Benign Prostatic Obstruction

Richard Pelman, MD
Partner, Bellevue Urology Associates, Bellevue WA
Clinical Professor of Urology, University of Washington, Seattle WA

As a man matures his prostate continues to grow. This slow benign (non cancerous) enlargement of the prostate gland is a normal feature of male aging. While all men’s prostate glands exhibit some degree of enlargement, only approximately one quarter to one third of men will find the symptoms of enlargement significantly bothersome to require intervention. The typical urinary symp­toms attributed to this condition are referred to as bladder storage symptoms- including urinary frequency, nocturia (the need to urinate at night), urinary urgency, urinary urge incontinence, uncontrolled loss of urine preceded by a strong desire to urinate), or even overflow incontinence (uncontrolled urine loss secondary to an inability to empty the bladder secondary to long standing blockage). Voiding urinary symptoms may also accompany the condition. These symptoms include urinary hesitancy (difficulty in getting the stream started), having to strain to urinate, a weak urinary stream, a sense of incomplete emptying of the bladder, and dribbling of urine at the completion of urination. A questionnaire called the American Urological Association symptom index can be filled out to weigh the severity of these symptoms. While some of these symptoms overlap with other urinary conditions, your physician will be able to sort out the Lower Urinary Tract Symptoms (LUTS) attributed to benign prostatic enlargement utilizing some simple testing. This may include a physical exam of the prostate, a urine test (urinalysis), and a Prostate Specific Antigen (PSA) that can be conveniently done during your office visit. On occasion your physician may feel that referral to a urological specialist is required. Some symptoms may also require imaging of the urinary tract.

Once it has been determined that your condition is secondary to benign enlargement of the prostate, your physician will discuss treatment options with you. These options may include observation of the problem, medications, or interventions.

A group of medications called alpha blockers are currently represented by Hytrin™ (Terazosin), Cardura™ (Doxazosin), Flomax™ (Tamsulosin), and Uroxatral™ (Alfuzosin). These medications are taken daily and will improve the symptoms related to the enlargement by relaxing the smooth muscle cells within the prostate and neck of the bladder. Another type of medication called Proscar™ (Finasteride) and Avodart™ may work to improve symptoms of a large prostate by shrinking the gland. A naturopathic medication called saw palmetto (Seronoa Repens) has demonstrated some ability to improve symptoms. No studies exist to comment on its ability to prevent progression of the process, or to prevent prostate cancer.

In the event that medication is not effective, not indicated or not well tolerated, surgical interventions can be considered. These are classified as to the degree they require hospitalization and recovery as being minimally invasive or invasive. Transurethral Microwave therapy of the Prostate —TUMT; transurethral needle ablation of the prostate — TUNA; and prostate laser procedures are considered minimally invasive thermal therapies. All of these therapies offer similar improvement of symptoms with the ability to accomplish them in an office based setting utilizing sedation, without the restrictions in activity that accompany traditional surgery. These procedures all use heat to kill cells within the prostate, and thus produce an im­proved passageway for the flow of urine. These procedures may not result in the same relief of symptoms to the degree of traditional surgery and they do not provide tissue that can be examined as a pathological specimen. The durability of these procedures is still under review, but does not approach the longevity of the traditional Trans Urethral Resection of the Prostate (TURP). The surgical procedure TURP is still considered the ‘Gold Standard’ for relief of symptoms from these conditions and results in superior relief of symptoms compared to medications or the minimally invasive procedures. It also is the most durable. Tissue is obtained and reviewed. A recovery period is required because actual trimming of tissue is done rather than just heating the tissue. A urological surgeon can council you as to which procedure may seem best for you, and give you full information regarding the procedure, it’s risk, complications, expected benefits, the alternatives and the phases of recovery.

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