Benign Prostatic Hyperplasia (BPH)/Enlarged Prostate
Dr. Banno and Midwest Urological Group have been successfully treating men for Enlarged Prostate (BPH) for over 3 decades. We continue to offer the latest in medical advancements for the treatment of BPH. Please call our office today, 309-692-9898 if you would like to be evaluated for enlarged prostate and please review the material below to assist you.
BPH is an enlarged prostate. The prostate goes through two main growth cycles during a man’s life. The first occurs early in puberty, when the prostate doubles in size. The second phase of growth starts around age 25 and goes on for most of the rest of a man’s life. BPH most often occurs during this second growth phase.
As the prostate enlarges, it presses against the urethra. The bladder wall becomes thicker. One day, the bladder may weaken and lose the ability to empty fully, leaving some urine in the bladder. Narrowing of the urethra and urinary retention – being unable to empty the bladder fully – cause many of the problems of BPH.
BPH is benign. This means it is not cancer. It does not cause or lead to cancer. However, BPH and cancer can happen at the same time.
BPH is common. About half of all men between ages 51 and 60 have BPH. Up to 90% of men over age 80 have it.
What is the Prostate
The prostate is part of the male reproductive system. It is about the size of a walnut and weighs about an ounce. The prostate is found below the bladder and in front of the rectum. It goes all the way around a tube called the urethra, which carries urine from the bladder out through the penis.
The prostate’s main job is to make fluid for semen. During ejaculation, sperm made in the testicles moves to the urethra. At the same time, fluid from the prostate and the seminal vesicles also moves into the urethra. This mixture – semen – goes through the urethra and out through the penis.
When the prostate is enlarged, it can bother or block the bladder. Needing to urinate often is a common symptom of BPH. This might be every 1 to 2 hours, mainly at night.
Other symptoms include:
- Feeling that the bladder is full, even right after urinating
- Feeling that urinating “can’t wait”
- A weak flow of urine
- Needing to stop and start urinating several times
- Trouble starting to urinate
- Trouble starting to urinate
- Needing to push or strain to urinate
If BPH becomes severe, you might not be able to urinate at all. This is an emergency that must be treated right away.
How Can BPH Affect Your Life?
In most men, BPH gets worse with age. It can lead to bladder damage and infection. It can cause blood in the urine and cause kidney damage.
The causes of BPH are not well-understood. Some researchers believe that factors related to aging and the testicles may cause BPH. This is because BPH does not develop in men whose testicles were removed before puberty.
Throughout their lives, men produce both testosterone, a male hormone, and small amounts of estrogen, a female hormone. As men age, the amount of active testosterone in the blood lowers, leaving a higher share of estrogen. Studies have suggested that BPH may happen because the higher share of estrogen in the prostate adds to the activity of substances that start prostate cells to grow.
Another theory points to dihydrotestosterone (DHT), a male hormone that plays a role in prostate development and growth. Some research has shown that, even when testosterone levels in the blood start to fall, high levels of DHT still build up in the prostate. This may push prostate cells to continue to grow. Scientists have noted that men who do not produce DHT do not develop BPH.
Who is at Risk for BPH?
Aging and a family history of BPH increase a man’s risk for BPH. Obesity, lack of staying active, and erectile dysfunction can also increase risk.
Can BPH be Prevented?
There is no sure way to stop BPH, but losing weight and eating a healthy diet that involves fruits and vegetables may help. This may relate to having too much body fat, may increase hormone levels and other factors in the blood, and stimulate the growth of prostate cells. Staying active also helps control weight and hormone levels.
Please call us today if you have symptoms that might be BPH. Call us or your primary care doctor right away if you have blood in your urine, pain or burning when you urinate, or if you cannot urinate.
We diagnose BPH based on:
- Personal or family history
- A physical exam
- Medical tests
The American Urological Association (AUA) has built a BPH Symptom Score Index. It’s a series of questions about how often urinary symptoms happen. The score rates BPH from mild to severe. We will have you take the test and talk with you about your results.
Dr. Banno and Midwest Urological Group will review your Symptom Score and take a medical history. You will also have a physical exam that involves a digital rectal exam (DRE). We may also want you to have some or all of these tests:
- Cystoscopy to look at the urethra or bladder with a scope
- Post-void residual volume to measure urine left in the bladder after urinating
- PSA blood test to screen for prostate cancer
- Ultrasound of the prostate
- Urinalysis (urine test)
- Uroflowmetry to measure how fast urine flows
- Urodynamic pressure to test pressure in the bladder during urinating
- Urinary blood test to screen for bladder cancer
PSA Blood Test
Prostate-specific antigen (PSA) is a protein that is made only by the prostate. When the prostate is healthy, very little PSA is found in the blood.
