Benign Prostatic Hyperplasia
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Benign Prostatic Hyperplasia (BPH)
Understanding & Managing Enlarged Prostate
However, when the prostate enlarges, as in cases of BPH, it can compress the urethra, restricting or even blocking the flow of urine. This can lead to issues such as difficulty starting urination, increased frequency of urination day and night, discomfort, and urinary retention. BPH is particularly common in men aged 45 and older.
About BPH
What is BPH?
BPH is a condition where the prostate gland enlarges (hypertrophy) due to age and hormonal influences, which can obstruct the flow of urine and semen through the urethra. While the enlargement itself is not dangerous, it can lead to bothersome symptoms that are challenging to manage and can greatly affect quality of life. Untreated BPH can also cause significant complications.
Symptoms
Common Symptoms of BPH
Frequent urination, especially at night (nocturia)
Inability to completely empty the bladder
Weak or interrupted urine stream
Difficulty starting urination
Dribbling at the end of urination
A feeling of urgency to urinate
BPH symptoms can significantly affect your quality of life. Fortunately, BPH is treatable, and you don’t have to live with discomfort. Take the BPH symptom assessment today and see if you have BPH.
Cause
Causes of BPH
BPH is a natural part of aging for many men. The exact cause is not fully understood, but hormonal changes, particularly the role of testosterone and dihydrotestosterone (DHT), are thought to play a key role in the growth of the prostate. Over time, the prostate increases in size, and more than 50% of men over 50 develop symptoms.
Several risk factors can increase the likelihood of developing Benign Prostatic Hyperplasia (BPH). These include:
1. Aging
Primary Risk Factor: BPH is rare in men under 40 but becomes increasingly common as men age. By the age of 60, about half of men experience some symptoms of BPH, and by 80, that number rises to around 90%.
2. Family History
A family history of BPH may increase your risk, particularly if your father or brothers have experienced prostate enlargement.
3. Hormonal Changes
Changes in male hormones as men age, particularly the imbalance of testosterone and dihydrotestosterone (DHT), contribute to prostate growth and are a key factor in BPH development.
4. Medical Conditions
Heart Disease and Diabetes: These conditions, along with certain medications used to treat them (e.g., beta-blockers), may increase the risk of developing BPH.
Obesity: Excess body weight, particularly central obesity, has been linked to a higher likelihood of developing BPH due to inflammatory processes and metabolic syndrome.
5. Lifestyle Factors
Sedentary Lifestyle: Lack of physical activity can increase the risk of BPH. Regular exercise has been shown to lower the risk of developing BPH symptoms.
Diet: A diet high in red meat and fats, and low in fruits and vegetables, may also raise the risk of developing an enlarged prostate.
6. Ethnicity
Some studies suggest that men of African descent may develop BPH symptoms earlier and more severely than other ethnic groups, while men of Asian descent may have a lower risk.
Understanding these risk factors can help in early detection and treatment. If you’re at risk, regular check-ups with your healthcare provider can help manage your prostate health and catch any signs of BPH early, minimizing duration of bothersome symptoms or complications such as urinary retention of kidney damage.
Diagnosis
Diagnosis
If you're experiencing symptoms, we encourage you to schedule a consultation. Dr.Shivank Bhatia, M.D., FSIR with decades-longurological /practice expertise will begin with a thorough medical history and physical exam to assess if you have BPH. We believe that a thorough urological work-up, including bladder function, is essential before offering treatment modalities to patients.
Additional diagnostic tools may include:
Questionnaires
Such as the International Prostate Symptom Score (IPSS) and Incontinence Questionnaires which quantify your symptoms and severity of BPH.
Urine Flow Study
Measures the strength of your urine stream.
Post-Void Residual Test
Checks how much urine remains in the bladder after you urinate.
Prostate-Specific Antigen (PSA) Test
To rule out prostate cancer.
Prostate Ultrasound or MRI
To evaluate the prostate’s size and anatomy.
Urine analysis/Urine culture
To evaluate if you have a urinary infection.
Severity of BPH
Is BPH a Serious Disease?
While BPH on its own is not life threatening, untreated BPH can lead to serious long-term complications. As the urethra becomes obstructed, the bladder may become irritated and overworked, causing it to thicken and lose its ability to hold normal amounts of urine. In severe BPH, back up of urine into the bladder and ureters can cause enlargement and damage to the kidneys, known as hydronephrosis.
Incomplete bladder emptying can result in residual urine, which creates an ideal environment for bacteria to grow, leading to urinary tract infections. These infections can also promote the formation of bladder stones. If infections become severe or chronic, they can cause damage to the bladder and kidneys. In rare cases, the infection can spread to the bloodstream, potentially leading to a life-threatening condition known as sepsis. Early treatment of BPH is imperative to preventing such complications.
Options
Treatment Options for BPH
1. Lifestyle Modifications:
- Reducing evening fluid intake
- Avoiding alcohol and caffeine
- Regular bladder training exercises
Lifestyle modifications are not likely to improve quality of life in patients other than those with early, mild symptoms.
2. Medications:
- Alpha Blockers: Relax the muscles of the prostate and bladder neck to improve urine flow. Eg. Flomax.
- 5-Alpha Reductase Inhibitors: Help shrink the prostate over time. Eg. Dutasteride.
- Combination Therapy: Sometimes a mix of medications is more effective.
3. Minimally Invasive Procedures:
- Prostate Artery Embolization (PAE): The least invasive procedure which involves injecting microscopic beads in the prostate artery to decrease blood flow to the prostate.
This decreases the volume of the prostate over several weeks, improving urine flow while preserving sexual function.
PAE is effective in both large (>80gm) and small (<80gm) prostates. - UroLift® System: A less invasive approach that lifts and holds the enlarged prostate tissue out of the way of the urethra without cutting or removing parts of the prostate.
It is approved only for smaller prostates (<80gm). - Aquablation® System: A less invasive approach that uses a water stream to remove prostatic tissue.
It is effective for smaller (<80gm) and larger prostates (>80gm), while preserving ejaculatory function.
Other minimally invasive options include Rezum®, Nitinol-based devices, and Transurethral Microwave therapy.
4. Surgical Options:
If medications and minimally invasive treatments do not provide sufficient relief, surgical intervention may be necessary to alleviate your symptoms. These typically have more adverse events and sexual dysfunction compared to the minimally invasive treatments. Surgical options include:
- Prostatectomy: The surgical removal of prostate tissue that is causing obstruction. This procedure may be partial or complete, depending on the severity of the enlargement and symptoms.
- Transurethral Resection of the Prostate (TURP): A well-established procedure where a portion of the prostate tissue is removed using an instrument inserted through the urethra.
This helps relieve the blockage and improve urine flow. TURP also has one of the highest risks of adverse events. - Laser Therapy: This approach uses high-energy lasers to vaporize or remove the excess prostate tissue that is blocking the urethra.
Laser therapy often has quicker recovery times and less bleeding compared to traditional surgery.
Our expert IRs will recommend treatment options tailored to your individual condition and health needs, with the goal of providing long-lasting symptom relief and improving your quality of life.
Why Choose Us
Why Choose Us for BPH Treatment?
Make an Appointment
Schedule an Appointment Today
If you’re experiencing symptoms of BPH or have questions about treatment options, don’t wait. Early diagnosis and treatment can improve your quality of life. Contact Florida Prostate Centers® or use our online booking system to schedule a consultation today.