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Prostate is gland that is present just distal to urinary bladder and is attached to upper urethra.
Benign Prostatic Hyperplasia (BPH)
After the age of 40 in males, prostate starts increasing in size. If it becomes too large or distorts in shape, it may compress on urethra.
About half of men in their 50s and about 90% of men in their 80s are likely to have enlarged prostates.
Symptoms
Early symptoms of BPH are:
Decreased stream of urine which may progress to complete blockage of urine
Incomplete emptying of bladder
Difficulty while starting to pass urine
Increased frequency of urination during day and or during night
Urine infection
Blood in the urine
Bladder stones
Kidney damage may happen in later stages
Diagnoses
Examination by doctor
Ultrasound
Blood tests like PSA may be done to rule out cancer of prostate
Treatment
Lifestyle changes: avoid alcohol and caffeine, decrease liquid intake especially before sleep, pelvic exercises.
The next level of treatment for benign prostatic hyperplasia is usually medications such as tamsulosin (Flomax®). This is a type of drug called an alpha blocker. It is meant to relax the bladder neck muscles and prostate muscles to increase urinary flow and decrease the urge to urinate.
Other drugs called alpha reductase inhibitors, such as finasteride (Propecia®, Proscar®) and dutasteride (Avodart®), can be used to reduce the size of the prostate and reduce urine flow.
If lifestyle changes and medications do not help with BPH, surgery is the next option. Surgical options range from minimally invasive therapies to full surgery.
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What are the reasons for benign prostatic hyperplasia (BPH) surgery?
Benign prostate surgery is recommended if less invasive treatments have failed, or if you have severe symptoms such as:
An inability to urinate
Frequent urinary tract infections
Excessive blood in the urine
Bladder stones
Kidney damage
What are the kinds of minimally invasive surgical treatments for benign prostatic hyperplasia (BPH)?
Several minimally invasive surgeries may be used for BPH. These include:
Greenlight laser: Photoselective vaporization of the prostate (PVP) is a treatment that vaporizes prostate tissue to create a channel in the urethra for free urination. This is an office-based therapy and requires an anesthetic.
Plasma button electrovaporization: Prostate tissue is removed using low temperature plasma energy. Tissue is vaporized. This is an operating room-based therapy and requires an anesthetic.
Rezum: Water vapor is directly delivered to the prostate tissue. Over a 3-month period the tissue is destroyed and reabsorbed by the body. This is an office-based therapy and is performed under a local tissue block.
Urolift: A mechanical approach that places implants to pin the lateral prostate lobes out of the way to reduce obstruction. This is an office-based procedure performed under a local tissue block.
What are other benign prostatic hyperplasia (BPH) surgery options?
If your symptoms are severe or minimally invasive surgical treatments do not help with your enlarged prostate, your doctor will likely recommend another kind of surgery. Several surgical options include:
Transurethral resection of the prostate (TURP): This is the most common treatment for BPH. During this procedure, your urologist will insert a rigid instrument called a resectoscope into the urethra. This is why it is called transurethral. Inserting the tube this way means no cutting into the prostate. He or she will then use the charged resectoscope to remove the excess tissue that is blocking the urine from exiting the bladder.
You may be put to sleep with general anesthesia. Local anesthesia for the lower part of the body may be used for this procedure. The average in hospital stay for TURP is 1 to 2 days.
Transurethral incision of the prostate (TUIP): This is a similar procedure to TURP. Instead of prostate tissue being removed the bladder neck and prostate are cut to relax the bladder opening, allowing urine to flow more freely. TUIP is most successful on men with smaller prostates.
Simple prostatectomy: A surgical procedure in which an incision is made through the abdomen or performed laporoscopically. The inner portion of the prostate gland is removed, leaving the outer segment intact.
What are the risks of benign prostatic hyperplasia (BPH) surgery?
Surgery for benign prostatic hyperplasia is common and generally very safe. However, there are risks with any surgery. Risks after procedures can include:
Urinary tract infections
Frequent urination
Blood in the urine
Problems urinating
An inability to hold urine (incontinence)
Large blood clots
Infections
Painful urination or difficulty urinating
Sexual dysfunction
Scar tissue
Erectile dysfunction
What is the outlook for men who have benign prostatic hyperplasia (BPH) surgery?
Benign prostatic hyperplasia surgery has a very high success rate. However, for the best results from treatment, you should seek medical help at the earliest signs of a problem. Also, talk with a doctor if you are experiencing symptoms of BPH after surgery.
There is no evidence that BPH increases the risk of developing prostate cancer. However, the symptoms of BPH and prostate cancer are similar. The American Urological Association and the American Cancer Society recommend annual prostate screenings for men ages 55 to 69. Men at high risk – such as African-American men and men with a family history of prostate cancer – should begin screening at age 40.