The PSA blood test measures the level of PSA in the blood. The test can be done in a lab, hospital, or doctor’s office. No special preparation is needed. The PSA test should be done before the doctor does a DRE. You should not ejaculate for 2 days before a PSA test. That’s because ejaculation can raise the PSA level for 24 to 48 hours.
A low PSA is better for prostate health. A rapid rise in PSA may be a sign that something is wrong. BPH is one possible cause of a high PSA level. Inflammation of the prostate, or prostatitis, is another common cause of a high PSA level.
Digital Rectal Exam
The DRE is done with the man bending over or lying curled on his side. Dr. Banno or physician extender puts on a lubricated, gloved finger into the rectum to feel the shape and thickness of the prostate. The DRE can help us diagnose prostate problems.
There are many options for treating BPH. We will decide together which treatment is right for you. Sometimes a mixture of treatments works best. Mild cases of BPH may not need treatment.
The main types of treatments for BPH are:
Watchful Waiting/Active Surveillance
If we choose this treatment option, your BPH will be closely watched but not actively treated. Diet and medicine can control your symptoms. You will have a yearly exam. If your symptoms get worse or if new symptoms appear, Dr. Banno may suggest that you begin active treatment.
What Are The Benefits, Risks and Side Effects of Watchful Waiting/Active Surveillance?
There are no side effects, but it may be harder to reduce your symptoms later.
Who Are Good Candidates for Watchful Waiting/Active Surveillance?
Men with mild symptoms may be good candidates for this. Men with moderate symptoms that do not bother them are also good candidates.
Alpha blockers are pills that relax the muscles of the prostate and bladder. They improve urine flow, reduce blockage of the urethra, and reduce BPH symptoms. They do not reduce the size of the prostate. Alpha-blocking drugs include alfuzosin (Uroxatral), terazosin (Hytrin), doxazosin (Cardura), and tamsulosin (Flomax).
What are The Benefits, Risks and Side Effects of Alpha Blockers?
One benefit of alpha blockers is they start to work right away. Side effects may include dizziness, lightheadedness, fatigue, and trouble ejaculating.
Who Are Good Candidates for Alpha Blockers?
Men with moderate to severe BPH and men who are bothered by their symptoms are good candidates. Alpha blockers are not a good choice for men who are about to have cataract surgery.
5-Alpha Reductase Inhibitors
5-alpha reductase inhibitors are pills that block the production of DHT, a male hormone that can build up in the prostate and may cause prostate growth. They shrink the prostate and increase urine flow. These drugs include finasteride (Proscar) and dutasteride (Avodart).
What Are The benefits, Risks and Side Effects of 5-Alpha Reductase Inhibitors?
These drugs reduce the risk of BPH complications. They also make it less likely that you will need surgery. Side effects include erectile dysfunction and reduced libido (sex drive). You must keep taking the pills to prevent symptoms from coming back.
Who Are Good Candidates for 5-Alpha Reductase Inhibitors?
These drugs may be best for men with very large prostate glands. Older men are good candidates.
In combination therapy, an alpha-blocker and a 5-alpha-reductase inhibitor are used together. Many studies, such as the Medical Therapy of Prostatic Symptoms (MTOPS) study, have shown that combining two types of medication, instead of using just one, can more effectively improve symptoms, urine flow, and quality of life. Possible drug combinations include:
- Finasteride (Proscar) and doxazosin (Cardura)
Dr. Banno may prescribe a combination of alpha-blockers and drugs called antimuscarinics for patients with overactive bladder symptoms. In overactive bladder, the bladder muscles contract uncontrollably and cause urinary frequency, urinary urgency, and urinary incontinence. Antimuscarinics are medications that relax the bladder muscles.
What Are The Benefits, Risks and Side Effects of Combination Therapy?
Alpha blockers and 5-alpha reductase inhibitors work better together than either drug does alone. They improve symptoms and prevent BPH from getting worse. But each drug can cause side effects. By taking two drugs, you may have more side effects than if you were taking just one.
In the MTOPS study, the most common side effects in patients on combination therapy were dizziness, erectile dysfunction, weakness or lack of energy, and a drop in blood pressure when moving from sitting or lying down to standing.
