Benign Prostatic Hyperplasia (BPH)

The prostate gland in its healthy state is about the size of a walnut. It’s located just below the bladder at the base of the penis and produces part of a man's seminal fluid. A natural consequence of aging, an enlarged prostate can cause problems that range from simple to serious.

BPH can include a burning sensation during urination, urinary tract infection, blood in the urine, leakage, urinary retention and a feeling that the bladder does not empty completely. The symptoms of BPH can be especially disruptive to nightly sleep and daily activity.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, more than half of men in their 60s have some symptoms of BPH, with as many as 90 percent displaying symptoms in their 70s and 80s.

As the prostate enlarges, it presses against the urethra, the tube that allows urine to pass out of the body, and interferes with urination. At the same time, the bladder wall becomes thicker and irritated, and begins to contract — even when it contains only small amounts of urine — which causes more frequent and sometimes urgent urination.

If the bladder continues to weaken, it may not empty completely and leave some urine behind, leading to a frequent sensation of having to void, having a slow urinary flow, increased risk of urinary infection and waking up at night to urinate. In the most severe cases when this condition is neglected, it can lead to irreversible bladder damage and kidney failure.

Prevention

Lifestyle management for BPH may include:

• Dietary factors. Avoiding or decreasing the intake of alcohol, coffee and other fluids particularly after dinner is often helpful. A higher risk for BPH has been associated with diets high in zinc, butter and margarine. Men who eat lots of fruits are thought to have a lower risk for BPH.
• Medications that worsen symptoms. Decongestants and antihistamines can slow urine flow in some men with BPH. Some antidepressants and diuretics can also aggravate symptoms. Consult your doctor to discuss changing dosages or switching medications.
• Kegel exercises. Repeatedly tightening and releasing the pelvic muscle, also known as Kegel exercises, is helpful in preventing urine leakage. Consult your doctor, who may recommend you practice this exercise while urinating. To perform a Kegel, you contract your pelvic muscle until the flow of urine stops, then release. Repeat five to 15 contractions, holding each for 10 seconds, three to five times a day. Often men confuse the “Kegel muscles” with their thigh muscles and squeeze their thighs. If you perform these exercises properly, you will not move your legs.

Symptoms and Diagnosis

When symptoms exist for an enlarged prostate, they may include:

• Leaking or dribbling of urine
• More frequent urination, especially at night
• Urgency to urinate
• Urine retention (inability to urinate)
• A hesitant, interrupted, weak stream of urine

These problems may lead to:

• Incontinence
• Kidney damage
• Bladder damage
• Urinary tract infections
• Bladder stones
• Inability to pass urine

The symptoms of benign prostatic hyperplasia may resemble other conditions or medical problems, which is why the urologists at El Camino Health perform such thorough examinations.

Diagnosing BPH in its earlier stages can lower the risk of developing complications. In addition to a complete medical history and physical examination, our diagnostic procedures for BPH may include:

• Digital rectal exam. The doctor inserts a gloved finger into the rectum to examine the rectum and the prostate gland.
• Intravenous pyelogram. Your doctor conducts a series of X-rays of the kidney, ureters (tubes that carry urine from the kidneys to the bladder) and bladder using an injection of contrast dye to detect tumors, abnormalities, kidney stones or other obstructions, and to assess renal (kidney) blood flow.
• Cystoscopy (also called cystourethroscopy). Your doctor inserts a flexible tube and viewing device through the urethra to examine the bladder and urinary tract for abnormalities or obstructions.
• Urine flow study. You urinate into a special device that measures how quickly the urine is flowing; reduced flow may suggest BPH.
• Residual urine measurement. Your doctor takes an ultrasound of your bladder to measure the amount of urine remaining after you have emptied your bladder.
• Urodynamics. For patients with more complex problems, doctors use this multifunctional test to asses voiding function.

BPH can raise PSA (prostate-specific antigen) levels two to three times higher than the normal level. While an increased PSA level does not necessarily indicate cancer, the higher the level, the higher the chance of having cancer.

Some of the signs of BPH and prostate cancer are the same; however, having BPH does not increase the chances of developing prostate cancer.

A man who has BPH may also have undetected prostate cancer at the same time or may develop it in the future. Therefore, the National Cancer Institute and the American Cancer Society recommend that all men over 50 consult their doctors about having a digital rectal and PSA examination once a year.

If your doctor suspects cancer, you may need a prostate biopsy, in which tissue samples are removed to determine if abnormal cells are present. Mountain View Hospital (El Camino Hospital) is one of the first South Bay hospitals to offer Artemis™ 3D Imaging and Navigation for exceptionally precise imagery, which we use to diagnose and perform biopsies.

Treatment

Research has shown that in some mild cases, symptoms of BPH may clear up without treatment. But eventually, BPH symptoms may demand your doctor’s attention.

Nonsurgical treatments include medication to shrink or stop the growth of the prostate, or loosen the muscles around the urethra so the urine flows more easily.

Treatment may also include surgery to remove the excess prostate tissue that is pressing against the urethra and blocking the flow of urine. Surgical options include:

• Transurethral Resection of the Prostate (TURP)
  Transurethral resection of the prostate, or TURP surgery is used to remove parts of the prostate gland through the penis. No incisions are needed. By inserting a resectoscope through the urethra, an electrical wire loop is used to cut tissue blocking the urethra. This surgery is most often done to relieve symptoms caused by an enlarged prostate.
• GreenLight™ Laser Therapy PVP
  Photoselective vaporization of the prostate, or PVP, is a procedure where a thin fiber inserted into the urethra delivers laser energy to precisely vaporize prostate tissue blockage.
  Most patients treated with the GreenLight XPS are released from the hospital within a few hours of the procedure and can return home. Typically, a catheter (a tube placed in the urethra that allows urine to drain from the bladder) is in place for less than 24 hours, and patients can resume normal non-strenuous activity within days.
  The laser can also be used to enucleate (remove without cutting) the excess tissue. If you have a very large prostate, your doctor may use GreenLight Laser Enucleation of the Prostate (GLEP) to avoid open surgery.
  El Camino Health also offers treatment via the Richard Wolf Piranha tissue morcellator. A morcellator is a surgical instrument used for division and removal of large masses of tissues during laparoscopic surgery. This technology allows the surgeon to puree large amounts of excess prostate tissue inside the body, then suction it out, decreasing the time it takes to operate.
• AquaBeam® Waterjet Ablation Therapy for endoscopic resection of prostate tissue

Aquablation Therapy | El Camino Health

• The AquaBeam® System combines real-time prostate imaging and surgical robotics to deliver Aquablation, a waterjet ablation therapy that enables targeted, controlled, heat-free and immediate removal of prostate tissue for the treatment of lower urinary tract symptoms caused by BPH.
• UroLift® Intra-Prostatic Suture Implant
  UroLift® is a minimally invasive FDA-approved procedure that lifts and holds the enlarged prostate tissue out of the way so it no longer blocks the urethra. There is no removal of tissue. It is the only BPH surgical procedure without sexual side effects. Watch an ABC news story about the Urolift device.
• Open Surgery
  The term “open surgery” refers to surgery that requires an external incision. Open surgery is performed for BPH when the prostate gland is very enlarged, when there are complicating factors or when the bladder has been damaged and needs to be repaired.