Benign Prostatic Hyperplasia (BPH)

The following are the most common symptoms for benign prostatic hyperplasia (BPH). However, you may experience symptoms differently – and these symptoms may resemble prostate cancer, so it’s always best to talk with your doctor. BPH symptoms 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

Diagnosing BPH in its earlier stages can lower the risk of developing complications. Delay can cause permanent bladder damage for which BPH treatment may be ineffective. In addition to a complete medical history and physical examination, diagnostic procedures for BPH may include:

• Digital Rectal Exam (DRE): A procedure in which the physician inserts a gloved finger into your rectum to examine it and the prostate gland for signs of cancer.
• Intravenous Pyelogram (IVP): A series of X-rays of your kidney, ureters and bladder with the injection of a contrast dye into the vein to detect tumors, abnormalities, kidney stones, or any obstructions, and to assess renal blood flow.
• Cystoscopy (also called Cystourethroscopy): An examination in which a flexible tube and viewing device (scope) is inserted through the urethra to examine the bladder and urinary tract for structural abnormalities or obstructions, such as tumors or stones.
• Urine Flow Study: A test in which you urinate into a special device that measures how quickly the urine is flowing. A reduced flow may suggest BPH.

Research has shown that in mild cases, some BPH symptoms clear up without treatment. But BPH symptoms usually require some kind of treatment eventually. When treatment is needed, your physician will determine the best course of action based on your age, overall health, medical history, the extent of the disease and your tolerance for specific medications, procedures or therapies. Of course, your personal opinions and preferences will also be taken into consideration. Treatments may include:

Surgery

• Transurethral Surgery: The surgeon reaches the prostate by inserting an instrument through your urethra. No external incision is needed.
• Transurethral Resection of the Prostate (TURP): An instrument that contains a light, irrigating fluid and an electrical loop for cutting tissue and sealing blood vessels (resectoscope) is inserted through the penis. The surgeon uses it remove obstructing tissue.
• Transurethral Incision of the Prostate (TUIP): A procedure that widens the urethra by making some small cuts in the bladder neck, where the urethra joins the bladder and in the prostate gland itself.
• Laser Surgery: Uses laser instruments to cut away obstructing prostate tissue.
• Open Surgery: Surgery that requires an external incision; often performed when the gland is very enlarged, when there are complicating factors, or when the bladder has been damaged and needs to be repaired.

Nonsurgical Treatments

• Balloon Urethroplasty: A thin tube with a balloon is inserted into the opening of the penis and guided to the narrowed portion of the urethra. The balloon is inflated to widen the urethra and ease the flow of urine.
• Transurethral Microwave Thermotherapy (TUMT): A device called a Prostatron uses microwaves to heat and destroy excess prostate tissue to reduce urinary frequency and urgency.
• Medications: Used to shrink or at least stop the growth of the prostate without using surgery, or to make the muscles surrounding the urethra looser so the urine flows more easily.
• Transurethral Hyperthermia: An investigative procedure that uses heat, usually provided by microwaves, to shrink the prostate.
• Prostatic Stents: An investigative procedure using stents inserted through the urethra to the narrowed area that are allowed to expand, like a spring, and push back the prostatic tissue and widen the urethra.

Lifestyle Management

• Dietary Factors: Consuming foods and drinks containing soy, drinking green tea, and taking saw palmetto supplements may benefit the prostate, although this is not yet proven. Also, avoiding or decreasing the intake of alcohol, coffee, and other fluids, particularly after dinner, is often helpful. A higher risk for BPH has been found in association with a diet high in zinc, butter and margarine, while individuals who eat lots of fruits are thought to have a lower risk for BPH.
• Avoiding Certain Medications: Decongestants and antihistamines can slow urine flow in some men with BPH. Some antidepressants and diuretics can also aggravate symptoms of BPH. Consult your physician if you are taking any of these medications to discuss changing dosages or switching medications, if possible.
• Kegel Exercises: Repeatedly tightening and releasing the pelvic muscle, also known as Kegel exercises, is helpful in preventing urine leakage. Physicians recommend practicing this exercise while urinating in order to isolate and train the specific muscle. To perform a Kegel, contract the muscle until the flow of urine decreases or stops and then release the muscle. It is recommended that men with BPH repeat five to 15 contractions, holding each for 10 seconds, three to five times a day.