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Minimally Invasive Management of BPH - An Overview

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BPH leads to prostate enlargement, which can cause various symptoms associated with the urinary system. This article explains this condition in detail.

Medically reviewed by

Dr. Madhav Tiwari

Published At February 8, 2023
Reviewed AtApril 1, 2024

Introduction

Benign prostatic hyperplasia (BPH) is a clinical condition characterized by prostate enlargement. It is observed when there is excessive multiplication of the prostate gland cells. This multiplication of cells leads to prostate gland swelling, and thus the urethra is compressed. Hence, the flow of urine is restricted. BPH is different from prostate cancer and does not increase the risk for cancer. However, it can be associated with symptoms that can affect the individual's quality of life. The prevalence of BPH is more common in men, especially in those above 50 years of age.

How Is It Caused?

BPH is a physiological condition that develops as the person ages. Those men who have undergone removal of their testicles at a younger age do not develop BPH. There is no such evident cause for this condition, but changes in the male sex hormones with increasing age are considered a cause. The risk factors include any family history of prostate diseases or abnormalities in the testicles.

What Are The Signs And Symptoms?

The signs and symptoms of this condition are usually very mild initially, but they may become severe if not managed in the early stages.

The following are the commonly observed symptoms:

  • Nocturia: The person tends to urinate frequently at night.

  • Incomplete emptying of the bladder.

  • Dribbling at the end of the urinary stream.

  • Straining during urination.

  • Weak urinary stream.

  • Sudden urge to urinate.

  • Urine leakage.

  • Delayed or slowed urinary passage.

  • Presence of blood in the urine.

  • Pain during urination.

How Can It Be Diagnosed?

Your physician will first ask questions about the signs and symptoms you are experiencing, your family history, your personal history, and your medications. The physical examination includes an examination of the rectum, which helps assess the prostate's size and shape.

Following are the other tests that can be performed:

  • Urinalysis: Analysis of urine is done to check for blood and bacteria.

  • Prostate-specific antigen (PSA) Test: It is a blood test to check for the presence of cancer in the prostate.

  • Urodynamic Test: This test is done to check for pressure in the bladder during urination. This is done by filling the bladder with liquid via a catheter.

  • Post-void Residual: This test helps in checking the amount of urine left in the bladder post-urination.

  • Cystoscopy: This is the urethral and bladder examination using a tiny lighted scope which is inserted into the urethra

How Can It Be Treated?

The management of BPH can be done both conservatively and surgically. Conservative management includes self-care and lifestyle adjustments along with medications.

BPH Natural Management

The natural treatment can include various actions or changes in lifestyle, which can help relieve the symptoms of BPH.

They are as the following:

  • Urinate as soon as you get the urge.

  • Avoid alcohol and caffeine, especially after having dinner.

  • Go to the bathroom regularly, even if you do not have the urge.

  • Try to reduce stress, as stress is a known cause of increased urine frequency. Try meditation and yoga to reduce stress.

  • Avoid over-the-counter decongestants or antihistamine medications, as they can make it difficult to empty the bladder.

  • Regular exercising.

  • Kegel exercises: regularly learn and practice them to help strengthen the pelvic muscles.

  • Keep yourself warm, as chillness can increase the symptoms.

Medications

You can shift to certain medications to relieve the symptoms when lifestyle changes do not provide relief. You should take these medicines only with the consent of your physician.

The medications which can help in treating the symptoms of BPH, as well as BPH itself, are as the following:

Alpha-1 blockers

Alpha-1 blockers are medications that help in relaxing the muscles of the bladder and the prostate. They are doxazosin, prazosin, alfuzosin, terazosin, and tamsulosin.

Hormone Reduction Medications

These medicines can help reduce the hormone levels produced by the prostate gland. The most commonly prescribed medicines are dutasteride and finasteride.

Antibiotics

Antibiotics can be prescribed for patients with chronic prostate inflammation due to bacterial prostatitis related to BPH.

Surgical Management for BPH

When conservative management does not help, various surgical procedures can be used to help in treating BPH. Some procedures are either noninvasive or minimally invasive and can often be performed in the clinic, called outpatient procedures. Other procedures are more invasive and require a hospital setup called inpatient procedures.

The various outpatient and inpatient procedures have been mentioned below:

Outpatient Procedures

Outpatient procedures involve the insertion of an instrument into the urethra and the prostate gland. They are as the following:

  • Transurethral needle ablation (TUNA).

  • Transurethral water vapor therapy (Rezum).

  • Water-induced thermotherapy (WIT).

  • Urolift.

  • Transurethral microwave therapy (TUMT).

  • High-intensity focused ultrasonography (HIFU).

Inpatient Procedures

Inpatient procedures are as the following:

  • Simple prostatectomy.

  • Transurethral resection of the prostate (TURP).

  • Transurethral incision of the prostate (TUIP).

Are There Any Complications Of BPH?

The symptoms of BPH can be ignored easily. Early diagnosis and prompt treatment can help in preventing complications.

People who have had a long-standing history of BPH can experience the following complications:

  • Urinary tract infections.

  • Kidney damage.

  • Urinary stones.

  • A sudden inability to urinate.

Bleeding In the Urinary Tract

In some patients, bladder outlet obstruction. This is a condition in which no urine can leave the bladder. This condition can be dangerous as the urine trapped in the bladder can lead to urinary tract infections and, thus, damage the kidneys.

Conclusion

BPH can be managed if diagnosed early. Most commonly, conservative management can prove t be beneficial in treating the condition. If the condition is severe, surgical methods can be done. You can consult a specialist online using online medical platforms to know more about this condition.

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Dr. Madhav Tiwari
Dr. Madhav Tiwari

General Surgery

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