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Benign Prostatic Hyperplasia

As men age, enlargement of the prostate gland — otherwise known as benign prostatic hyperplasia (BPH) is very common. In fact, approximately 50 percent of men in their 50s will have BPH. Other risk factors include family history, diabetes and/or heart disease, the use of beta blockers and obesity. While it’s not life-threatening, it causes a variety of uncomfortable urinary symptoms such as problems with urination. 

While BPH and prostate cancer both affect the prostate gland, BPH is a benign condition and is not linked to an increased risk for prostate cancer. However, since many of the symptoms are similar — seeing a urologist to discuss your symptoms and rule out cancer is very important. WakeMed Urology has decades of expertise in the diagnosis and treatment of BPH. Whether you choose medications, minimally-invasive treatments or surgery, our team will be here for you every step of the way.

 

How Do I Know if I Have BPH?

BPH generally causes symptoms such as blocking the flow of urine out of the bladder, which can lead to increased frequency of urination (particularly at night), weak stream or a stream that stops and starts, dribbling at the end of urination, or an inability to completely empty the bladder. Generally, the severity of symptoms will get worse over time without proper treatment.

To check for BPH, your urologist will talk to you about your medical history and symptoms, and will likely perform a series of tests to check for BPH and to evaluate you for prostate cancer. These tests may include:

  • A urine test (urinalysis) that can rule our infection or other causes for your symptoms.
  • A blood test to rule out kidney problems.
  • Urinary flow evaluation to measure the speed of your urine output.
  • A test to measure how much urine remains in your bladder after urination.
  • A prostate-specific antigen (PSA) test, which is a simple blood test to check protein levels.
  • A digital rectal exam that allows the urologist to feel whether your prostate is enlarged.
  • An ultrasound of the prostate gland.
  • A biopsy of the prostate tissue.
  • A cystoscopy to allow your urologist to see inside your urethra and bladder.

Treatment Options for BPH

While BPH isn’t prostate cancer, many of the treatment options are the same since they’re both treating an enlarged prostate gland.

  • Medication therapies typically work well for men with mild to moderate symptoms. Options include alpha blockers, 5-alpha reductase inhibitors, a combination of the two therapies, or certain drugs used to treat erectile dysfunction.
  • Procedural options are typically indicated for patients with moderate to severe symptoms where medication hasn’t been effective or isn’t preferred.  There are numerous options, including:
    • Transurethral resection of the prostate (TURP) is the gold standard and most studied surgical procedure for the treatment of BPH. It involves removing the portions of the prostate that are causing urinary symptoms. It’s considered minimally-invasive because it’s performed using a scope that’s inserted through the urethra — leaving no scars.  It may, however, cause retrograde ejaculation which is when semen enters the bladder instead of coming out through the penis during orgasm. This is typically only a problem for men who are trying to conceive. Blood in the urine and urinary urgency are common temporary side effects. Very rarely, patients can experience urinary leakage afterward which is also usually temporary.
    • Transurethral incision of the prostate (TUIP) is a procedure that involves a few incisions designed to reduce the pressure the prostate gland puts on the urethra. This procedure is often recommended for men with smaller prostate glands and comes with less risk for retrograde ejaculation.
    • UroLift system is a permanent device placed to lift and hold enlarged prostate tissue, preventing it from blocking the urethra.

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    • Greenlight laser vaporization can be used to kill prostate tissue and reduce the size of the gland. Advantages of this procedure is that it can be performed on patients taking long-term anticoagulation therapy that can’t be discontinued for cardiac or other reasons.
    • Prostatic artery embolization (PAE) is a minimally-invasive treatment designed to reduce symptoms of BPH. It’s performed by an interventional radiologist who will use a catheter to administer particles that will reduce blood supply to the prostate and thereby shrink the prostate gland and reduce symptoms.
    • Open or robotic simple prostatectomy procedures are performed when the prostate is very enlarged. Prostatectomies can be performed using open, minimally-invasive or robotic techniques — which typically vary based on your surgeon’s preference or training.
    • Rezum heated steam treatment is a minimally-invasive option that uses steam vapor to target and kill the affected prostate tissue. In all, the procedure takes less than five minutes and isn’t painful. There are no reported sexual side effects and the treatment doesn’t impact the urinary sphincter — which means there is minimal risk of incontinence.

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Determining the best procedural option for you will involve a discussion with your urologist who can make recommendations based on the size of your prostate and the severity of your symptoms, taking into consideration other factors such as health and family history and your personal preferences.