Benign prostatic hyperplasia (BPH), also known as benign prostatic hyperplasia, is a common condition as men age. An enlarged prostate can cause unpleasant urinary symptoms such as obstruction of urine flow from the bladder. It also causes bladder, urinary tract, and kidney problems.
In this article, you will find everything about BPH diagnosis and treatment
Initial diagnostic tests may include:
● Digital rectal examination: The doctor inserts a finger into your rectum to check the size of the prostate.
● Urinalysis: Analyzing a urine sample can help rule out infection or other conditions that may cause similar symptoms.
● Blood test: The results may indicate kidney problems.
● Prostate-specific antigen (PSA) blood test: PSA is a substance made by the prostate. Having an enlarged prostate raises PSA levels. However, elevated PSA levels may also be due to recent procedures, infections, surgery, or prostate cancer.
Your doctor may then recommend additional tests to confirm an enlarged prostate and rule out other conditions:
● Urine flow test: You urinate into a container connected to a device that measures the strength and volume of your urine flow. Test results can help diagnose whether your condition is getting better or worse.
● Test of residual urine volume after conception: This test measures your ability to empty your bladder completely. This test can be done using ultrasound or by inserting a catheter into the bladder after voiding to measure the amount of urine remaining in the bladder.
● 24-hour voiding diary: Recording the frequency and amount of urine is especially useful if more than one-third of the daily urine output occurs at night.
If your condition is more complicated, your doctor may recommend:
● Transrectal Ultrasound: An ultrasound probe is inserted into the rectum to measure and evaluate the prostate.
● Prostate Biopsy: Transrectal ultrasound guides a needle that is used to take a sample of tissue (biopsy) from the prostate. Examining tissue helps doctors diagnose or rule out prostate cancer.
● Urodynamics and Pressure Flow Studies: A catheter is inserted into the bladder through the urethra. Water or usually air is slowly injected into the bladder.
Doctors can then measure bladder pressure to determine how well the bladder muscles are working. These studies are usually only used in men suspected of having neurological problems and in men who have had previous prostate surgery and still have symptoms.
● Cystoscopy: A flexible, clear instrument (cystoscope) is inserted into the urethra so the doctor can see inside the urethra and bladder. Local anesthesia is performed before the examination.
There are various BPH treatments, including drug therapy, minimally invasive treatments, and surgery. Choosing the best treatment for you depends on several factors, including:
● Prostate size
● Your age
● Your overall health
● The amount of discomfort or annoyance you experience.
If symptoms are tolerable, simply delay treatment and manage symptoms. In some men, symptoms may subside without treatment.
Drug therapy is the most common treatment for mild to moderate symptoms of BPH. The options are:
- These drugs relax the muscles of the bladder
- neck and muscle fibers of the prostate gland and make urination easier.
- Alpha-blockers such as alfuzosin (Uroxatral), doxazosin (Cardura), tamsulosin (Flomax), and silodosin (Rapaflu) usually work quickly in men with smaller prostates.
- Side effects may include dizziness and a harmless condition in which semen flows back into the bladder instead of the tip of the penis (retrograde ejaculation).
These drugs shrink the prostate by preventing the hormonal changes that cause it to grow.
These drugs, including finasteride (Proscar) and dutasteride (Avodart), may take up to 6 months to work. A side effect is retrograde ejaculation.
● Concomitant drug therapy: If either drug alone is not effective, your doctor may recommend taking an alpha-blocker and a 5-alpha reductase inhibitor at the same time.
● Tadalafil (Cialis): Studies show that this drug, which is usually used to treat erectile dysfunction, can also treat prostate enlargement.
Minimally invasive treatment or surgery
Minimally invasive treatment or surgery may be recommended if:
● Your symptoms are moderate to severe.
● Symptoms do not improve with medication.
● You have urinary obstruction, bladder stones, hematuria, or kidney problems.
● You prefer definitive treatment.
Minimally invasive treatment or surgery may not be an option if:
● Untreated urinary tract infection.
● Urethral stricture.
● Previous prostate radiotherapy or urinary tract surgery.
● Neurological disorders such as Parkinson’s disease and MS.
Depending on the chosen method, the following complications may occur:
● Semen flows backward into the bladder instead of exiting the penis during ejaculation (retrograde ejaculation).
● Temporary difficulty urinating.
● Urinary tract infection.
● Erectile dysfunction.
● Rarely, is loss of bladder control (incontinence).
Types of minimally invasive or surgical treatments.
● Transurethral resection of the prostate (TURP)
● Transurethral incision (TUIP) of the prostate
● Transurethral microwave thermotherapy (TUMT)
● Removal of the needle through the urethra (tuna)
● Laser therapy:
2) Extraction methods
● Prostatic urethral lift (PUL)
● Open or robot-assisted prostatectomy