What is Benign Prostatic Hyperplasia
Benign prostatic hyperplasia (BPH), also known as lower urinary tract symptoms (LUTS), is a common urological condition caused by the non-cancerous enlargement of the prostate gland in aging men. As the prostate enlarges, it can squeeze down on the urethra. This can cause men to have trouble urinating leading to the symptoms of BPH.
What are some of the risk factors for BPH?
Risk factors for developing BPH include increasing age and a family history of BPH.
What are some of the symptoms associated with BPH?
Since the prostate surrounds the urethra just below the bladder, its enlargement can result in symptoms that irritate or obstruct the bladder. A common symptom is the need to frequently empty the bladder, sometimes as often as every one to two hours, especially at night. Other symptoms include the sensation that the bladder is not empty, even after a man is done urinating, or that a man cannot postpone urination once the urge to urinate arises. BPH can cause a weak urinary stream, dribbling of urine, or the need to stop and start urinating several times when the bladder is emptied. BPH can cause trouble in starting to urinate, often requiring a man to push or strain in order to urinate. In extreme cases, a man might not be able to urinate at all, which is an emergency that requires prompt attention.
How is BPH diagnosed?
In order to help assess the severity of such symptoms, Symptom Score Index was developed. This diagnostic system includes a series of questions that ask how often the urinary symptoms identified above occur. This helps measure how severe the BPH is ranging from mild to severe.
When a doctor evaluates someone for possible BPH, the evaluation will typically consist of a thorough medical history, a physical examination (including a digital rectal exam or DRE), and use of the Syntom Score Index.
There are a series of other studies that may or may not be offered to a patient being evaluated for BPH depending on the clinical situation.
1. prostate specific antigen (PSA), a blood test to screen for prostate cancer
2. a measurement of post-void residual volume (PVR), the amount of urine left in the bladder after urinating
3. uroflowmetry, or urine flow study, a measure of how fast urine flows when a man urinates
4. cystoscopy, a direct look in the urethra and/or bladder using a small flexible scope
5. urodynamic pressure-flow study that tests the pressures inside the bladder during urination
6. ultrasound of the kidney or the prostate
When should I see a doctor about BPH?
A man should see a doctor if he has any of the symptoms mentioned previously that are bothersome. In addition, he should see a doctor immediately if he has blood in the urine, pain with urination.
When is surgical treatment suggested as a form of treatment?
When medical therapy fails, surgery is required to remove the obstructing tissue. Surgery is almost always recommended for men who are unable to urinate, have kidney damage, frequent urinary tract infections, significant bleeding or stones in the bladder.
Transurethral resection of the prostate (TURP):
Transurethral resection is the most common surgery for BPH.. This can be done using electric current or with laser light. After the patient receives anesthesia, the surgeon inserts an instrument called a resectoscope through the tip of the penis into the urethra. The removed tissue pieces are carried by the irrigating fluid into the bladder and then flushed out and sent to a pathologist for examination under a microscope. At the end of the procedure, a catheter is placed in the bladder through the penis. The bladder is continuously irrigated with fluid through the catheter in order to monitor bleeding and prevent blood from clotting and obstructing the catheter. Since there are no surgical incisions with this procedure, patients normally stay in the hospital only one to two days. Depending on surgeon preference, the catheter may be removed while the patient is still in the hospital or the patient may be sent home with the catheter in place, attached to a leg bag for convenience and removed several days later as an outpatient procedure.