Benign Prostatic Hyperplasia (BPH)

Benign Prostatic Hyperplasia (BPH) is an enlargement of the tissue within the prostate gland. Benign means non-cancerous and hyperplasia means excessive growth of tissue. By age 40 to 45, your prostate gland enlarges normally as benign tumors develop inside. It is not known what causes these growths, but they may be related to hormonal changes that occur with aging. The prostate gland surrounds the urethra, the tube that carries urine from the bladder to the outside of the body. As these tumors grow they may narrow the urethra, thus causing difficulty in urination.

Q. What are the risk factors?
A.  BPH is a condition of aging. Over 12 million Americans suffer from the effects of BPH. By age 60, more than half of all American men have microscopic signs of BPH, and by age 70, more than 40% will have enlargement that can be felt on physical examination.

Q. How can BPH be diagnosed?
A.   A physical examination, patient history, and evaluation of symptoms provide the basis for a diagnosis of benign prostatic hyperplasia. There are number of different tests that the physician may choose to run such as:

  • Digital Rectal Examination (DRE): This is usually performed during the physical examination. The process involves the physician feeling the prostate gland through the surface of the rectal wall. If the tissue feels abnormal then further tests are performed to determine the nature of the abnormality.
  • AUA Symptom Index: The American Urological Association Symptom Index is a questionnaire designed to determine the seriousness of a man’s urinary problems and to help diagnose BPH.
  • PSA and PAP Tests: Blood tests are taken to check the levels of prostate specific antigen (PSA) and prostatic acid phosphatase (PAP) in patients who may have BPH. These tests help physicians eliminate a diagnosis of prostate cancer.
  • Urodynamic Testing: Urodynamic tests are used to measure the volume and the pressure of urine in the bladder and to evaluate the flow of urine. This is particularly useful for the diagnosis of intrinsic sphincter deficiency and uncertain cases of mixed, overflow, urgency or total incontinence. Additional tests may be conducted if symptoms indicate that blockage is caused by a condition other than BPH.
  • Uroflowmetry: This is a simple test performed to record urine flow, to determine how quickly and completely the bladder can be emptied and to evaluate obstruction. A reduce flow rate may indicate BPH
  • Pressure Flow Study: TThis test measures pressure in the bladder during urination and is designed to detect a blockage of flow. It is the most accurate way to evaluate urinary blockage.
  • Post-Void residual (PVR): This test measures the amount of urine that remains in the bladder after urination. PVR less than 50 mL generally indicates adequate bladder emptying and measurements of 100 to 200 mL or higher often indicate blockage.

Q. What are treatment and follow-up options for BPH?
A.  BPH cannot be cured, but its symptoms can be relieved by surgery or drugs. Here are some of the methods that are common:

  • Watchful Waiting: Men whose symptoms are mild often opt for watchful waiting. This means that they report for regular checkups and have further treatment only if and when the symptoms become too bothersome.
  • Surgery: There are several types of surgeries:
    • Transurethral resection of the prostate (TURP)
    • Prostatectomy
    • Transurethral incision of the prostate (TUIP)
    • Transurethral ultrasound-guided laser incision of the prostate (TULIP)
  • Laser Treatments:
    • Interstitial Laser Coagulation
    • Photoselective vaporization of the prostate(PVP)
    • Holmium laser enucleation of the prostate (HoLEP)
  • Microwave Treatments:
    • Cooled ThermoTherapy™ (TUMT™)
    • CoreTherm®
    • ThermMatrx®
    • Prolieve™ RF therapy
  • Other Minimally Invasive Treatments:
    • AquaTherm™
    • Prostiva™RF therapy
    • Transurethral vaporization of the prostate (TUVP)
    • High Intensity Focused Ultrasound (HIFU)
  • Drug Therapy:
    • Alpha adrenergic blockade: relaxes the muscle portion of the prostate, which allows the urine to flow more freely
    • Finasteride: Shrinks the prostate by blocking an enzyme that converts the male hormone testosterone into a more potent growth-stimulating form.

Q. What are some questions to ask my physician?
A.  Here are some questions that will be important to ask:

  • For my diagnosis what treatment options do I have?
  • If I do not receive treatment, what might happen
  • What would you recommend and why?
  • What are the benefits and side effects of these treatments?
  • Will any treatments cause problems with my medication?(if you are taking medications)
  • What can I do to make my treatment most effective?
  • Will I need more tests? For what purpose?

This report is intended for patient education and information only. It does not constitute advice, nor should it be taken to suggest or replace professional medical care from your physician. Your treatment options may vary, depending upon medical history and current condition. Only your physician and you can determine your best option.

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