BPH (Benign Prostatic Hyperplasia)

BPH enlarged prostate treatmentAbout BPH
Enlargement of the prostate gland (known as benign prostatic hyperplasia or BPH) is very common in older men. BPH affects 40 percent of men in their 50s and 90 percent of men in their 80s. If the enlarged gland begins to press upon the urethra and to interfere with urination, then treatment may be needed.

Diagnosis
To diagnose benign prostatic hyperplasia (BPH) Mayo urologists first gather a comprehensive medical history. Afterwards, if BPH is suspected, the physician may use different tests and procedures to analyze the patient's condition.

Digital Rectal Exam
Because of the physical location of the prostate, a physician can determine if the prostate is enlarged by inserting a gloved finger into the rectum. This procedure also helps to detect prostate cancer.

Urine Analysis
Urine analysis can detect infections, prostatitis, cystitis and other conditions.

Prostate-Specific Antigen (PSA) Blood Test
Higher than normal levels of prostate-specific antigen in the bloodstream may indicate BPH, prostate cancer or prostatitis.

Urinary Flow Test
Ongoing measurement of the strength and amount of urine flow can help the urologist track changes over time.

Post-void Residual Volume Test
Physicians use either a tube inserted into the urethra or ultrasound to check if urine is left in the bladder after normal urination. Ultrasound is more comfortable than inserting a tube in the bladder, but often it is less accurate at determining whether the bladder empties.

Ultrasound
Imaging through ultrasound is used to estimate the size of the prostate gland. In addition, ultrasound can help detect problems such as a kidney obstruction, stones in the kidneys or prostate, or a tumor in the prostate. This noninvasive procedure is especially useful when the patient has experienced allergic reactions to other imaging procedures that require contrast dyes injected into the veins.

Urodynamic Studies
These studies are used when the urologist thinks that a patient's symptoms may be related to bladder problems rather than BPH. A catheter is threaded through the urethra and into the bladder. Water is then used to measure the internal pressure and contractions of the bladder.

Cystoscopy
A thin tube containing a lens with a light system (cystoscope) is inserted into the urethra under local anesthesia. This allows the urologist to view the inside of the urethra and bladder. The procedure can detect various problems and abnormalities, including BPH.

Intravenous Pyelogram
In this procedure, dye is injected into a vein, and an X-ray is taken of the kidneys, bladder and tubes that connect to the kidneys. The image helps detect urinary stones, tumors or blockage above the bladder.

Retrograde Pyelography
In this procedure, X-rays of the urinary tract are taken after contrast dyes are injected into the ureters.

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Treatment Options
The following treatment options are available at Mayo Clinic for patients with benign prostatic hyperplasia (BPH). Treatment decisions will be based on each patient's condition.

Behavioral Therapy
Several changes in behavior can help some patients avoid surgery. Examples include reducing fluid intake in the evening and eliminating bladder irritants from the diet.

Medications
In patients who have moderate symptoms, drugs are often used to control BPH. The main options are: Alpha-blockers make it easier to urinate by relaxing the muscles located where the bladder narrows toward the urethra. Several forms of alpha-blockers have been approved for treatment of BPH by the United States Food and Drug Administration.
Finasteride or dutasteride shrinks the prostate gland but may only cause noticeable improvements for men with significantly enlarged prostates.
A combination of these two kinds of drugs can be more beneficial than either drug alone.

Minimally Invasive Therapies
With the exception of some laser procedures, the minimally invasive therapies are slower to produce results than conventional surgical procedures. This is because the overgrown prostate tissue has been killed but not removed from the body. It takes time for the dead tissue to be broken down and reabsorbed naturally. Men not troubled by severe BPH symptoms are often willing to accept this trade-off in order to avoid hospitalization and the chance of more serious complications.

These minimally invasive therapies tend to produce similar side effects — some degree of swelling of the prostate gland, which may interfere with urination. This problem can be easily managed by occasional use of a urinary catheter after the procedure.

Microwave thermal therapy, otherwise known as transurethral microwave thermotherapy (TUMT), is an outpatient procedure that takes about one hour. With the aid of a urinary catheter, a tiny antenna is inserted into the urethra. The antenna delivers microwave energy to heat and destroy the overgrown tissues while avoiding damage to normal tissues. The procedure does not require anesthesia; sedatives are given to minimize pain and discomfort.

Mayo Clinic urologists have been pioneers in researching and demonstrating the effectiveness of microwave energy for treatment of BPH. Temperature mapping studies done at Mayo Clinic have been important in studying the effects of different antenna designs and in determining how much energy is needed to achieve the right result. Mayo Clinic urologists also published the only randomized double-blind clinical trial of microwave thermal therapy that assessed its safety and efficacy in comparison to a sham procedure.

Since development of these studies of microwave thermal therapy, the technology has become widely available as an outpatient procedure. However, microwave thermal therapy is not appropriate for every patient with BPH, because the anatomy of the gland affects the quality of the results. For example, if prostate enlargement occurs mainly in the middle lobe of the prostate, causing it to grow upward to press on the bladder, then the microwave antenna may not apply enough energy to reach the upper part of the gland.

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Needle Ablation
In this technique, needles are used to deliver energy to destroy overgrown prostate tissue.

Transurethral Needle Ablation (TUNA)
TUNA uses radio frequency energy. Unlike microwave thermal therapy, TUNA requires some anesthesia — either pelvic blocks, a spinal anesthetic, or a general anesthetic. It is an outpatient procedure usually performed in a hospital setting. TUNA can be used to target sections of the gland that may not be accessible to the microwave antenna. For example, if an overgrown lobe is protruding into the bladder, the radio frequency needles can be placed in that area to destroy the overgrown tissue.

Indigo Laser Therapy
In indigo laser therapy, laser energy is delivered through a needle, causing the prostate to resemble Swiss cheese. This minimally invasive BPH treatment is done in the outpatient surgery department under sedation or light anesthesia. The laser destroys prostate cells deep in the gland, which are sloughed off during healing. Because the central urethra is not treated, significant bleeding rarely occurs. This type of laser therapy improves urine flow in about two-thirds of patients. It rarely causes bleeding, and retrograde ejaculation (where the seminal fluid is ejaculated into the bladder instead of outside through the urethra) occurs in less than 20 percent of patients. The procedure is best for men with mild to moderate symptoms in prostates of small to moderate size. A catheter may have to be worn for three to seven days after the procedure until the swelling subsides.

Laser Therapy
High-energy laser therapy, which vaporizes overgrown prostate tissue, is often used to provide more immediate relief of symptoms. A number of laser therapy procedures have been developed to treat BPH. Urologists at Mayo Clinic pioneered the development of one type called KTP laser therapy and led the initial clinical trials. Some Mayo urologists favor the high energy Holmium laser.

Transurethral Resection of the Prostate (TURP)
TURP has been the gold standard for surgical treatment of BPH for many years. It remains a very effective treatment for patients who retain urine and have moderate to severe symptoms. In this procedure, a surgeon threads a narrow instrument (resectoscope) into the urethra and uses small cutting tools to scrape away excess prostate tissue. Patients can expect to stay in the hospital for one to three days after surgery.

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