bladder emptying) to “irritative” (urgency to void, voiding multiple times at night). Overtime, the bladder, which works harder and harder to get the urine out, may start to become abnormal. BPH is NOT the same as prostate cancer. Prostate cancer is also common in men but usually does not cause urinary symptoms until it has been present for a long time.
There is also a link between ED and BPH although no one is entirely sure why that is. We know that if one is treated, the other often gets better also.
Symptoms may include:
- Urinary frequency (day or night)
- Urinary urgency (i.e. a stronger urge than usual to urinate). If this is very strong, the patient may even have incontinence [link]
- Urinary hesitancy (difficulty initiating the urination) or straining to urinate
- Incomplete bladder emptying: this may be just a feeling or it may be the case that the bladder is retaining too much urine
- Weak or “stuttering” urinary stream
There are many tools to evaluate how severe the problem is and how we may best fix it.
Some common ones include:
- Questionnaires, such as the AUSSS [link to form]
- Ultrasound to determine whether the bladder is emptying
- Rectal examination to evaluate the size and texture of the prostate
- Blood tests including PSA (the level of a chemical made by the prostate)
- Cystoscopy (looking inside urinary channel with a small camera)
TREATMENT OF BPH
Treatment depends on a larger number of factors, including how severe the symptoms are, the size of the prostate, whether bladder is normal or abnormal, etc. If the patient is not very bothered by the symptoms, often they do not require any treatment other than a periodic visit to make sure things aren’t getting worse.
If treatment is desired or required, there are various medications aimed at relaxing the muscles in the prostate (Flomax/tamsulosin, Hytrin/terazosin, etc), shrinking the prostate (Proscar/finasteride, Avodart/dutasteride), or relaxing the bladder (Sanctura/trospium, Detrol/tolteridine, Ditropan/oxybutinin, etc). These medications work for many men and are generally well-tolerated although they often have mild side effects.
For those men who either fail medications or do not want to be on chronic medications, office procedures may be helpful such as thermotherapy or TUMT (which uses microwaves). These are office procedures that are relatively quick and require only pills for pain control.
For men who want more definitive therapy and who either cannot take medication or do not want to be on chronic medications, surgical procedures are the “gold standard” for treatment of BPH.
- Open, “simple” (i.e. done for BPH, not prostate cancer) prostatectomy is not performed often, since other less invasive procedures are so successful. It is reserved for very large prostates. It requires several days stay in the hospital.
- TURP (TransUrethral Resection of the Prostate) is still commonly done and works very well. With new, bipolar technology and techniques, the patient usually just stays overnight in the hospital and does not require going home with a catheter. This is done through a camera (there are no incisions).
- Laser prostate surgery has become very popular, since it works well, has very little bleeding, and most patients can go home the same day. It is an attractive alternative to TURP for many patients. We have expertise at this type of prostate surgery as well. [link to Greenlight site]