Treatment. Prostate BPH (Benign prostatic hyperplasia)

Diagnostics of BPH

Firstly the doctor will ask questions about your health and perform an initial physical exam that includes a urine test, digital rectal exam, blood test, and prostate-specific antigen (PSA) blood test.
Based on the initial examination results, your doctor may prescribe extra tests to confirm benign prostatic hyperplasia and exclude other possible medical conditions. Such tests include:

• Postvoid residual volume test. It is performed by ultrasound or by inserting a catheter into the bladder to determine how much urine is left after urination.
• Urinary flow test. To perform this test, you need to urinate into a receptacle attached to the particular machine. This machine measures the amount and the strength of the flow of your urine.
• 24-hour voiding diary. It is a recording of the amount and frequency of urination during 24 hours.

In more complicated cases, a doctor can also prescribe the following tests:

• Prostate biopsy
• Transrectal ultrasound
• Cystoscopy
• Pressure flow and urodynamic studies

BPH treatment

The doctor will prescribe you a treatment based on several factors, such as your age, prostate size, your overall health, the level of discomfort you’re experiencing.

Medications

Medication is a treatment of choice for patients with mild to moderate symptoms of BPH. Among the options are:

• 5-alpha reductase inhibitors. The mode of action of such medication is to reduce the size of the prostate gland by preventing the hormonal changes responsible for it growing. Unfortunately, the side effect of these medications is retrograde ejaculation (when during orgasm, the semen goes into the bladder instead of going out through the penis).
• Tadalafil (Cialis). These medications are used to treat erectile dysfunction. However, as studies suggest, tadalafil can treat benign prostatic hyperplasia.
• Alpha blockers. These medications make urination easier by relaxing muscle fibres in the prostate and bladder neck muscles.
• Combination drug therapy. If either medication alone does not work, your doctor may recommend combining alpha blockers and 5-alpha reductase inhibitors.

Minimally invasive or surgical treatment methods

Your doctor may recommend you minimally invasive or surgical treatment if:

1. Medications failed to relieve your pain
2. You have moderate to severe symptoms
3. Decisive treatment is your preference
4. You have problems with the urinary tract, bloody urine, kidney problems or bladder stones.

There are some circumstances when minimally invasive or surgical treatments are not appropriate:

• Infection of the urinary tract that has not been treated
• The disease of urethral stricture
• Neurological disorders (for example, Parkinson’s disease)
• If you have had radiation therapy of the prostate or urinary tract surgery in the past

Surgery and minimally invasive treatments are available in varying forms:

• Transurethral recision of the prostate (TURP). By inserting a lighted scope into the urethra, the surgeon removes all except the outer part of the prostate.
• Transurethral incision of the prostate (TUIP). The surgeon inserts a lighted scope in your urethra and makes one or two tiny cuts in the prostate gland. Consequently, it’ll be easier for the urine to pass through the urethra.
• Transurethral microwave thermotherapy (TUMT). A special electrode is inserted into your prostate through the urethra. As a result of the microwave energy from the electrode, the inner portion of the enlarged prostate gland is destroyed so that the gland shrinks and eases urine flow.
• Transurethral needle ablation (TUNA). By the scope inserted in your urethra, the surgeon places needles into the prostate gland. Radio waves that pass through needles heat and destroy excess prostate tissue.
• Laser therapy. An application of a high-energy laser destroys overgrown prostate tissue so that it can be removed. The doctor may prescribe laser therapy to men who shouldn’t have any other prostate procedure because they take blood-thinning medications.

There are two options for laser therapy:

1. Enucleative procedures.  In these procedures, the surgeon removes whole prostate tissue. It blocks the urine flow and prevents tissue regrowth. Holmium laser enucleation of the prostate (HoLEP) is an example of enucleative procedures.
2. Ablative procedures. The procedures increase the flow of the urine by vaporizing obstructive tissue of the prostate gland. Such methods include holmium laser ablation of the prostate (HoLAP) and photoselective vaporization of the prostate (PVP).

• Embolization. The surgeon blocks the supply of blood to/from the prostate gland. Consequently, the prostate reduces in size.
• Prostatic Urethral Lift (PUL). To increase the urine flow, the surgeon places specific tags that compress the sides of the prostate.
• Open or robot-assisted prostatectomy. In order to access the prostate and remove tissue, an incision will be made in your lower abdomen.

After any surgical treatment of benign prostatic hyperplasia, your doctor will recommend you escape exercises and lifting something heavy for at least seven days.

What can I do to manage the symptoms of prostate enlargement?

• Stay active
• Keep warm
• Eat healthily
• Limit beverages in the evening
• Take decongestants and antihistamines in moderation 
• Limit alcohol and caffeine
• Schedule washroom visits
• Go to the washroom when you first feel an urge
• After finishing urinating, wait few moments and then urinate again