Benign Prostatic Hyperplasia (BPH)
Benign Prostatic Hyperplasia (BPH)
During adulthood, a man’s prostate gland continues to grow. Eventually, an enlarged prostate, known as benign hyperplasia or BPH, may interfere with urination.
The prostate gland in its healthy state is about the size of a walnut. It’s located just below the bladder at the base of the penis and produces part of a man's seminal fluid. A natural consequence of aging, an enlarged prostate can cause problems that range from simple to serious.
BPH can include a burning sensation during urination, urinary tract infection, blood in the urine, leakage, urinary retention and a feeling that the bladder does not empty completely. The symptoms of BPH can be especially disruptive to nightly sleep and daily activity.
According to the National Institute of Diabetes and Digestive and Kidney Diseases, more than half of men in their 60s have some symptoms of BPH, with as many as 90 percent displaying symptoms in their 70s and 80s.
As the prostate enlarges, it presses against the urethra, the tube that allows urine to pass out of the body, and interferes with urination. At the same time, the bladder wall becomes thicker and irritated, and begins to contract — even when it contains only small amounts of urine — which causes more frequent and sometimes urgent urination.
If the bladder continues to weaken, it may not empty completely and leave some urine behind, leading to a frequent sensation of having to void, having a slow urinary flow, increased risk of urinary infection and waking up at night to urinate. In the most severe cases when this condition is neglected, it can lead to irreversible bladder damage and kidney failure.
Lifestyle management for BPH may include:
- Dietary factors. Avoiding or decreasing the intake of alcohol, coffee and other fluids particularly after dinner is often helpful. A higher risk for BPH has been associated with diets high in zinc, butter and margarine. Men who eat lots of fruits are thought to have a lower risk for BPH.
- Medications that worsen symptoms. Decongestants and antihistamines can slow urine flow in some men with BPH. Some antidepressants and diuretics can also aggravate symptoms. Consult your doctor to discuss changing dosages or switching medications.
- Kegel exercises. Repeatedly tightening and releasing the pelvic muscle, also known as Kegel exercises, is helpful in preventing urine leakage. Consult your doctor, who may recommend you practice this exercise while urinating. To perform a Kegel, you contract your pelvic muscle until the flow of urine stops, then release. Repeat five to 15 contractions, holding each for 10 seconds, three to five times a day. Often men confuse the “Kegel muscles” with their thigh muscles and squeeze their thighs. If you perform these exercises properly, you will not move your legs.
Symptoms and Diagnosis
When symptoms exist for an enlarged prostate, they may include:
- Leaking or dribbling of urine
- More frequent urination, especially at night
- Urgency to urinate
- Urine retention (inability to urinate)
- A hesitant, interrupted, weak stream of urine
These problems may lead to:
- Kidney damage
- Bladder damage
- Urinary tract infections
- Bladder stones
- Inability to pass urine
The symptoms of benign prostatic hyperplasia may resemble other conditions or medical problems, which is why the urologists at El Camino Hospital perform such thorough examinations.
Diagnosing BPH in its earlier stages can lower the risk of developing complications. In addition to a complete medical history and physical examination, our diagnostic procedures for BPH may include:
- Digital rectal exam. The doctor inserts a gloved finger into the rectum to examine the rectum and the prostate gland.
- Intravenous pyelogram. Your doctor conducts a series of X-rays of the kidney, ureters (tubes that carry urine from the kidneys to the bladder) and bladder using an injection of contrast dye to detect tumors, abnormalities, kidney stones or other obstructions, and to assess renal (kidney) blood flow.
- Cystoscopy (also called cystourethroscopy). Your doctor inserts a flexible tube and viewing device through the urethra to examine the bladder and urinary tract for abnormalities or obstructions.
- Urine flow study. You urinate into a special device that measures how quickly the urine is flowing; reduced flow may suggest BPH.
- Residual urine measurement. Your doctor takes an ultrasound of your bladder to measure the amount of urine remaining after you have emptied your bladder.
- Urodynamics. For patients with more complex problems, doctors use this multifunctional test to asses voiding function.
