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BPH

                                          

Benign Prostatic Hyperplasia (BPH) is an enlargement of the prostate gland. BPH is a common condition as men get older and can cause bothersome urinary symptoms. An untreated prostate gland enlargement can block the flow of urine out of the bladder and can cause kidney or bladder problems.

Symptoms

Prostate gland enlargement varies among men and tends to gradually worsen over time. The size of your prostate does not necessarily indicate the severity of symptoms. Prostate gland enlargement symptoms include: 

  • Weak urine stream
  • Difficulty starting urination
  • Stopping and starting while urinating
  • Dribbling at the end of urination
  • Frequent or urgent need to urinate
  • Increased frequency of urination at night (nocturia)
  • Straining while urinating
  • Not being able to completely empty the bladder
  • Urinary tract infection
  • Formation of stones in the bladder
  • Reduced kidney function

Treatments

A wide variety of treatments are available for enlarged prostate. Your doctor will have you fill out a symptom questionnaire and may do certain studies such as urinalysis, uroflow (a study to determine the rate of urine speed/flow), and post void bladder residual determination (PVR) to help guide in management.

Behavioral Therapy

This includes avoiding foods/beverages that are irritating to the urinary tract (e.g. caffeine, alcohol) and fluid restriction to help your symptoms.

Medications

Medications are the most common treatment for moderate symptoms of prostate enlargement. Medications used to relieve symptoms of enlarged prostate include:

  • Alpha blockers. These medications relax bladder neck muscles and muscle fibers in the prostate itself and make it easier to urinate. These medications include terazosin, doxazosin (Cardura), tamsulosin (Flomax), alfuzosin (Uroxatral) and silodosin (Rapaflo).
  • 5 alpha reductase inhibitors. These medications shrink your prostate by preventing hormonal changes that cause prostate growth. They include finasteride (Proscar) and dutasteride (Avodart). They generally work best for very enlarged prostates. It may be several weeks or even months before you notice improvement.
  • Combination drug therapy. Taking an alpha blocker and a 5 alpha reductase inhibitor at the same time is generally more effective than taking just one or the other by itself.
  • Tadalafil (Cialis). This medication, from a class of drugs called phosphodiesterase inhibitors, is often used to treat impotence (erectile dysfunction). It also can be used as a treatment for prostate enlargement. Tadalafil should be used with caution in combination with alpha blockers. It can’t be taken with medications called nitrates, such as nitroglycerin.

Surgery

Your doctor may recommend surgery if medication isn’t effective or if you have severe symptoms. There are several types of surgery for an enlarged prostate. They all reduce the size of the prostate gland and open the urethra by treating the enlarged prostate tissue that blocks the flow of urine. The decision about which type of surgery may be an option is based on a number of factors, including the size of your prostate and the severity of your symptoms. 

Any type of prostate surgery can cause side effects, please ask your doctor about the specific risks of each treatment you’re considering.

Minimally-Invasive Surgery

Minimally invasive treatments are less likely to cause blood loss during surgery and require a shorter, if any, hospital stay. These treatments also typically require less pain medication. Depending on the procedure — and how well it works for you — you may need follow-up treatments. Below are minimally-invasive procedures offered at Northwest Arkansas Urology Associates for BPH.

Laser surgery

Laser surgeries (also called laser therapies) use high-energy lasers to destroy or remove overgrown prostate tissue. Laser surgeries generally relieve symptoms right away and have a lower risk of side effects than does TURP. Some laser surgeries can even be used in men on anticoagulant (blood thinner) medications.

Laser surgery can be done with different types of lasers and in different ways.

  • Ablative procedures (including vaporization) remove prostate tissue pressing on the urethra by burning it away, easing urine flow. Ablative procedures may cause irritating urinary symptoms after surgery and may need to be repeated at some point.
  • Enucleative procedures are similar to open prostatectomy, but the tissue is removed through the urethra.  A laser is used to resect the prostate tissue. A specimen will be available for pathologic evaluation unlike ablative procedures.

Transurethral resection of the prostate (TURP)

TURP has been a common procedure for enlarged prostate for many years, and it is the surgery with which other treatments are compared. With TURP, a surgeon places a special lighted scope (resectoscope) into your urethra and uses small cutting tools to remove all but the outer part of the prostate (prostate resection). TURP generally relieves symptoms quickly, and most men have a stronger urine flow soon after the procedure. Following TURP, there is a risk of bleeding and infection, and you will temporarily require a catheter to drain your bladder after the procedure. You’ll be able to do only light activity until you’re healed.

Transurethral incision of the prostate (TUIP or TIP)

This surgery is an option if you have a small prostate gland causing obstructive urinary symptoms. Like TURP, TUIP involves special instruments that are inserted through the urethra. But instead of removing prostate tissue, the surgeon makes two small cuts in the prostate gland to open up a channel in the urethra — making it easier for urine to pass through.

Open or laparoscopic subtotal prostatectomy

This type of surgery is generally done if you have a very large prostate, bladder damage or other complicating factors, such as bladder stones. It’s called open because the surgeon makes an incision in your lower abdomen to reach the prostate. Subtotal prostatectomy is the most effective treatment for men with severe prostate enlargement, but it is more invasive and often has a longer recovery period. It generally requires a short stay in the hospital and is associated with a higher risk of needing a blood transfusion. This type of procedure can also be performed in a laparoscopic and robot-assisted laparoscopic manner.