Overview
Diagnosis
Diagnosis of BPH typically starts with a medical history review and a physical exam, including:
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Digital Rectal Exam (DRE): To check prostate size and texture.
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Urine Test: Screens for infections or other conditions with similar symptoms.
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Blood Test: Evaluates kidney function and may include prostate-specific antigen (PSA) to assess prostate health.
Additional tests may include:
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Urinary Flow Test: Measures strength and volume of urine flow.
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Postvoid Residual Volume Test: Determines how completely the bladder empties.
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24-hour Voiding Diary: Tracks urination patterns, especially nighttime urine output.
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Transrectal Ultrasound (TRUS): Uses sound waves to measure prostate size.
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Prostate Biopsy: Samples tissue to rule out cancer.
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Urodynamic and Pressure Flow Studies: Measures bladder muscle function.
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Cystoscopy: Uses a lighted scope to examine the urethra and bladder.
Treatment
Treatment depends on prostate size, symptoms, overall health, and personal preference. Mild symptoms may not require immediate treatment.
1. Medications
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Alpha Blockers: Relax bladder and prostate muscles to improve urine flow (e.g., tamsulosin, alfuzosin). Side effects may include dizziness and retrograde ejaculation.
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5-Alpha Reductase Inhibitors: Shrink the prostate over several months (e.g., finasteride, dutasteride). Possible sexual side effects.
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Combination Therapy: Using both alpha blockers and 5-alpha reductase inhibitors if single therapy is insufficient.
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Tadalafil (Cialis): Can improve urinary symptoms and erectile dysfunction.
2. Minimally Invasive Procedures & Surgery
Procedures may be needed if medications fail or complications arise. Options include:
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Transurethral Resection of the Prostate (TURP): Removes inner prostate tissue.
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Transurethral Incision of the Prostate (TUIP): Small cuts in the prostate to improve urine flow.
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Transurethral Microwave Therapy (TUMT): Uses microwave energy to shrink prostate tissue.
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Laser Therapy: High-energy lasers destroy or remove excess tissue (PVP, HoLEP).
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Prostate Lift: Compresses the prostate to ease urine flow with fewer sexual side effects.
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Water Vapor Thermal Therapy (WVTT): Uses steam to remove excess tissue.
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Robotic Waterjet Treatment: Water jets remove obstructive tissue.
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Open or Robot-Assisted Prostatectomy: Surgical removal for very large prostates.
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Prostate Artery Embolization (PAE): Blocks blood flow to shrink the prostate; performed by a trained interventional radiologist.
Potential Side Effects:
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Retrograde ejaculation
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Urinary leakage
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Urinary tract infection
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Bleeding
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Erectile dysfunction
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