Who are Good Candidates for Combination Therapy?
Men with larger prostates are good candidates for this treatment.
Phytotherapies are herbal treatments. They are a popular form of “self-treatment.” They are not prescribed by a doctor. Instead, you buy them over the counter as dietary supplements. One popular herb is saw palmetto. However, herbal therapy is not recommended by health care providers. Several important studies show they don’t work. Also, the quality and purity of supplements vary.
What Are The Benefits, Risks and Side Effects of Phytotherapies?
The well-designed studies of herbal treatments studies show that they do not work. Also, herbal treatments do not go through the same testing process or have to follow the same manufacturing rules that drugs do. As a result, the quality and purity of over-the-counter supplements can vary.
Who are Good Candidates for Phytotherapies?
Doctors do not currently recommend herbal treatments for BPH.
Minimally Invasive Surgeries
Minimally invasive surgery is done with minimal anesthesia, as on outpatient and involves a quicker recovery. The procedure may be done in our office or at an outpatient center.
Choosing the right type of minimally invasive surgery for you may depend on:
- The size of your prostate
- How healthy you are
- Your personal choice
There are several types of minimally invasive procedures to choose from, including:
- Prostatic Urethral Lift (PUL)
- Convective Water Vapor (steam) Ablation (Rezum)
- Transurethral Microwave Thermotherapy (TUMT)
- Transurethral Water Vapor Thermal Therapy
What Are the Benefits, Risks, and Side Effects of Minimally Invasive Surgeries?
Symptom relief is the biggest benefit of minimally invasive surgery. Some men have fewer problems controlling their urine after they have one of these procedures. However, having minimally invasive surgery may increase the risk that you will need to have another surgery in the future.
Side effects ofminimally invasive surgery may include:
- Urinary tract infection
- Blood in the urine
- Burning with urination
- Needing to urinate more often
- Sudden urges to urinate
- Less often:
- Erectile dysfunction
- Semen flowing backward into the bladder instead of out of the penis (retrograde ejaculation)
Minimally Invasive Surgeries and Interventions that ARE NOT recommended:
- Prostate Artery Embolization (PAE)
- Transurethral Needle Ablation (TUNA)
Who Are Good Candidates for Minimally Invasive Surgery?
Men who are having trouble urinating are good candidates for minimally invasive surgery. In addition, you may be a good candidate if you:
- Have moderate to severe BPH symptoms
- Have urinary tract obstruction, bladder stones, or blood in your urine
- Can’t empty your bladder completely
- Have bleeding from your prostate
- Urinate very slowly
- Have taken medications for BPH but they did not work
Prostatic Urethral Lift (PUL)
PUL (also known as UroLift®) uses a needle to place tiny implants in the prostate. These implants lift and hold the enlarged prostate so that it no longer blocks the urethra. PUL may be done with either local or general anesthesia.
What Are The Benefits, Risks and Side Effects of PUL?
PUL uses no cutting or heat to destroy or remove prostate tissue. It takes less than an hour and you can usually go home the same day. Most men see symptom improvement within about 2 weeks. However, reduction of symptoms and improvement in urinary flow may be less than with transurethral resection of the prostate (TURP).
Some men may have pain or burning when passing urine, blood in the urine, or a strong urge to urinate. These side effects usually go away within two to four weeks. Men may have fewer sexual side effects after PUL than after other types of minimally invasive surgery.
Who Are Good Candidates For Prostatic Stents?
Men with many medical problems may be good candidates. Men for whom surgery is high-risk may also be good candidates.
Many men with enlarged prostates and urinary symptoms may be good candidates for PUL. However, it is not clear if this therapy works for those prostates with a middle lobe. Men who have PUL can still have other treatment if they need it. If you are allergic to nickel, titanium, or stainless steel, talk to your doctor before getting PUL. This is a newer treatment, so it’s not clear if future treatment would be needed. There are concerns that this may not be a durable treatment as 33% of men need additional surgeries or go back on medications.
Convective Water Vapor (Steam) Ablation (CWVA, Rezum)
This treatment is also known as Rezum. This treatment uses the stored thermal energy in water vapor (steam) to kill excess prostate tissue. Inside a handheld device, sterile water is heated to just above the boiling point, when it turns into steam. A precise dose of thermal energy from the steam is then injected into the prostate with a small needle. The release of this thermal energy causes rapid cell death. The body’s natural healing response then breaks down and removes the dead tissue, causing the prostate to shrink.
