As men naturally age, they become at higher risk for larger prostate glands and the development of benign prostatic hyperplasia (BPH). BPH is a non-cancerous growth that results from an enlargement of the prostate gland. As the prostate gland sits below the bladder, this condition primarily affects urination in men. An enlarged prostate can squeeze or partially block the urethra – the tube by which urine exits the body. Men with an enlarged prostate can experience discomfort in the form of poor urinary flow, more frequent urination, and dribbling at the end of urination. Men over the age of 40 are at risk for BPH; the risk of BPH increases with age – approximately a third of men over 50 experience BPH while 80-90% of men older than 90 experience BPH. Worldwide, approximately 30 million men have symptoms related to BPH. While BPH does not seem to increase the risk of prostate cancer, similar symptoms exist across the two disease states.
Symptoms of BPH
Enlargement of the prostate can result in blockage of the urethra. Minor or early symptoms associated with this include:
- Frequent urination
- Weak stream
- Urgency to urinate
- A feeling of incomplete bladder emptying
- Excessive urination at night (nocturia)
- Pain after ejaculation or while urinating
- Urine that looks or smells different
If left untreated, BPH can yield more severe symptoms, including:
- Bladder stones or infection
- Blood in the urine
- Long-term kidney damage caused by retaining extra urine in the bladder
Furthermore, patients with these symptoms below should seek medical attention immediately:
- Pain in the lower abdomen or genitals during urination
- Inability to urinate altogether
- Pain, fever, chills while urinating
- Blood in the urine
The International Prostate Symptom Score (IPSS) was developed to measure the severity of BPH symptoms. This assessment scores between 0-35, where scores of 0-7 represent mild BPH, 8-19 represent moderate BPH, and 20-35 represent severe BPH. Patients should consider this assessment to get a reference point of their BPH in preparation for visiting a urologist.
Causes of BPH
BPH is caused by enlargement of the prostate as part of the natural male aging process. While the prostate grows naturally during puberty, it can undergo a second growth spurt again as men age into their 40s and 50s. This may occur as a result of excess hormones such as dihydrotestosterone (DHT) and estrogen.
Diagnosis of BPH
BPH and other incontinence conditions require a thorough diagnosis with a variety of tests:
- Digital Rectal Exam: Your physician may be able to detect prostate enlargement by feeling the wall of the rectum directly.
- Urinalysis: Laboratories can test the urine to rule out bladder infections and bladder cancer.
- Prostate-Specific Antigen Test (PSA): Measurement of prostate-specific antigen can help diagnose prostate cancer and an enlarged prostate.
- Urodynamic Tests: Diagnostic tests that measure lower urinary tract performance.
- Cystoscopy: Evaluation of the urethra, prostate, and bladder anatomies with a camera inserted into the urethra
Treatments for BPH
Rezum is a minimally invasive technique used in the treatment of BPH. Rezum is a handheld ablation tool that is administered through the urethra to reach the prostate. The surgeon will use rezum to inject doses of hot steam to ablate portions of a swollen prostate. The steam damages the excessive tissue growth, causing the benign cells to die, and autophagy removes the cell.
Urolift is a minimally invasive procedure that delivers small, long-term, permanent implants. These implants are used to lift and hold the enlarged tissue in the prostate to keep the prostate lobes apart.
A transurethral resection of the prostate (TURP) is a surgery that removes parts of the prostate gland through the patient’s penis. TURP is done to relieve enlarged prostate symptoms (most commonly those due to BPH) while not necessarily treating the enlarged prostate itself.
Compared to PAE (see below), patients undergoing TURP generally require overnight hospital stays, longer recovery times up to 8 weeks, and general anesthesia. PAE patients undergo the procedure as outpatients and are discharged the same day, recover in 7-10 days, and are treated through the arteries non-invasively as opposed to direct cauterization through the penis.
In transurethral microwave thermotherapy (TUMT), microwave energy is emitted through an antenna to the prostate in order to kill the tissue. Subsequent healing of the prostate will shrink and relieve BPH symptoms. This is also known as cooled thermal therapy as cooling fluid is circulated around the antenna to prevent overheating of the urethra wall.
Prostate artery embolization (PAE) is a technique for blocking blood flow to the prostate by releasing microsphere particles into the arteries directed towards the prostate. Interventional radiologists perform this using an X-ray to guide a catheter to the prostate arteries. This is a non-invasive outpatient procedure that results in minimal pain and more minor side effects than alternate procedures (see TURP section above).