Benign prostatic hyperplasia (BPH), also know as Enlarged Prostate, is a common problem that develops as men age.
Symptoms related to prostate enlargement usually do not develop until later in life. Over half of men in their sixties and as many as 90 percent of men in their seventies and eighties have symptoms of enlarged prostate. In 2000, there were 4.5 million visits to physicians related to enlarged prostate.
At Urology of Indiana, our physicians have significant experience treating men with BPH using the latest medical and surgical advances. Treatment options range from medical management and behavoral modification to office based and outpatient procedures to help reduce the size of the prostate and provide symptomatic relief.
- Blood in the urine (i.e. hematuria), caused by straining to void
- Dribbling after voiding
- Feeling that the bladder has not emptied completely after urination
- Frequent urination, particularly at night (i.e. nocturia)
- Hesitant, interrupted, or weak urine stream caused by decreased force
- Leakage of urine (i.e. overflow incontinence)
- Pushing or straining to begin urination
- Recurrent, sudden, urgent need to urinate
An evaluation of symptoms, patient history, and physical examination provide the basis for diagnosis of enlarged prostate. Evaluation and diagnosis includes the following:
AUA Symptom Index
The AUA (American Urological Association) Symptom Index is a questionnaire designed to determine the severity of a man´s urinary problems and to help diagnose BPH. The patient answers seven questions related to common urinary symptoms. The frequency that the patient experiences each symptom is rated on a scale of 1 to 5. These numbers added together provide a total score. Typically, an AUA score of 0 to 7 means the condition is mild; 8 to 19, moderate; and 20 to 35, severe.
Digital Rectal Examination
Digital rectal exam (DRE ) is an important aspect in the evaluation of BPH. The doctor inserts a lubricated, gloved finger into the patient’s rectum to feel the surface of the prostate gland through the rectal wall to assess its size, shape, and consistency.
Prostate-specific antigen (PSA) is a specific antigen produced by the cells of the prostate capsule (membrane covering the prostate) and periurethral glands. PSA along with DRE are the main screening tools for prostate cancer. Patients with BPH may produce larger amounts of PSA and have higher baseline levels as the value is also determined in part by the size and weight of the prostate.
Uroflowmetry uses a device to record the rate of urine flow. With a full bladder, the patient urinates into a uroflowmeter that records the amount of urine, the time it takes for urination, and the rate of urine flow. A reduced flow rate may indicate obstruction secondary to BPH.
Post void residual (PVR) measures the amount of urine that remains in the bladder after urination. The patient is asked to urinate immediately prior to the test and the residual urine is determined by ultrasound. PVR less than 50 mL generally indicates adequate bladder emptying and measurements of 100 to 200 mL or higher often indicate blockage and poor bladder emptying.
Numerous medical and surgical options are available for the treatment BPH and the associated symptoms of enlarged prostate.
Alpha blockers relax the muscles of the bladder neck and prostate, which increases urinary flow and improves symptoms. Commonly prescribed alpha blockers include:
- Doxazosin (Cardura®)
- Terazosin (Hytrin®)
- Tamsulosin hydrochloride (Flomax®)
- Alfuzosin (Uroxatral®)
- Silodosin (Rapaflo®)
5-Alpha reductase inhibitors
5-Alpha reductase inhibitors prevent the conversion of testosterone to the hormone dihydrotestosterone (DHT) within the prostate. This results in a decrease in prostate size and an improvement in symptoms. 5-Alpha reductase inhibitors are often used in combination with alpha blockers in men with prostates greater than 40 grams. The medications currently on the market are:
- Dutasteride (Avodart®)
- Finasteride (Proscar®)
Surgery involves removing or ablating the enlarged portion of the prostate that constricts the urethra. It is often recommended for patients who experience complications from BPH, or those that do not want to be on medications or respond poorly to them. Some common complications of BPH may include:
- Bleeding through the urethra (hematuria)
- Damage to the kidneys caused by urine backing up
- Frequent urinary tract infections
- Inability to urinate (urinary retention)
- Stones in the bladder.
This office based procedure uses a special catheter to deliver high-temperature (41°- 44°C) microwave energy to the prostate without affecting adjacent structures. The heated catheter destroys the overgrown prostate tissue and dialates the urethra. A fiberoptic thermosensor monitors temperatures throughout the procedure, and a cooling system circulates water within the catheter applicator to protect the urinary tract. The procedure takes about an hour and is performed with a local anesthetic.
Transurethral Needle Ablation (TUNA)
The TUNA procedure delivers low level radio frequency (RF) energy to the prostate, relieving obstruction without causing damage to the urethra. A small probe is inserted through the urethra and into the prostate. Two small electrodes are deployed into the prostate and a low level of radio frequency energy is applied. The energy heats the prostate tissue and shrinks it, relieving the obstruction while protecting the urethra and surrounding areas. The TUNA procedure can be performed in an office or hospital outpatient center in less than 1 hour using minimal anesthesia.
Photoselective Vaporization of the Prostate (PVP)
PVP is a minimally invasive procedure that uses a special high-energy laser to vaporize excess prostate tissue and seal the treated area. The procedure is performed on an outpatient basis in a hospital or surgical center and may be performed under spinal or general anesthesia. PVP typically takes between 30 and 60 minutes to perform, depending on prostate size and patients are usually discharged within a few hours. Many patients do not require a catheter after PVP, and those who do typically are catheterized for less than 24 hours.
Transurethral resection of the prostate (TURP)
This procedure is performed under general or regional anesthesia and usually requires an overnight stay in the hospital. The surgeon inserts an instrument called a resectoscope into the penis through the urethra. The resectoscope is about 12 inches long and one-half an inch in diameter. It contains a light, valves for controlling irrigating fluid, and an electrical loop to remove the obstructing tissue and seal blood vessels.