If you are seeing this, you have attempted to link to the UpToDate widget but are experiencing a problem. Please visit UpToDate for more information.

 
 

Attention

The information presented here is for basic descriptions of diagnosis with generalized care options.  In no way is this information to be used as a definite diagnosis or as a replacement for care from a physician.  If you have a concern regarding your diagnosis please contact your physician and speak to him/her about your diagnosis.
--------------------------------------------------------------------------

 
BPH (LUTS)
Benign prostatic hyperplasia (BPH) is the non cancerous enlargement of the prostate. Although BPH is not a life threatening condition it is important to properly diagnose and treat to preserve the person’s quality of life as sometimes the symptoms can be frustrating or intrusive.

BPH can cause a variety of lower urinary tract symptoms as the enlarged prostate can put pressure on the bladder and urethra. These symptoms may include, but not limited to, slowed urinary stream, overactive bladder, inability to empty bladder or hematuria, however these symptoms alone can indicate a variety of urinary tract problems not only Benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) occurs as a natural part of aging because as men age the prostate continues to grow at a slow rate. There is little significant scientific evidence as to the exact biological cause to the development of Benign Prostatic Hyperplasia. Some studies suggest a connection between male hormones and the development of BPH but there is no clear cause and effect relationship as of yet. Not all men will develop BPH in their lifetime but no matter what, as men age it becomes a larger possibility.

How is BPH Diagnosed?
To assist in positively diagnosing benign prostatic hyperplasia, your doctor may perform or request a variety of tests which could include: Digital rectal Exanimation (DRE), a Cystoscopy, Transrectal Ultrasound of the prostate (TRUS), Transrectal Ultrasound Biopsy (TRUS Biopsy), a urine culture to rule out infection, urinalysis to rule out other Urinary tract problems as well as other diagnostic tools.

A Digital Transrectal Examination (DRE) allows the doctor to check for lumps or hardness within the prostate as well as the general size of the prostate. The prostate is located just below the bladder and is detectable just inside the rectum. The DRE is usually done in the doctor’s office and consists of the doctor inserting a well lubricated gloved finger just into the rectum to feel the prostate.

A Transrectal Ultrasound (TRUS) is performed at the hospital by your doctor. The TRUS consists of the doctor inserting an ultrasound probe that is slightly larger than the index finger into the rectum to get a clear picture of the prostate on the ultrasound to assist in the correct diagnosis. A Transrectal Ultrasound Biopsy (TRUS Biopsy) is performed at the hospital by your doctor. This is generally only done when there is a suspicion of prostate cancer. The ultrasound probe is inserted into the rectum to visualize the prostate to assist in the correct position of the freezing and then the biopsy needle.

Treatment for BPH
When BPH is positively diagnosed there are two main categories for treatment medication or surgery. Within the surgery option there are a few different types that may be discussed with your doctor depending on your individual situation; these may include Trans-urethral Resection of the Prostate (TURP) and Green Light laser. Within the Drug option there are two main categories of drugs used Alpha Blockers which work by relaxing the muscles in the prostate and bladder and Alpha-reductase inhibitors which are considered a Long term therapy as they work to slowly reduce the size of the prostate.

If you decide that your symptoms do not negatively affect your quality of life and/or you would prefer not to have surgery or medication at this time it is possible to manage your BPH by Watchful Waiting. Watchful Waiting uses the monitoring and managing of fluid intake as well as bathroom techniques such as double voiding to reduce the symptoms of BPH.

Types of Surgery
Trans-urethral Resection of the Prostate (TURP) is the coring of the inner prostrate which will remove the obstruction and allow the urine to flow more freely. The TURP will be performed either by general anaesthetic (being put to sleep) or by spinal anaesthetic (freezing from waist down).

Removing the inner prostate is done with the use of a special instrument called a resectoscope which is placed into the urethra opening in the penis) making no skin incision. The area to be removed is broken into small pieces and is flushed out of the bladder and examined. After the procedure a catheter is inserted into the urethra and is to be kept in place for as long as the surgeon has determined. Generally 2 nights.

Risks of TURP include:
  1. infection, which may require the treatment of antibiotics,
  2. bleeding ,that may require a transfusion,
  3. retrograde ejaculation where the semen flows backward into the bladder and results in a reduced volume of ejaculate which does not affect your ability or enjoyment of sexual activity.
  4. Incontinence or the inability to control your urine
  5. Erectile dysfunction
Green Light Laser therapy is where high powered laser energy is used to vaporize the prostate tissue. The Green light laser will be performed with either a general anaesthetic (being put to sleep) or a spinal anaesthetic (freezing from waist down). The systematic evaporation of prostate tissue is done by inserting a cystoscope with a fiber attached, into the urethra to deliver the high powered energy to the prostate. After the procedure a catheter is inserted into the urethra and is to be kept in place for as long as the surgeon has determined.

Risks for Green light laser therapy are similar to those for TURP with less risk of bleeding and greater risks of dysuria or painful passing of the urine in the short term. Types of Drug Therapy

Alpha blockers treat of symptoms of BPH by relaxing the muscles in the prostate and bladder to allow the urine to flow better. It is important to discuss with your doctor all the precautions and side effects of the drugs before a decision is made about your care.

Alpha-reductase inhibitors lessen the symptoms of BPH by lowering specific hormones consequently slowly reducing the size of the prostate. This treatment is considered a long term therapy as it is a gradual reduction and resultsmay not be seen for a few months. The Alpha-reductase inhibitors may also be prescribed along side with an Alpha-blocker to lessen the symptoms of BPH.

Remember it is important to completely discuss all your options with your doctor so you may together find the best treatment for your BPH.

Quick Q&A
1. Is BPH a form of cancer?
  • No, Benign prostatic hyperplasia (BPH) is the non cancerous enlargement of the prostate.
2. What causes BPH?
  • Benign prostatic hyperplasia (BPH) develops as men age as the prostate continues to slowly grow through a man’s life. The biological triggers are not totally understood at this time but it is considered a natural part of aging.
3. Will I have BPH for the rest of my life?
  • There is no ‘cure’ for benign prostatic hyperplasia (BPH) as it is a natural part of aging in men. However there are many treatments that can drastically reduce the symptoms of BPH.
4. What can I do if I do not to do surgery or drug therapy?
  • If you would prefer not to have surgery or drug therapy at this time it is possible to manage your Benign prostatic hyperplasia (BPH) by Watchful Waiting which uses the monitoring and managing of fluid intake as well as bathroom techniques, such as double voiding, to reduce the symptoms of BPH.
Other References
Boehringer Ingelheim info
Merck Frosst info