Incontinence

Benign Prostate Hyperplasia (BPH)

The prostate is a gland that is found in men. Its purpose is to secrete the major component of ejaculatory fluid.

The prostate sits directly below the bladder and surrounds the urethra as it exists the bladder.

As a man ages, the prostate enlarges and begins to press on and narrow the opening of the bladder neck and urethra. This occurs gradually over several years. Initially symptoms may be extremely subtle and well tolerated such as urinating frequently, decrease force of urinary stream, and urinating more than twice at night. As the condition progresses the bladder has to work harder to expel urine. This causes the bladder muscle to become thick (hypertrophic). This results in a diminished bladder capacity and decreased elasticity of the bladder wall, causing problems with urinary function.

This condition affects about 40% of men in their 50’s, 60% of men in their 60’s and more than 80% of men in their 80’s. About half of such men develop moderate to severe Lowe Urinary Tract Symptoms (LUTS), which could interfere with advancing age.

In assessing your symptoms I use the BPH Symptom Score so known as the American Urological Association Score. The purpose of the test is to determine how bothersome is the enlargement of the prostate.

Men with LUTS and BPH also have been found to be at greater risk for Erectile Dysfunction(ED). The connection between LUTS, BPH and ED is not entirely clear. If you are experiencing LUTS or ED, please contact your health care provider.

If left untreated, an enlarged prostate can cause permanent urinary problems. While it may be a natural part of the aging process, that doesn’t mean you have to live with it. There are effective options for treatment.

Symptoms 

If you have an enlarged prostate, you may experience these symptoms: 

• A frequent urge to urinate, especially at night
• An urgent need to urinate with little warning
• Difficulty beginning urination
• Pain or burning during urination
• Feeling that your bladder never completely empties
• Dribbling or leaking urine
• A weak urine stream
• Intermittent—or on/off—urine flow
• Blood in the urine

How is an enlarged prostate (BPH) diagnosed? 

Whether you first notice difficulty with urination or your doctor finds that your prostate is enlarged during a routine exam, a smart first step toward a solution is an appointment with my office—that specializes in Functional Urology health. Several tests help identify the problem and suggest the best course of action. Tests vary from patient to patient, but these are the most common:

• Digital Rectal Exam (DRE)
• Prostate Specific Antigen (PSA) Blood Test
• Ultrasound
• Urine Flow Study – Advance Urodynamics investications
• Urethoscopy – Cystoscopy

Treatment Options For An Enlarged Prostate

Based on prostate symptoms and test results, doctors may offer a number of treatment options for an enlarged prostate.
They include:

Watchful Waiting

If your symptoms are mild, your doctor may recommend simply monitoring the situation before taking action.

Oral Therapy

Oral therapy has potential for symptom relief. It has the advantage of no surgery. Disadvantages include ongoing medication therapy, risks of side effects, high out of pocket cost, and sometimes over time effectiveness diminishes. Certain men also do not like to take medications.

Alpha Blocker Drugs

This is the most common way to treat BPH. They basically relax the smooth muscle cells in the prostate to relieve urinary obstruction. Like most medicines side effects can occur. They are mild in most cases and include dizziness on standing, feeling fatigued, loss of ability to ejaculate with orgasm.

 Alpha Reductase Inhibitors

are drugs that work by bringing about hormonal changes that actually shrink the prostate. These  however must only be used by men who exhibit clear signs of prostate enlargement, not just LUTS. Side effects include excess hair growth, decrease volume of ejaculation and decreased sexual desire.

Surgical Treatment

Surgical removal of the prostate (Prostatectomy)

If your BPH symptoms are severe and all other treatment options have not been successful, surgery (prostatectomy) may be recommended. These surgeries remove large amounts of prostate tissue. They have to be performed in the Clinic require anesthesia .

Transuretheral resection of the prostate (TURP)

This is one of the most common surgeries performed. With TURP, the inner portion of the  prostate is cut out through the urethra using a cystoscope. It is effective in most cases and can provide long-term relief. It requires a short hospital stay.

 Laser Surgery

This is essentially very similar to the TURP. Whereas in the TURP the electric current is used to cut the prostate, here a laser beam is used instead.