Overview
- The prostate is a walnut sized gland that sits at the base of the bladder. It makes up part of the urethra, which allows urine to flow out of the bladder. The prostate’s role is in reproduction – it makes up the majority of the ejaculatory fluid to support sperm with fluids and nutrients.
- As men age, the prostate enlarges. This is called benign prostatic hyperplasia (BPH). BPH is a non-cancerous condition that can make urination bothersome or difficult. 50% of men have symptoms of BPH by the age of 55.
Symptoms
- Signs/symptoms of BPH can include:
- Difficulty starting urination
- Sudden or frequent urge to urinate
- Slow or weak urinary stream
- Waking at night to urinate
- Straining to urinate
- Incomplete bladder emptying
- Urine leakage
- Recurrent urinary tract infection
- Inability to empty the bladder (urinary retention)
- Bladder stones
Evaluation
- Treating BPH is important as untreated BPH can cause bladder and/or kidney damage. Also, there are other causes of bothersome urinary symptoms that need to be ruled-out before a diagnosis of BPH is made, like prostate or bladder cancer, urethral stricture, bladder failure, etc.
- In addition to a medical history and physical exam, your doctor may use any combination of the following tests to diagnose BPH:
- Questionnaire – symptom assessment forms help determine mild, moderate, or severe symptoms
- PSA – blood test that is used to determine your risk for prostate cancer.
- Urinalysis – evaluate for blood or bacteria in the urine.
- Uroflow – measure the flow of urine as you empty your bladder.
- Bladder scan – non-invasive measurement of the amount of urine left in the bladder after you urinate.
- Urodynamics – minimally-invasive, in-office test that measures bladder function during all stages of filling and emptying – this is the best test we have to evaluate the function of the bladder.
- Cystoscopy – small, flexible camera is used to look in the urethra, prostate, and bladder. This will evaluate the internal anatomy of the prostate and it will help rule out other issues, such as tumors, stones, or strictures.
- Prostate ultrasound – small ultrasound probe is inserted in the rectum and the size and dimensions of the prostate is noted.
Treatment
- Lifestyle modifications: for men with mild symptoms, changing dietary or voiding habits can provide the needed relief.
- Medications: medications are often used to treat mild/moderate BPH.
- Alpha-blockers – relax the muscles surrounding the prostate and bladder, allowing urine to flow easier.
- 5-alpha reductase inhibitors – inhibit testosterone in the prostate and shrink the prostate over time. It can take 6 months to notice improvement in symptoms with these medications.
- Surgical treatments: used for moderate/severe symptoms, when medications don’t work, or when men have side effects from medications.
- Urolift: small, permanent implants are placed into the prostate to hold the obstructive tissue out of the urinary channel. This is a minimally invasive procedure and patients go home the same day, most without a catheter.
- Transurethral resection of the prostate (TURP): “gold standard” treatment for BPH. Using endoscopy (all done through the urethra), obstructive prostate tissue is resected in small pieces to open the urinary channel. Most men go home the same day, some require a short hospital stay. A urinary catheter is left in place for a short time after the procedure.
- Robotic simple prostatectomy: Using laparoscopic instruments, the inside of the prostate is removed and the capsule is left in place. This allows for a maximally open urinary channel for urination. Men stay overnight in the hospital after this surgery and keep a urinary catheter for 7-10 days. This surgery is typically reserved for very large prostate glands.
The doctors at Magic Valley Urology can treat your BPH. Call 208-733-3404 for an appointment today.