BPH Basics

By Anshu Guleria, MD

Prince William Urology Associates

. http://www.guleriaurologyassociates.com/

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BPH Basics

The Prostate

The prostate is a walnut sized organ at the base of a man's bladder. The prostate produces fluid, which aids in transporting sperm through the female reproductive system. The urethra carries urine from the bladder through the prostate then out through the penis.

What Is BPH?

Benign prostatic hyperplasia (BPH) is a natural process of aging in men but varies with genetic and environmental factors. The maximal rate of growth of the prostate occurs from age 40-50, but symptoms usually occur later. About 25-30% of men may need surgery for BPH during their lifetime.

Benign growth occurs centrally around the urethra so as the growth occurs, it blocks the urinary flow through the urethra. It may lead to permanent bladder or kidney damage if ignored.

Symptoms

The severity of symptoms may not be related to the size of the prostate. Symptoms include urinary frequency, urgency, night-time urination, a weak stream, a delayed starting of stream, a start-stop stream (intermittency), dribbling after voiding, and incontinence.

Fortunately, there are many options to treat BPH. Treatment of BPH may be non-invasive, minimally invasive, or involve open surgery.

Non-invasive Treatments

• Observation, which is typically used for patients with mild symptoms and urinary problems
• Taking oral medications, including herbal remedies such as Saw Palmetto
• Prescribing alpha blockers to relax muscles around the prostate
• Prescribing 5-alpha reductase inhibitors to block conversion of testosterone to DHT

Minimally Invasive Procedures

Minimally invasive procedures to treat BPH all involve creating a channel through the central prostate using some form of heat energy.

One popular method is transurethral microwave thermotherapy (TUMT). The procedure is performed in the office under local anesthesia using a catheter with a microwave transducer in the prostatic channel. The prostate tissue is slowly heated to 45-55o C over 30 to 60 minutes of therapy time.

Another office treatment is called transurethral needle ablation (TUNA), which uses a radiofrequency generator to produce heat at the tip of prongs that are inserted into the central prostate via a scope. A prostatic temperature of 90-100o C is achieved. This treatment can be done in the office under local anesthesia, but may require some sedation.

Surgical Procedures

A popular surgical procedure is trans-urethral laser vaporization of the prostate. It requires hospitalization and anesthesia but offers rapid destruction of obstructing prostate tissue. Most patients are able to void immediately and stop taking medications.

In rare cases, when the prostate is too large to treat via a scope, an open prostatectomy may be required. This involves making an incision in the lower abdomen.

A prostatectomy requires general or spinal anesthesia, two to five days in the hospital, and includes a much higher risk of bleeding and incontinence.