Male Urinary Symptoms/BPH
WHAT IS BPH?
Benign prostatic hyperplasia (BPH) is a common urological condition caused by the non-cancerous enlargement of the prostate gland in aging men. As the prostate enlarges, it can squeeze down on the urethra. This can cause men to have trouble urinating leading to the symptoms of BPH.
WHAT ARE SOME OF THE RISK FACTORS FOR BPH?
Risk factors for developing BPH include increasing age and a family history of BPH.
WHAT ARE SOME OF THE SYMPTOMS ASSOCIATED WITH BPH?
Many men with benign prostate hyperplasia have no symptoms. When symptoms occur, they may range from mild and barely noticeable to serious and disruptive. The amount of prostate enlargement is not always related to the severity of the symptoms. Some men with only slight enlargement have serious symptoms, and some men with a great deal of enlargement have few symptoms
Since the prostate surrounds the urethra just below the bladder, its enlargement can result in symptoms that irritate or obstruct the bladder.
- Difficulty starting urine stream (hesitancy and straining).
- Decreased strength of the urine stream (weak flow).
- Dribbling after urination.
- Feeling that the bladder is not completely empty.
- An urge to urinate again soon after urinating.
- Pain during urination (dysuria).
- Waking at night to urinate (nocturia).
- Frequent urination.
- A sudden, uncontrollable urge to urinate
In extreme cases, a man might not be able to urinate at all, which is an emergency that requires prompt attention.
HOW IS BPH DIAGNOSED?
In order to help assess the severity of such symptoms, the American Urological Association (AUA) BPH Symptom Score Index was developed. This diagnostic system includes a series of questions that ask how often the urinary symptoms identified above occur. This helps measure how severe the BPH is – ranging from mild to severe
EVALUATION FOR POSSIBLE BPH
The evaluation will typically consist of a thorough medical history, a physical examination (including a digital rectal exam or DRE), and use of the AUA BPH Symptom Score Index. In addition, the urologist will generally do a urine test called a urinalysis. There are a series of other studies that may or may not be offered to a patient being evaluated for BPH depending on the clinical situation. These include:
- prostate specific antigen (PSA), a blood test to screen for prostate cancer
- urinary cytology, a urine test to screen for bladder cancer
- a measurement of post-void residual volume (PVR), the amount of urine left in the bladder after urinating
- uroflowmetry, or urine flow study, a measure of how fast urine flows when a man urinates
- cystoscopy, a direct look in the urethra and/or bladder using a small flexible scope
- urodynamic pressure-flow study that tests the pressures inside the bladder during urination
- ultrasound of the kidney or the prostate
WHEN SHOULD I SEE A UROLOGIST FOR BPH?
You should see your urologist if you have any of the symptoms mentioned previously that are bothersome. In addition, you should see your urologist immediately if you have blood in the urine, pain with urination, burning with urination or is unable to urinate.
ARE THERE TREATMENTS AVAILABLE FOR ENLARGED PROSTATE OR BPH?
BPH treatment decisions are based on individual conditions. Your urologist will discuss the pros and cons of each option during your BPH treatment planning.
Treatment options for enlarged prostate, or benign prostatic hyperplasia (BPH), may include the following:
- Behavioral changes (e.g. reduce evening intake of fluids, eliminating bladder irritants such as caffeine and alcohol from diet, regular urinations cycles and regular moderate exercise)
- Medications (e.g., alpha blockers)
Minimally invasive treatments (thermotherapy)
- Laser therapy: a laser heats and vaporizes tissue of the obstructing prostate
- Microwave (TUMT) : microwave energy heats and reduces the enlarged tissue of the prostate
- Other thermotherapies (e.g., Prolieve) reduce the enlarged tissue of your prostate
- Transurethral resection of the prostate (TURP)
- Holmium laser enucleation of the prostate (HoLEP)
- Transurethral incision of the prostate (TUIP)
- Transurethral ultrasound-guided laser incision of the prostate (TULIP)
FREQUENTLY ASKED QUESTIONS
Is BPH a rare condition?
No, it is very common. It will affect approximately 50 percent of men between the ages of 51 and 60 and up to 90 percent of men over the age of 80.
Does BPH lead to prostate cancer?
No, BPH is not cancer and cannot lead to cancer, although both conditions can exist together. There are usually no symptoms during the early stages of prostate cancer, and so yearly physical examinations and PSA tests are highly recommended to eliminate cancer diagnosis.
Are there risks in not seeking treatment for BPH?
In the majority of men BPH is a progressive disease. It can lead to bladder damage, infection, blood in the urine, and even kidney damage. It is therefore important for men with this condition to continue to be followed.
Which type of drugs are the best?
To date, there is not enough research data to predict who will respond to medical therapy or which drug will be better for an individual patient. There is a variety of drugs available and, in some men, a combination of drugs may work best.
How do I know if oral medications are the best treatment for me?
If you are diagnosed with BPH, you should discuss all treatment options with your urologist. Together, you can decide whether medication, minimally invasive therapy or surgical treatment is best for you.