Benign Prostatic Hyperplasia, BPH

Benign Prostatic Hyperplasia, BPH, causes an enlargement of the prostate gland which can obstruct the flow of urine as it passed through the prostate causing obstructive symptoms (see below).  The bladder then has to work harder to expel the urine which in turn can affect its function, causing irritative urinary symptoms to develop.

Incidence of BPH

BPH is a common condition:

• 50% of men aged 50 and above experience some degree of prostate enlargement.
• By the age of 80, this increases to approximately 90%.
• While not every man with BPH experiences symptoms, about 30% to 50% will seek medical attention for bothersome urinary issues.

Investigating BPH

To accurately diagnose BPH and tailor treatment, several investigations may be performed:

• Frequency/Volume Chart Assessment:
  • You will document your urination habits over several days, noting the time and volume of each void. This helps assess patterns like frequent urination or excessive nighttime voiding.
• Flow Rate Test:
  • Measures the speed and force of your urine stream. A reduced flow rate often indicates an obstruction caused by an enlarged prostate.
• Bladder Scan:
  • A quick ultrasound scan checks for residual urine left in your bladder after urination. This reveals how well your bladder empties.
• Prostate Size Assessment:
  • Imaging techniques, such as an ultrasound, are used to measure the size of the prostate and assess its impact on the bladder.

Managing BPH

Treatment depends on the severity of symptoms and their impact on daily life. Options range from lifestyle modifications to advanced surgical interventions.

Lifestyle and Dietary Measures:

• Reduce caffeine and alcohol intake, as they can irritate the bladder.
• Stay hydrated but limit fluid intake in the evening to minimize nocturia.
• Maintain a healthy weight and engage in regular physical activity.

Medications:

• Alpha-blockers: Relax the prostate and bladder neck muscles, improving urine flow. Such drugs include tamsulosin and alfuzosin.
• 5-alpha-reductase inhibitors: Shrink the prostate by reducing hormone activity. Such drugs are finasteride and dutasteride.
• Anticholinergics or beta-3 agonists: These medications help manage irritative symptoms by relaxing the bladder muscle reducing urinary urgency and frequency.  The most commonly used medications are solifenacin, darifenacin and mirabegron.
• Combination Therapy: A mix of both for moderate to severe symptoms.

Surgical and Procedural Options:

For patients with significant symptoms or those unresponsive to medications, the following surgical options are available:

Surgical Procedures

Bi-Polar Plasma TURP (Transurethral Resection of the Prostate):

• What Happens:
  • Excess prostate tissue is removed using a specialised electrode through the urethra. This improves urine flow and reduces obstruction. It is considered the gold-standard operation for enlarged prostates. It also allows tissue to be sent for examination in the laboratory to ensure there is no cancer. (see BAUS booklet on TURP) and A Patients guide to TURP
  • Performed under general or spinal anaesthesia.

   

• Recovery:
  • Hospital stay: 1–2 days with rapid symptom relief.
  • Catheter required for 1–2 days post-surgery, removed before discharge.
  • Men may notice a reduction/loss of semen at the time of ejaculation, however most men can continue to have erections and experience an orgasm.

Rezum:

• What Happens:
  • Uses steam to destroy excess prostate tissue. A small probe delivers steam to targeted areas through the urethra, which shrinks overgrown tissue over time.
  • Usually performed under general anaesthesia as a day case procedure. Patients go home with a catheter for a week as the prostate initially swells after the operation worsening the obstruction.
• Recovery:

• • Quick recovery; most patients resume normal activities within a 10 days. It may take 3 months before the treated tissue is re-absorbed by the body and the prostatic obstruction relieved. (see BAUS booklet on REZUM).
  • Some urinary discomfort may persist initially but frequently men retain production of fluid (semen) at the time of ejaculation.

Aquablation:

• What Happens:
  • A robotic system uses high-velocity water jets to precisely remove prostate tissue with device inserted through the. Often combined with TURP equipment to help control any bleeding  after the prostate tissue has been excised. This new minimally invasive approach helps preserves surrounding structures and may allow the preservation of semen production at the time of orgasm.
  • Prostate tissue is sent for examination in the laboratory to ensure no cancer is present.
  • Performed under general or spinal anaesthesia.

Recovery:

• • Hospital stay: 1 day.
  • Rapid symptom relief with minimal side effects.

HoLEP (Holmium Laser Enucleation of the Prostate):

• What Happens:
  • A laser is used to enucleate and remove excess prostate tissue though the urethra. The tissue is then fragmented and washed out from the bladder. (see BAUS booklet on HoLEP).
  • Performed under general or spinal anaesthesia.
  • Suitable for large prostates over 120cc.
• Recovery:
  • Hospital stay: 1–2 days with rapid symptom relief.
  • Catheter required for 1–2 days post-surgery and removed before discharge.
  • Men may notice a reduction/loss of semen at the time of ejaculation, however most men can continue to have erections and experience an orgasm.
  • Occasionally men may experience a little urinary leakage after the procedure that usually settles with time and helped by performing pelvic floor exercises post operatively (see BAUS booklet on Pelvic Floor Ex).

EchoLaser:

• What Happens:
  • Laser energy is delivered via a thin probe transperineally under ultrasound control to shrink prostate tissue. This new minimally invasive option is performed under local anaesthesia.
  • Patients go home with a catheter for a week as the prostate initially swells after the operation worsening the obstruction.

• Recovery:
  • Outpatient procedure with a short recovery period. It may take 3 months before the treated tissue is re-absorbed by the body and the prostatic obstruction relieved.
  • Minimal discomfort post-procedure and men frequently retain production of fluid (semen) at the time of ejaculation.

Supporting Your Journey

BPH is a very manageable condition and a wide range of treatments are available to improve your quality of life. The goal at the Specialist Urology Centre, with experience of all the different procedures is to provide personalized care tailored to your specific symptoms and health needs. If you have any questions or wish to discuss your options further, please don’t hesitate to contact Specialist Urology.