Enlarged Prostate (BPH)

Benign Prostatic Hyperplasia (BPH) is a noncancerous enlargement of the prostate gland. Typically, the prostate gland continues to grow during adult life, beginning to cause urinary symptoms when a man reaches his 40’s. Fifty percent of all men between the ages of 51 and 60 and 90% of men over the age of 80 have BPH.

Because the urinary tube runs through the middle of the prostate, as the prostate grows, it may cause significant urinary symptoms. Patients often experience a slowing of the flow of urine and more nighttime trips to the bathroom. If left untreated, the bladder muscle may become weak and cause health problems, including irreversible bladder or kidney damage, bladder stones and incontinence.

Who is more likely to develop BPH?

You're more likely to develop BPH if you:

• Are age 40 or older.
• Have family members who have had BPH.
• Have certain health conditions such as:
  • Obesity.
  • Heart disease and problems with blood circulation.
  • Type 2 diabetes.
  • Erectile dysfunction.
  • Don't get enough physical activity.

What are the symptoms of BPH?

Symptoms of BPH include:

• Having a frequent or urgent need to urinate
• Waking up many times to urinate
• Having problems with urine flow, such as:
• Trouble starting to urinate
• A stream that's weak, slow, or stops and starts
• Dribbling after urination
• Urinary incontinence
• Feeling that you can't completely empty your bladder

It's important to see your health care provider if you have any of these symptoms because they could be from a more serious health problem.

What other problems can BPH cause?

Symptoms of BPH can range from mild to moderate to severe and often worsen over time. BPH increases your chance of developing serious conditions, including:

• Acute urinary retention. A sudden inability to urinate at all. This a medical emergency. It may be triggered by:
  • Taking certain over-the-counter cold or allergy medicines
  • Drinking alcohol
  • Cold temperatures
  • Not moving enough over a long period of time
  • Urinary tract infections (UTIs)
  • Bladder damage and bladder stones

How is BPH diagnosed?

To find out if you have BPH, your provider will:

• Ask about your medical history. Be sure to tell your provider about all the medicines you take, because certain medicines can make BPH symptoms worse.
• Ask about your family health history.
• Examine you. The exam may include a digital rectal exam (DRE) of your prostate. In a DRE, your provider inserts a gloved finger into your rectum to help determine the size of the prostate and to try to rule out more significant issues like prostate cancer.
• Order medical tests, if needed, such as:
• Urine tests.
• A PSA blood test (prostate-specific antigen test).
• Urodynamic testing to see how well you can hold and release urine.
• Cystoscopy to look inside your urethra, prostate and bladder.
• Ultrasound pictures of your prostate and urinary tract.
• A prostate biopsy if there is any concern for prostate cancer.

What are the treatments for BPH?

Treatment options depend on how much your symptoms bother you, your health, age, and the size of your prostate. It is important to not ignore symptoms as they can have lasting impacts on the health and function of the bladder:

Lifestyle changes may improve mild symptoms. They include:

• Drinking less before bedtime or going out
• Avoiding or cutting back on beverages with caffeine and alcohol
• Bladder training and exercising the muscles that control urine flow
• Preventing or treating constipation

Medication can help mild to moderate symptoms. They improve symptoms by:

• Stopping the prostate from growing
• Shrinking the prostate
• Relaxing muscles to improve urine flow

However, the most commonly prescribed medications, alpha blockers and 5-alpha-reductase inhibitors, that have traditionally been used to treat BPH can have several side effects, including sexual issues.

Surgery or other procedures can help improve moderate to severe BPH symptoms. They’re an option if you:

• Don't get enough relief from medicines.
• Prefer not to try medicine.
• Have other problems like bladder stones, blood in the urine or UTIs.

There are a number of surgical techniques for BPH. Each involves increasing the passageway for urine to travel out of the bladder by removing the obstructing prostate tissue. However, the potential permanent side effects of traditional surgery include an impact on sexual function.

The newest way to reliably remove the most tissue with the least likelihood of sexual side effects or the need for a repeat surgery is called Aquablation — a minimally invasive, robotically controlled procedure.