Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is the non-cancerous enlargement of the prostate, a walnut-sized reproductive organ.  Prostate growth and enlargement are typically seen with aging.  In some patients, that growth can block or obstruct the flow of urine. This makes it difficult to empty the bladder, leading to a sense of having to urinate more frequently or with a greater sense of urgency.

Benign Prostatic Hyperplasia Symptoms 

Symptoms of BPH can include: 

• Urinary hesitancy or straining (i.e. difficulty starting a urine stream) 

• Weak flow  

• Dribbling after urination  

• A sensation that the bladder is not completely empty

• Frequency or a sensation of needing to urinate again soon after urination  

• Dysuria, painful urination (burning sensation with urination)

• Nocturia, waking up at night to urinate  

• A sudden, uncontrolled urge to urinate  (a feel to rush to the restroom to urinate)

Causes & Risk Factors for Benign Prostatic Hyperplasia 

The exact cause of benign prostatic hyperplasia is unknown.

 Risk factors that increase the chances of BPH include: 

• Age, particularly over the age of 40 years old 

• Hormonal changes 

• Family history of prostate disorders 

Importantly, benign prostatic hyperplasia is NOT prostate cancer and does NOT increase the chances of developing prostate cancer in the future. 

Evaluation and Treatment for Benign Prostatic Hyperplasia 

Evaluation of benign prostatic hyperplasia can include: 

• A medical history and physical exam focused on the urinary tract 

• A neurological exam to determine whether symptoms are related to a problem with the nerves controlling the bladder. 

• Other tests include: 

o   Digital rectal exam (DRE) to check the size and firmness of the prostate 

o   A urinalysis to evaluate for the presence of infection or any abnormalities  

o   Postvoid residual to evaluate the amount of urine left in the bladder after urination 

o   A prostate specific antigen (PSA) test (blood test) to check for prostate cancer 

• If symptoms are severe, tests may include: 

o   Blood creatinine to assess how well the kidneys are working 

o   Urodynamics, or pressure-flow studies, to distinguish whether your urinary symptoms are due to blockage from an enlarged prostate or from a problem with the bladder

o   Cystoscopy to evaluate the anatomy of the prostate and to assess for any bladder related conditions.

o   Transrectal ultrasound to measure the size of the prostate 

Treatment for benign prostatic hyperplasia focuses on reducing its associated symptoms and depends on how bothersome symptoms are. The American Urological Association (AUA) Symptom score is one way to measure how affected you are by your symptoms and how well you are responding to treatment.  

Non-surgical treatment  

• Behavioral changes: Behavioral modification includes double voiding, timed voiding, avoidance of caffeine, alcohol and other diuretics, as well as night-time fluid restriction.  

• Medical therapy: 

o   Alpha blockers: Flomax (Tamsulosin), Uroxatral (Alfuzosin), Rapaflo (Silodosin), Cardura (Doxazosin), or Hytrin (Terazosin) relax the muscle around the prostate and bladder neck, increasing urinary flow and decreasing symptoms. 

o   5-alpha reductase inhibitors (5ARIs): Proscar (Finasteride) or Avodart (Dutasteride) block the conversion of testosterone to dihydrotestosterone within cells of the prostate, shrinking the prostate size with time that helps reduce the blockage of urine

o   Overactive bladder medications: These are a number of medications that inhibit bladder contractions and improve symptom relief 

o   Cialis: Cialis (Tadalafil) helps to reduce the symptom bother associated with BPH

Surgical treatment 

Surgery is the most effective way to relieve urinary symptoms, but it is typically reserved for situations where medications are not helpful or cannot be prescribed.  

• Endoscopic surgery: Surgery that does not require any incision and uses instruments that are passed via the urethra to the level of the prostate. 

• Transurethral resection of the prostate (TURP): Electrosurgical as well as laser energy used to cut the core of the prostate into small pieces and remove it. Laser TURP is performed using a variety of laser types and wavelengths (e.g. holmium laser, Greenlight™ laser) which decrease the risk of complications such as intraoperative bleeding and fluid absorption.  
• Electrosurgical technologies: Use of a bipolar button or loop to decrease the risk of fluid absorption.  
• Urolift: Minimally invasive procedure using small anchors to mechanically retract enlarged prostatic tissue 
• Aquablation: Minimally invasive surgery that uses a robotic camera and ultrasound imaging to guide high pressure water jets that destroy extra prostate tissue that needs to be removed. 
• Holmium Laser Enucleation of the Prostate (HoLEP): Highly effective, minimally invasive procedure that uses MOSES laser technology to improve outcomes and provide lasting relief from prostate obstruction 

• Simple Prostatectomy: Performed in open, laparoscopic, or robotic fashion, and is typically reserved for patients with very large prostates, where transurethral surgery would be difficult to perform safely. With this procedure, the prostate is accessed via small incisions in the abdominal skin.