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Benign Prostatic Hyperplasia

The benign prostatic hyperplasia is characterized by an expansion in size of the prostate due to increased cell growth (hyperplasia). Most growing cells are located in the transitional zone of the prostate, found in the inner part of the prostate. As we age, especially after age 50, the prostate naturally becomes larger following testosterone. Almost all men have a prostate larger at the age of 70. BPH does not increase the risk of developing prostate cancer.


Signs and Symptoms

There are no signs and symptoms in the early stages of BPH. They appear when the prostate begins to compress the urethra like a donut hole becomes smaller. It then causes changes in urination:

  • difficulty urinating
  • more frequent urination during the day, especially at night
  • weak or slow urine stream
  • inability to empty the bladder completely
  • urinary stream that stops and resumes
  • drip at the end of urination
  • reluctance to begin urination
  • urinary retention


Diagnostic

If there are BPH signs and symptoms manifestations and they become bothersome, the doctor will analyze or examinate in order to diagnose. These may include the following:

  • medical history and physical examination
    • rectal examination (DRE)
    • questionnaire to assess the severity of bladder disorders and how they affect human quality of lifeurine studies
  • urine analyzes
    • urine flow measurement (urodébitmétrie)
    • keeping a voiding diary on several 24-hour periods
  • Blood tests
  • imagery
    • kidneys, bladder and prostate ultrasonography
    • post voiding bladder ultrasound to determine the amount of urine left in the bladder after urination (residual urine)
    • endoscopy
  • cystoscopy
  • biopsy guided by transrectal ultrasound


We use these analyzes and tests to confirm a diagnosis of BPH. They are also used to rule out other problems such as urinary tract infection or a prostate cancer. They also verify the presence of any complication related to BPH.


Treatment

BPH treatments may include the following:


The Observation

This method consists of observing the person carefully, without administering any treatment. The signs and symptoms can be detected gradually. We may use it for men with few symptoms or only mild symptoms.


Medical Treatment

When a man has BPH symptoms that bother him, the doctor may prescribe medications to relieve them.


Inhibitors of 5-alpha-reductase

Inhibitors of 5-alpha-reductase block the testosterone conversion, in the prostate, into another form called dihydrotestosterone. This processing class prevents the increase of the prostate size and gradually reduces it. They are especially effective for men who have an enlarged prostate. These medications take several months to relieve the symptoms.


The two drugs in this category are the finasteride (Proscar) and the dutasteride (Avodart). Side effects may include:

  • reduction of sexual desire
  • erectile dysfunction
  • reduced sperm ejaculation
  • swelling of the breasts or nipples sensitivity


Alpha-Adrenergic Antagonists

These drugs have the effect of relaxing the muscles located near the prostate and a part of the bladder. They reduce the pressure on the urethra and allow urine to flow more easily. They do not reduce the size of the prostate.


The most common drugs are:

  • Tamsulosin (Flomax)
  • Alfuzosin (Xatral)
  • Silodosin (Rapaflo)


Side effects may include:

  • dizziness
  • tiredness
  • headache
  • decrease in blood pressure
  • Retrograde ejaculation (semen enters the bladder during ejaculation instead of out through the urethra)
surgery


Surgery

The BPH surgery is indicated in cases where symptoms are severe or if the man is completely unable to urinate, or when drug treatment was not effective.


Transurethral resection of the prostate (TURP)

TURP is to remove the prostate tissue through the urethra in order to reduce the size of the prostate. This is the most common surgical procedure for BPH:


  • it is practiced mostly under spinal anesthesia and sometimes general

  • a rigid tubular instrument with a light and a camera (resectoscope) is inserted into the urethra to the prostate

  • the surgeon can observe the inside of the urethra, the prostate and the bladder

  • the excess prostate tissue is resected into small chips in the area around the urethra. They are then removed

  • a catheter is placed into the bladder with a continuous washing to allow urine to flow

  • the catheter is removed when there is no more blood in the urine (usually the next day)

  • it usually requires a hospital stay of one night


The side effects of TURP may include:


  • bleeding

  • infection

  • retrograde ejaculation

  • erectile dysfunction - rare

  • incontinence - rare

  • urethral stricture – rare

Some men would possibly undergo a second surgery (10% of men after 10 years).


Other Types of Surgery

Other forms of surgery, many are similar to TURP, which may be used are the following:


  • Transurethral Incision of the Prostate

    • One or two cuts are made in the prostate to reduce the constriction of the urethra.

    • Transurethral incision of the prostate is used for smaller prostates.

  • Electrospray Transurethral

    • It is the burning of fabric by means of an electric current or by laser

  • Resection Holmium Laser

    • We may use a holmium laser to cut (enucleated) or vaporize the prostate in cases of prostate too large for a standard technique.


In private practice, we offer evaluation of BPH, investigations and medical treatments including observation.

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