BPH

Treating Prostate Conditions in the Blue Ridge Area

WHAT IS BENIGN PROSTATE HYPERPLASIA (BPH)?

Benign prostatic hyperplasia is the medical terminology used when referring to an enlarged prostate or prostate enlargement. This is a common condition that affects men as they age. Men can begin to experience symptoms of benign prostate hyperplasia in their 40s and 50s and more than 50% of men have enlarged prostates in their 60s. Having benign prostate hyperplasia does not increase the risk of prostate cancer.

The prostate is a small gland that sits just below the bladder and surrounds the urethra, or the tube that passes urine from the bladder through the penis. As the prostate enlarges, the prostate tissue eventually restricts its growth causing the prostate gland to put pressure on the urethra. This pressure eventually leads to urinary tract symptoms.

Enlarged Prostate

SYMPTOMS OF ENLARGED PROSTATE

As the prostate enlarges and restricts the urethra, several symptoms can occur that are a result of two different factors; obstructive and changes in the bladder. The obstructive symptoms are caused by pressure on the urethra and usually first develop as urinary symptoms like:

  • Frequent nighttime urination

  • Feeling the need to strain to start urinating

  • A weak stream and smaller amounts of urine with each trip to the bathroom

  • Urination that stops and starts several time during one trip to the bathroom

  • Dribbling after urination

For patients who have had an enlarged prostate for many years, the bladder begins to change as a result of the obstructive symptoms. The bladder acts as a pump that pushes the urine out of the body. After a period of time, the bladder muscle tends to become thicker, stronger and more sensitive causing it to contract frequently with only small amounts of urine. This sensation is known as urinary frequency. If you urinate more than 8 times a day, you may be diagnosed with urinary frequency. Other BPH symptoms related to changes in the bladder include:

  • Sudden onset of a strong feeling to urinate – this is known as urgency

  • Waking during the night to urinate

  • The feeling that your bladder is not empty even right after you use the bathroom is known as urinary retention

Urinary retention can become a more serious complication of benign prostate hyperplasia. The risk of urinary tract infection increases if the bladder retains urine. Urinary retention may also lead to bladder stones which may cause blood in the urine. Urinary incontinence, or the loss of bladder control, can develop if the benign prostate hyperplasia is left untreated.

If the flow of urine is completely blocked, this is a medical emergency. You will need to seek medical attention immediately for acute urinary retention.

DIAGNOSIS OF ENLARGED PROSTATE

At Blue Ridge Urological, we specialize in making swift and accurate diagnoses so that we can develop an effective treatment plan to help you manage the symptoms of enlarged prostate. Diagnosing benign prostate hyperplasia early is important as it helps to prevent further complications of the condition such as urinary tract infections, bladder stones, kidney stones and incontinence. During your consultation with one of our board certified urologists, we will record your medical history and perform a physical examination. We will also perform several types of tests to determine the best way to treat your specific urological issues.

Physical Examination

The physical examination includes a digital rectal exam or DRE to feel for the size of the prostate and assess the presence of any lumps or nodules. A blood test will help determine your risk of prostate cancer. This blood test is known as a PSA or a prostate-specific antigen. If the PSA blood test comes back with a higher number, outside the normal range, this may be an indication of prostate enlargement, infection or prostate cancer and will need further analysis. A urinalysis may be performed to detect blood in the urine or the presence of an infection.

Bladder function testing, also called urodynamics testing, is used to check how well the bladder can retain the urine and then push it through the urethra. These studies also show how well the urethra and sphincters work. During the bladder function studies, measurements will be recorded for how much urine is left in the bladder after you use the bathroom, how fast you release urine and how much pressure is required on your bladder for you to begin urination.

Advanced testing may be required to evaluate the health of the bladder and prostate. These tests may include a cystoscopy, which involves inserting a small camera into the bladder to determine if the urethra is blocked and to look for bladder stones or tumors. A transrectal ultrasound may be used to determine the size of the prostate as well as inspect the prostate for irregularities. Finally, a needle biopsy can be performed to sample a small amount of prostate tissue to check for cancer. This will only be necessary if the PSA blood work is high or a lump or nodule was found during the DRE.

TREATMENT FOR ENLARGED PROSTATE

At Blue Ridge Urological, we specialize in diagnosing and treating conditions of the urinary tract. If you have been diagnosed with benign prostate hyperplasia, you may not need treatment until you develop symptoms that are bothersome or complications such as recurrent urinary tract infections.

The first line of treatment is usually suggesting lifestyle modifications that include eating healthy and avoiding alcohol or caffeinated beverages. Restricting your drinking after 8:00 pm may help with urinary frequency at night.

There are medications, known as alpha-blockers, that can help to relax the muscles in the prostate and bladder which may improve the flow of urine. Other medications work by shrinking the prostate over time. It may take 6-12 months to notice an improvement in symptoms of BPH. You and your provider will be able to discuss the risk/benefit analysis of these medications to determine what is right for you. In rare cases, minimally invasive procedures or surgical treatment may be necessary to relieve severe symptoms.

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