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WSUS914 164th St. SE
Suite B-12 #244
Mill Creek, WA 98012
(425) 971-5822
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Benign Prostatic Hyperplasia (BPH)
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Richard Pelman, MD
Partner, Bellevue Urology Associates, Bellevue WA
Clinical Professor of Urology, University of Washington, Seattle WA
Watch Video
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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