What are the Benefits, Risks, and Side Effects of CWVA?
The treatment is done in the doctor’s office with local anesthesia or after you have taken a pill for pain. You may have blood in your urine and need to use a catheter for a few days. Painful or frequent urination should go away within about 3 weeks. Sexual side effects, such as erectile dysfunction, are unlikely.
Studies currently suggest that symptom improvement may last for up to 4 years. It is not currently known whether the treatment continues to work long-term or whether patients eventually need to have additional treatment.
Who are Good Candidates for CWVA?
Men may be good candidates if they don’t want to take medication for BPH, or if they have tried medication and found it didn’t work. Unlike other minimally invasive therapies, this therapy can treat men who have a middle lobe of the prostate. Men who prefer not to have surgery or want to avoid sexual side effects may also be good candidates.
Transurethral Microwave Thermotherapy (TUMT)
TUMT uses microwaves to destroy prostate tissue. The urologist threads a catheter through the urethra to the prostate. A device called an antenna sends microwaves through the catheter to heat selected portions of the prostate. The heat destroys excess prostate tissue. A cooling system protects the urinary tract from heat damage during the procedure.
What are the Benefits, Risks, and Side Effects of TUMT?
TUMT does not require anesthesia. The surgeon numbs the skin and gives you a pain pill. TUMT only takes an hour. It may relieve bladder obstruction. There is little blood loss or fluid absorption. You can usually go home the same day. TUMT poses a low risk of side effects such as urinary tract infections, urinary incontinence, and scarring in the urethra. About 25% of men have symptoms that may include frequent or intense urges to urinate and a burning sensation when urinating. Despite the fact that the therapy has been available for more than 20 years, the long-term effectiveness is still unclear. Very few of these are done each year and even that number is dropping rapidly as the newer therapies with more clear outcomes are replacing it.
Who are Good Candidates for TUMT?
Men with too many medical problems for invasive surgery may be good candidates for TUMT. Men with weak hearts may be good candidates because there is no blood loss. So are men who want to avoid anesthesia.
This is not therapy or a treatment but rather a temporary measure for men who cannot empty their bladders completely. A catheter is a thin, hollow plastic tube that is inserted into the bladder to drain urine. The catheter may be “clean,” which means it is placed and removed every 6 to 8 hours. Or it may be “indwelling,” which means it is left in the bladder for a short or long time.
A catheter can be placed in the bladder through the urethra. Or, the doctor may insert the catheter through a small puncture in the bladder, just below the navel and above the pubic bone. This is called a suprapubic catheter. A “clean” catheter is one that you, or a caregiver, can place and remove so that you do not have to wear it all the time.
What are the Benefits, Risks, and Side Effects of Catheterization?
Catheters can provide temporary relief of BPH symptoms. Infection is the biggest risk of having a catheter in place for a long time. Bacteria can stick to the catheter surface. This makes it hard for the immune system or antibiotics to work. Using a catheter for a few years increases risk for bladder cancer and can destroy the tissue of the penis. This is probably due to the long-term irritation caused by the catheter sitting in the bladder or at the meatus (urine opening at the tip of the penis). The risk of infection and cancer is lower with “clean intermittent catheterization” than with an “indwelling” catheter.
Who are Good Candidates for Catheterization?
Good candidates for catheterization include men who are waiting for medication to work or waiting for surgery. Catheters are also used during treatment for an infection. They may be a good choice for men who have multiple medical problems and a short life expectancy. The risks and discomfort of surgery may outweigh the risk of infection or cancer.
When medical therapy fails or when BPH symptoms are severe, surgery can be done to remove obstructing prostate tissue. Surgery is almost always recommended if you:
- Are unable to urinate
- Have kidney damage
- Have frequent urinary tract infections
- Have a lot of bleeding
- Have stones in the bladder
These types of surgery can be performed for BPH (please note these surgeries appear in order of least invasive to most invasive):
- Transurethral Incision of the Prostate (TUIP)
- Photoselective Vaporization of the Prostate (PVP)
- Transurethral Resection of the Prostate (TURP)
- Holmium Laser Enucleation of the Prostate (HoLEP)
- Thulium Laser Enucleation of the Prostate (ThuLEP)
- Transurethral Electrovaporization of the Prostate (TUVP)
- Transurethral Water–Jet Ablation
Please call our office today for an Enlarged Prostate (BPH) evaluation; 309-692-9898