Benign Prostatic Hyperplasia – Diagnosis and Treatment
Diagnosis
How Healthnile Specialists Evaluate and Test
Diagnosing benign prostatic hyperplasia (BPH) usually starts with a close look at your symptoms.
The focus is on lower urinary tract issuesâthings like a weak urine stream, frequent trips to the bathroom, trouble getting started (hesitancy), not feeling empty, and waking up at night (nocturia).
Doctors often do a digital rectal examination (DRE). They gently insert a finger into the rectum to check the prostate gland, feeling for swelling or changes in texture.
Lab tests help a lot here. A urine analysis (urinalysis) can rule out other causes, like infection or blood in the urine (hematuria). A blood test checks kidney function, especially if youâve had long-term urinary retention.
The prostate-specific antigen (PSA) blood test is another key tool. PSA is a protein only the prostate makes. If the PSA level goes up, it could mean BPH, but it might also point to prostate cancer or something else.
PSA results help doctors decide if more digging is needed.
To figure out how your bladder and urethra are working, specialists use different tests:
| Diagnostic Test | Purpose |
|---|---|
| Urinary flow (uroflowmetry) | Measures how fast and how much urine flows out during urination. |
| Postvoid residual volume | Checks how much urine remains in the bladder after urinating using ultrasound or catheter. |
| 24-hour voiding diary | Tracks frequency and amount of urination throughout the day and night. |
| Transrectal ultrasound | Uses sound waves to make images and to measure prostate size and shape. |
| Cystoscopy | Uses a lighted, flexible tube to look directly inside urethra and bladder. |
| Urodynamic and pressure flow studies | Measures pressure inside the bladder and strength of urinary flow. |
| Prostate biopsy | Removes small tissue samples to check for prostate cancer. |
For trickier cases, doctors might go with more advanced exams. A transrectal ultrasound creates detailed images of the prostate, showing its size and any odd spots.
During a cystoscopy, a flexible tool lets the provider look inside the urethra and bladder. This can reveal blockages or other structural problems.
If a high PSA or strange findings suggest prostate cancer, doctors might recommend a prostate biopsy. They take tiny pieces of tissue from the prostate, usually with ultrasound guidance, and check them under a microscope.
Treatment
Medicines for Treating an Enlarged Prostate
Doctors usually start with medicines for men who have mild or moderate symptoms. The main groups are alpha-blockers and 5-alpha reductase inhibitors.
- Alpha-blockers relax the muscles in the prostate and bladder neck. This makes urination easier. They often work fastâsometimes in just days or weeksâespecially if the prostate isnât too big. Common side effects? Dizziness or retrograde ejaculation, where semen goes into the bladder instead of out.
- 5-alpha reductase inhibitors shrink the prostate over time. They lower hormone levels that make the prostate grow, but you might have to wait months to see the full effect. Possible side effects include lower sex drive or erection troubles.
- Sometimes, doctors prescribe both types togetherâcombination therapyâif one alone isnât cutting it.
- PDE5 inhibitor is another option. While itâs mainly for erectile dysfunction, it can help urinary symptoms for some men.
Operations and Procedures for Enlarged Prostate
If medicines arenât doing the trick, or if youâre having serious trouble like not being able to urinate, doctors might suggest more involved treatments. These range from minor procedures to traditional surgery.
Not everyone is right for every procedure. If youâve got certain infections, past radiation, or nerve problems, some options are off the table. All procedures have risks, like leaking urine, semen going backward, infection, or bleeding.
Resecting the Prostate Through the Urethra (TURP)
During transurethral resection of the prostate (TURP), the surgeon puts a scope through the urethra. They remove parts of the inner prostate that block urine flow. Most men see improvement pretty quickly, with a stronger stream.
Youâll probably need a catheter for a bit afterward. TURP remains one of the most common and effective surgeries.
Small Cuts in the Prostate (TUIP)
With transurethral incision of the prostate (TUIP), the surgeon uses a lighted tool through the urethra to make one or two small cuts in the prostate. These cuts ease pressure and let urine flow better.
TUIP usually works best for smaller prostates or for males who shouldnât have bigger surgeries. Recovery tends to be faster than with larger operations.
Heat Treatment with Microwaves (TUMT)
Transurethral microwave thermotherapy (TUMT) uses a special catheter in the urethra. It sends microwaves into the prostate, heating and destroying some of the extra tissue.
Symptoms can improve, but this is mostly for smaller prostates. Results might take a while, and sometimes youâll need a repeat treatment.
High-Energy Laser Treatments
Laser therapy uses focused light to get rid of or destroy extra prostate tissue. The risk of side effects is usually lower than with classic surgery. Laser treatments often suit people on blood thinners.
There are two main laser procedures:
- Ablative treatments burn away tissue that blocks urine. Some men get mild irritation for a bit after.
- Enucleative treatments remove all the tissue blocking urine flow, which can stop it from growing back. Doctors can check the removed tissue for cancer.
Squeezing the Prostate with Special Implants (Prostate Lift)
A prostate lift uses tiny implants to hold prostate tissue away from the urethra, making it easier to pee.
