BPH and enlarged prostate are common terms for Benign Prostatic Hyperplasia. It is one of the most common health disorders faced by men aged 50 and older. Benign Prostatic Hyperplasia affects more than 40 to 50 percent of men aged 51 to 60. Some experts believe that by the time men are in their 80s, more than 80 percent will suffer from this condition.
Symptoms
- Feeling the need to urinate frequently
- Nocturia (getting up during the night to urinate)
- Feeling the urgency to urinate
- Incontinence or dribbling (inability to hold urine)
- Weak stream
- Hesitant or intermittent urination
- Straining to urinate
- Feeling that urination did not empty bladder
Symptoms can be irritating, frustrating and inconvenient. They can also be a sign of a more serious problem, including cancer.
Diagnosis
To diagnose this disorder, your Ohio State urologist will ask you questions about your medical history and will do a digital rectal exam to feel the prostate gland. Other tests that may be used to diagnose your condition include:
- Urine flow rate
- Post-void residual urine test (to see how much urine is left in your bladder after urination)
- Pressure flow studies to measure the pressure in the bladder as you urinate
- Urinalysis, a study of your urine to check for blood or infection
- Urine culture to check for infection
- Prostate-specific antigen (PSA) blood test to screen for prostate cancer
- Cystoscopy, insertion into the urethra of a small tube tipped with a miniature camera to view the urethra and bladder
Treatment
After a diagnosis has been made, you and your Ohio State urologist can determine a personalized treatment plan. Several treatment options may be considered.
Lifestyle changes may include:
- Urinate when you first get the urge. Go to the bathroom when you have the chance, even if you don't feel a need to urinate.
- Avoid alcohol and caffeine, especially after dinner.
- Don't drink a lot of fluid all at once. Spread out fluids during the day. Avoid drinking fluids within two hours of bedtime.
- Try to avoid over-the-counter cold and sinus medicines that contain decongestants or antihistamines as these drugs can increase BPH symptoms.
- Keep warm and exercise regularly. Cold weather and lack of physical activity may worsen symptoms.
- Learn and perform Kegel exercises (pelvic strengthening exercises).
- Reduce stress. Nervousness and tension can lead to more frequent urination.
Medicines to treat BPH include:
- Alpha 1-blockers, which relax the muscles of the bladder neck and prostate to allow for easier urination.
- Finasteride and dutasteride, which lower levels of hormones produced by the prostate. These drugs can reduce the size of the gland, increase urine flow rate, and decrease symptoms of BPH.
- Antibiotics may be prescribed to treat chronic prostatitis (inflammation of the prostate), which may occur with BPH.
Surgery may be recommended based upon the severity of your symptoms and the size and shape of your prostate gland. Some of the more common surgical options include:
- Transurethral resection of the prostate (TURP) – TURP is the most common and most proven surgical treatment for BPH. TURP is performed by inserting a scope through the penis and removing the sections of the prostate gland.
- Simple prostatectomy – An open prostatectomy is usually performed using general or spinal anesthesia. An incision is made through the abdomen or perineum (the area behind the scrotum). Only the inner part of the prostate gland is removed. The outer portion remains. Our surgeons offer this surgery through a robotic, minimally invasive approach which allows for faster recovery and shorter hospital stay. This treatment is most often done on men who have very large prostate glands.
- Holmium Laser Enucleation of the Prostate (HoLEP) – HoLEP is the equivalent of a simple prostatectomy that is performed through the penis and can be performed for any prostate size. HoLEP has excellent, long-term results, but it is difficult to learn so it is not offered by many centers. Ohio State Department of Urology has a fellowship trained surgeon who performs HoLEP.
- Minimally invasive procedures – Minimally invasive techniques can also be employed to widen the urethra.
