Benign prostatic hypertrophy
The prostate is a small gland present in men, located just below the bladder. The prostate encloses the urine passage (urethra) and is usually about the size of a walnut. Although men have a prostate all their lives it usually begins to enlarge at mid-life. As men age, the prostate continues to grow and may push in on the urine passage. A prostate gland that is larger than normal is said to be hypertrophic, and the condition is called benign prostatic hypertrophy (BPH). An enlarged prostate does not indicate prostate cancer. The enlargement caused by aging is inevitable, but suffering from symptoms of an enlarged prostate is not.
The Department of Urology at Wayne State University has extensive experience treating men with BPH. We have been a leader in urologic research and innovative surgical treatment. Most of the diagnostic procedures for BPH can be completed in office.
Symptoms of BPH
- weak urine stream
- hesitancy when starting to urinate
- stopping and starting of urine stream
- sensation of incomplete emptying of the bladder
- frequent daytime urination
- recurrent urinary tract infections
- urgency with or without leakage of urine
- getting up at night to urinate
Testing for BPH
The evaluation of BPH begins with a physical examination which includes a rectal exam (DRE). The DRE helps the doctor estimate the size of the prostate gland, and is a screening for abnormal nodules. Laboratory tests useful for diagnosing BPH include urinalysis and a blood test for PSA. PSA is a substance produced by the prostate and may be increased in the presence of prostate problems. Some other investigations that are useful include uroflowmetry and PVR. Uroflowmetry measures the force of the urine stream and the amount of urine passed. It is typically done in the doctor's office by urinating into a special receptacle. PVR is usually done by ultrasound to detect the presence of urine left in the bladder after voiding. This also is typically performed in the doctor's office. sometimes pressure-flow studies are needed to assess the cause of urinary symptoms. These are done as an outpatient procedure in the hospital, and record more detailed information about the bladder and urine flow. An ultrasound examination of prostate is useful to determine the exact size of the gland and to check for any areas suspicious for cancer. Prostate ultrasound may be done in the doctor's office or in the radiology department of a hospital.
Treatment for BPH
- Surgery
- TURP - Transurethral resection of the prostate is a common surgery for BPH often nicknamed "roto-rooter" surgery. In a TURP an instrument is passed through the urine passage to the point where the prostate is blocking the flow of urine. The excess tissue is then cut away. There is no incision on the outside of the body and usually a hospital stay of only a few days is required. TURP has been used for many years and most patients notice a rapid improvement in symptoms which lasts for many years.
- Laser Surgery - Laser surgery for BPH is very similar to TURP and they are often used together. The prostate is approached in the same manner, through the urine passage, and therefore there is no external incision. The benefits of using laser with or without TURP include less bleeding and a shorter hospital stay.
- Open Prostatectomy - Open prostatectomy is indicated for treatment of BPH in men with a very large prostate gland. In this surgery an incision is made (usually in the lower abdomen) and part of the prostate gland is removed. This surgery usually also results in a rapid and long-lasting improvement in urinary symptoms.
Medical Treatment
- Proscar - Proscar is an oral medication that is sometimes used to shrink the prostate gland and thereby improve urinary symptoms. Sometimes it may take a few months to notice an improvement in urinary symptoms and if the medication is stopped, symptoms may return. Some side effects associated with the use of Proscar are erection problems and decrease in sexual interest.
- Other Drug Therapy - Alpha blocker drugs are also used to treat BPH. These drugs work by relaxing muscles in the prostate, and thereby decreasing urinary symptoms. It may take a few weeks to notice improvement. Some adjustments in dosage may be necessary. Some potential side effects of alpha blocker drugs are headaches, tiredness or low blood pressure. Alpha blocker drugs work to decrease urinary symptoms only as long as the medication is continued. Some examples of alpha blockers are Hytrin and Cardura.
- Watchful Waiting - Watchful waiting may be a good choice by men who are not significantly bothered by urinary symptoms, and who wish to wait and see if the symptoms worsen. Watchful waiting is not a treatment and a series of regular exams by a qualified urologist are essential.
Complications of BPH
If left untreated and unmonitored, BPH may lead to serious complications. The presence of an enlarged prostate interferes with the emptying of urine from the bladder. This creates resistance to the flow of urine from the bladder and in turn leads to increased pressure in the bladder. The increased pressure in the bladder may lead to a backup of urine through the ureters and into the kidneys. A backup of urine in these areas is called hydroureter and hydronephrosis, eventually this may lead to kidney failure. The higher than normal pressure in the bladder may also stretch and weaken the bladder wall, which has a layer of muscle. Bladder weakness causes urine to remain inside the bladder, even after urination. The presence of residual urine in the bladder may lead to repeated urinary tract infections which then may travel up the urinary tract to the kidneys.