This works best if the middle of the prostate isnât blocking the way. Itâs less likely to cause sexual side effects compared to some surgeries.
Steam Therapy Using Water Vapor (WVTT)
Water vapor thermal therapy (WVTT) treats an enlarged prostate without major cuts. A thin device sends steam into the prostate, and the heat destroys extra tissue.
This relieves symptoms and has a lower risk of sexual side effects than older surgeries. Itâs a solid option for a lot of men.
Robotic Waterjet Removal
Robotic waterjet treatment uses real-time images to guide robotic tools inside the urethra. Powerful water jets cut and remove extra prostate tissue. This can help, just like other surgeries such as TURP. Risks are similarâthink infection or bleeding.
Large Cut or Robotic Prostate Surgery
Open or robot-assisted prostatectomy is usually for very large prostates. The doctor makes a cut in the lower belly and removes prostate tissue or, sometimes, the whole gland.
Since itâs more invasive, you might need a hospital stay and thereâs a higher chance youâll need a blood transfusion.
Blocking Blood Supply to the Prostate (PAE)
Prostate artery embolization (PAE) isnât surgery, but a doctor blocks certain blood vessels to the prostate using imaging. The gland shrinks over time, making urination easier.
An interventional radiologist does this, and itâs a good option for men who canât have surgery. Be sure to talk over the risks and benefits with your healthcare provider.
Care After Treatment
Follow-up care changes depending on what procedure you had. Doctors give instructions on what to avoid and how long recovery might take. Regular check-ups help track how well the treatment is working and spot any problems.
At visits, doctors usually check bladder function and prostate size. Some men might still need medicines or more treatments.
Day-to-Day Choices and Remedies at Home
Healthy daily habits can really help cut down on urinary problems tied to an enlarged prostate. You can start by making small changes to your drinking patterns.
Try to skip fluids in the evening if you want to avoid waking up at night to use the bathroom. Cutting back on caffeine and alcohol might also help, since these drinks often make people urinate more or irritate the bladder.
Eating habits matter, too. Spicy foods sometimes bother the bladder, so you might want to pay attention to how you feel after eating them.
Staying at a healthy weight and getting regular exercise can boost your overall urinary health. Moving your body might even lower your chances of incontinence or sudden urges to go.
When you feel the urge, just go to the restroomâdonât wait too long. If you keep holding it in, you could stretch your bladder and end up with overflow incontinence or even damage.
Planning bathroom breaks every few hours might help you manage urgency and frequency better. Itâs not a perfect system, but it often works for folks.
Some people use double voiding: pee, wait a moment, then try again. This can help your bladder empty out more completely.
Try to keep warm, too. Cold weather seems to make urine retention worse for a lot of people. If you can, avoid certain medications like decongestants and antihistamines. These drugs sometimes make urination harder.
Making these small changes could lower your risk of sudden urine retention, bladder swelling, or urinary tract infections. The idea is to make life more comfortable and help prevent bigger problems down the road.
Getting Ready for Your Visit
Steps You Can Take Beforehand
A little preparation before your doctorâs visit can make a big difference. Jot down all your symptoms, even if some seem unrelated.
Track how often you use the bathroom and whether you feel like your bladder empties completely. A simple chart can help you remember the details.
List any health issues you have and every medicine you take. That means prescriptions, over-the-counter stuff, vitamins, and supplements. Donât forget to write down any questions or worries you have about your condition.
Hereâs an example of a table that might help you organize things for your appointment:
| Symptom/Concern | When it Happens | Notes |
|---|---|---|
| Frequent urination | Night | Wakes up 2-3 times a night |
| Feeling of incomplete emptying | Day | Happens after most bathroom trips |
| Pain or burning when urinating | Sometimes | Mild, not every time |
Key Topics to Discuss with Your Provider
These questions might help you get the most out of your visit:
- Can you tell if my symptoms are from an enlarged prostate, or could it be something else?
- What tests will I need to figure this out?
- What treatment options do I have, and whatâs involved with each?
- How should I handle my other health issues along with this?
- Are there any rules or advice about sexual activity I should know?
Bring any extra questions that pop into your head. Writing them down is a good way to make sure you remember everything you want to ask.
What Your Provider Might Ask You
Your doctor will probably want to know all the details about your symptoms and medical history.
- You might need to talk about when your symptoms started. Have they gotten worse over time?
- They’ll ask how often you have to pee, both during the day and at night. You may need to mention if you leak urine, have trouble getting started, or if you have to strain.
- Donât forget to mention any burning, pain, or blood when you urinate.
- If youâve had urinary tract infections or other bladder problems before, bring that up too.
- Your provider might ask about your family history. For example, did anyone in your family ever have prostate problems, cancer, or kidney stones?
- They could also want to know about any surgeries or procedures involving your urinary tract.
- Sometimes, they’ll ask about sexual function or if you use blood thinners.
It helps to be ready to talk about what you drinkâlike caffeine or how much fluid you usually have in a day.
