Benign Prostatic Hyperplasia (BPH)
What is Benign Prostatic Hyperplasia?
Benign prostatic hyperplasia, or BPH, is a normal noncancerous enlargement of the prostate gland, and is a very common issue that many men will encounter in their lifetime.
Common Symptoms
BPH symptoms can be divided into those caused directly by urethral obstruction and those due to secondary changes in the bladder.
Common symptoms of BPH include:
Frequent or urgent need to pee
Peeing more often at night
Trouble starting to pee
Weak urine stream, or a stream that stops and starts
Dribbling at the end of urination
Not being able to fully empty the bladder
Less common symptoms include:
Urinary tract infection
Not being able to pee
Blood in the urine
The symptoms of BPH tend to slowly get worse with time. Sometimes they stay the same or even improve over time.
The size of the prostate doesn't always determine how serious the symptoms are. Some people with slightly enlarged prostates can have major symptoms. Others who have very enlarged prostates can have minor problems. And some people with enlarged prostates don't have any symptoms at all.
Risk Factors
Risk factors for an enlarged prostate include:
Aging. An enlarged prostate gland rarely causes symptoms before age 40. After that, the chance of having an enlarged prostate and related symptoms starts to rise.
Family history. Having a blood relative with prostate problems makes you more likely to have problems with your prostate.
Diabetes and heart disease. Studies show that diabetes and heart disease might raise the risk of symptomatic BPH.
Lifestyle. Obesity raises the risk of BPH. Exercise can help lower the risk.
Diagnosis
If you have symptoms of BPH, your doctor will ask you how severe they are. You may also be asked to complete a questionnaire about your urinary symptoms and bladder habits.
If your doctor thinks you might have BPH, you will be sent for tests to diagnose or rule out BPH as well as other problems, such as a urinary tract infection or prostate cancer. These tests include:
a physical exam
a digital rectal exam (DRE)
urine tests, including urinalysis and urine culture
blood tests, including a prostate-specific antigen (PSA) test
If your test results are abnormal or your doctor can't make a diagnosis, you may have the following:
Cystoscopy: checks for possible causes of your symptoms by having the Urologist insert a narrow tube with a tiny lens inside the bladder
Flow Rate and Residual Ultrasound: a test to check the flow rate of the urine followed by an ultrasound to see how much urine is left behind in the bladder
Imaging tests: such as an ultrasound or CT scan, to check the kidneys, bladder and prostate
Urodynamic assessment: a test to see how well the bladder and urethra can hold and release urine
Biopsy of the Prostate: done through the rectum using an ultrasound to guide the needle (called a transrectal ultrasound-guided biopsy)
Treatment
You and your Urologist will discuss which treatment is right for you. This decision is usually based on your symptoms, how severe your symptoms are, how much they bother you, your test results and/or your preferences. Treatment options for BPH include the following:
Lifestyle changes: Including modification of diet and habits, along with timing of fluid intake, will be reviewed in order to reduce your BPH symptoms.
Medications: May be discussed as another means of gaining control over symptoms caused by BPH. These medications may focus on relaxing the smooth muscles near the prostate or by trying to reduce the size of the prostate.
Surgical Options:
Transurethral Resection of the Prostate (TURP)
Transurethral resection of the prostate (TURP) removes prostate tissue through the urethra. It is the surgery most commonly used to treat BPH. While TURP relieves urinary symptoms in most men, urinary problems can come back over time if the prostate starts to grow again. This is why younger men may need to have this surgery more than once.
During this surgery, the Urologist passes a resectoscope through the urethra to reach the prostate. A resectoscope is a type of endoscope. It has a thin wire that carries an electric current. The Urologist uses the electric current to cut away prostate tissue around the urethra. This tissue is then removed through the resectoscope.
The most common side effects of TURP include:
bleeding
infection
semen flowing into the bladder instead of out the end of the penis (called retrograde ejaculation)
In rare cases, you may develop erectile dysfunction or incontinence after TURP. This surgery has a lower risk of these side effects compared to surgery to remove the prostate (called prostatectomy).
Rezum Therapy (non-OHIP)
Rezum Water Vapor Therapy is a non-surgical therapy that uses the natural energy stored in water vapor, or steam, to shrink enlarged prostates caused by BPH. It eliminates excess prostate tissue pressing on the urethra to improve urine flow.
Rezum Therapy is typically performed in a Urologist’s outpatient surgery facility and completed in one short appointment.
During each treatment, sterile water vapour is released throughout the targeted prostate tissue. When the steam contacts the prostate tissue, all the stored energy is released into the tissue. The Urologist will determine the amount of treatments you need based on the size of your prostate.
Over time, your body’s natural healing response absorbs the treated tissue, shrinking the prostate. With the extra tissue removed, the urethra opens, reducing BPH symptoms.
Ask your Urologist at Muskoka Urology about an expedited referral to a Rezum Therapy provider
Other Resources
Canadian Urological Association: Benign Prostatic Hyperplasia Brochure
How Rezūm Water Vapor Therapy Works video