Benign Prostatic Hypertrophy (BPH)

General

Benign Prostatic Hypertrophy (BPH) is the benign enlargement of the prostate (i.e. enlargement that is not related to cancer).

Prostate enlargement is typically related to the effects of testosterone and dihydrotestosterone. Enlargement typically occurs in the tissue of the prostate surrounding the urethra as it traverses through the prostate. There can also be stimulation of the prostatic smooth muscle leading to increased urethral resistance.

Enlargement of the peri-urethral prostate tissue and increased urethral resistance can lead to symptomatic BPH:

  • Weak Stream, hesitancy (i.e. increased interval between trying to urinate and actually urinating), intermittency (i.e. start and stop stream), incomplete bladder emptying, postvoid dribbling, straining to urinate, prolonged urination, frequent urination, night time urination, urgency (i.e. urgent need to urinate)

Prolonged, untreated, symptomatic BPH can lead to:

  • Urinary tract obstruction with urine retention (i.e. inability to empty the bladder), urinary tract infections, bladder stones, bladder diverticulum (i.e. outpouching of the bladder due to pressure), poorly functioning or non-functioning bladder, kidney insufficiency or failure, blood in the urine.

Evaluation

  • Lab tests (i.e. creatinine for kidney function and PSA for prostate cancer screening)
  • Urine test (i.e. urinalysis and urine culture evaluating for UTI or hematuria)
  • Digital rectal exam (to be performed in conjunction with PSA for prostate cancer screening)
  • Possible studies: cystoscopy (i.e. scoping the urinary tract to evaluate the amount of obstruction), urodynamics (i.e. studies performed to physical examine the function of the lower urinary tract), imaging of the upper urinary tract (i.e. kidneys and ureters) if kidney function is thought to be abnormal based on lab tests.

Treatment Options

  • Treatment for symptomatic BPH typically starts with medical management. However, surgical management to remove obstructive tissue is typically used as first line treatment in patients with refractory urinary retention, excessive urinary retention, recurrent blood in the urine, when a bladder stone is present, when kidney insufficiency is present, or when the patient is catheter dependent.
  • Medical management

    • Typical starting medications are alpha-blockers (i.e. Flomax, Uroxatrol, Hytrin, Cardura) which relax the prostate and/or 5-alpha reductase blockers (i.e. proscar, avodart) which shrink the prostate. Some benefit has been noticed with alternative options such as Saw Palmetto and other plant based therapy, but these are less commonly advocated.
  • Surgical management:

    • As previously discussed, surgical management is used as first line therapy for patients with refractory urinary retention, excessive urinary retention, recurrent blood in the urine, when a bladder stone is present, when kidney insufficiency is present, or when the patient is catheter dependent. It is used as second line therapy in patients who have persistent symptoms with no improvement with medical management, patients who are not happy with the level of improvement with medical management, and patient who have worsening symptoms while on medical management.
  • Surgical options offered by Newport Urologic Oncology:

    • Transurethral laser photovaporization of the prostate (greenlight laser)
    • Transurethral resection of the prostate (TURP)
    • Transurethral button electrovaporization of the prostate
  • Surgical options not offered by Newport Urologic Oncology:

    • Prostatic urethral stent
    • Transurethral microwave therapy of the prostate (TUMT)
    • Transurethral needle ablation of the prostate (TUNA)

Monitoring

Patients are typically monitored periodically during and after the treatment process to evaluate for symptomatic improvement

Male prostate anatomy lateral view

About Benign Prostatic Hypertrophy

General
Evaluation
Treatment Options
Monitoring