BPH can raise PSA (prostate-specific antigen) levels two to three times higher than the normal level. While an increased PSA level does not necessarily indicate cancer, the higher the level, the higher the chance of having cancer.
Some of the signs of BPH and prostate cancer are the same; however, having BPH does not increase the chances of developing prostate cancer.
A man who has BPH may also have undetected prostate cancer at the same time or may develop it in the future. Therefore, the National Cancer Institute and the American Cancer Society recommend that all men over 50 consult their doctors about having a digital rectal and PSA examination once a year.
If your doctor suspects cancer, you may need a prostate biopsy, in which tissue samples are removed to determine if abnormal cells are present. El Camino Hospital is one of the first South Bay hospitals to offer Artemis™ 3D Imaging and Navigation for exceptionally precise imagery, which we use to diagnose and perform biopsies.
Research has shown that in some mild cases, symptoms of BPH may clear up without treatment. But eventually, BPH symptoms may demand your doctor’s attention.
Nonsurgical treatments include medication to shrink or stop the growth of the prostate, or loosen the muscles around the urethra so the urine flows more easily.
Treatment may also include surgery to remove the excess prostate tissue that is pressing against the urethra and blocking the flow of urine. Surgical options include:
Photoselective vaporization of the prostate, or PVP, is a procedure that removes prostate tissue by using a laser inserted through the penis to turn the excess tissues into gas. The surgery can be done on an outpatient basis, in most cases.
El Camino Hospital urologists are known for their expertise in the use and training of the newest and most sophisticated PVP technology, GreenLight™ XPS.
When using GreenLight, the surgeon inserts a thin fiber into the urethra through a cystocope which gives the surgeon the ability to view and control the treatment area. The laser energy can be precisely delivered to the excess prostate tissue that is obstructing the passage of urine, where it vaporizes and destroys the blockage.
Most patients treated with the GreenLight XPS are released from the hospital within a few hours of the procedure and can return home. Typically a catheter (a tube placed in the urethra that allows urine to drain from the bladder) is in place for less than 24 hours, and patients can resume normal non-strenuous activity within days.
The laser can also be used to enucleate (remove without cutting) the excess tissue. If you have a very large prostate, your doctor may use GreenLight Laser Enucleation of the Prostate (GLEP) to avoid open surgery.
El Camino Hospital also offers treatment via the Wolf Pirhana morcellator. A morcellator is a surgical instrument used for division and removal of large masses of tissues during laparoscopic surgery. This new technology allows the surgeon to puree large amounts of excess prostate tissue inside the body, then suction it out, decreasing the time it takes to operate.
Transurethral vaporization of the prostate, or TUVP, is a surgical procedure that uses a resectoscope inserted through the penis to reach and remove obstructive prostate tissue with electrovaporization.
El Camino Hospital uses the new PlasmaButton™ technology. The resectoscope (a combined visual and surgical instrument) contains a light and a rollerball electrode. The electrode uses low-voltage and low -temperature plasma energy to gently heat and dry up tissue and seal blood vessels. A catheter is then inserted into the bladder. You receive general or spinal anesthesia and remain in the hospital on a "short stay" or outpatient basis. Relief from the symptoms of BPH quickly follows the procedure.
Transurethral Incision of the Prostate (TUIP)
This type of prostate surgery relieves moderate to severe urinary symptoms caused by BPH. The surgeon inserts a resectoscope (a combined visual and surgical instrument) through the urethra, to the point where it is surrounded by prostate tissue. To open up the urinary channel, the surgeon cuts one or two small grooves in the area where the prostate and the bladder are connected (bladder neck). This allows urine to pass through more easily.
Your surgeon inserts the UroLift device into the urethra through a slender rigid sheath (cystoscope). The tip of the device is used to push the obstructive prostate tissue out of the way. Your surgeon then deploys a needle from the device to deliver the permanent suture implant, using as many sutures as needed. Watch an ABC news story about the Urolift device.
The term “open surgery” refers to surgery that requires an external incision. Open surgery is performed for BPH when the prostate gland is very enlarged, when there are complicating factors or when the bladder has been damaged and needs to be repaired.
To learn more about how we can help you, call 408-866-7331.
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