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Benign Prostatic Hyperplasia - BPH

BPH or benign prostatic hyperplasia is a common problem affecting most men in some shape or form in their lifetime. It has been estimated that over 70% of men over age 60 suffer from BPH and the incidence increases as men approach age 80. Symptoms of BPH may consist of urinary frequency and urgency, especially at night. A weak stream of urine or dribbling before, during, and after urination is also common. Many patients report the sensation of incomplete emptying.

Traditionally patients are evaluated by their primary care physicians and if symptoms are consistent with the diagnosis of BPH, they are offered treatment options. These may include life style modifications, bladder training strategies, and medication.

There are two main classes of medication available for the treatment of BPH symptoms, alpha blockers and alpha-reductase inhibitors. Alpha blockers are designed to relax the muscle of the prostate and bladder neck, which may allow urine to flow more easily. There are multiple medications in this category that have different chemical formulas but work in the same fashion with slightly different side effect profiles.

Alpha reductase inhibitors are a class of medication that affect male hormones such as testosterone and may slow the prostate from growing further or sometimes cause it to shrink. This effect may take more than six months to develop and the prostate may eventually outgrow the medication.

BPH is a mechanical problem. Although BPH medication can alleviate the symptoms, they are only a Band-Aid that do not treat the underlying issue. Although physicians first believed that alpha blockers and alpha reductase inhibitors were fairly safe, we are now seeing the long lasting side effects they can cause.

For instance, did you know that one dose of the most commonly prescribed alpha blocker tamsulosin could expose you to a devastating complication during cataract surgery known as Intraoperative Floppy Iris Syndrome (IFIS), especially if your ophthalmologist does not know that you have taken it before?

There is also emerging data on the increased risk of dementia among patients who are or have used tamsulosin in the past, according to a Medicare data analysis published in Pharmacoepidemiology Drug Safety.

Finasteride (Proscar™) and Dutasteride (Avodart™) have significant sexual side effects, which can persist even after stopping the medication. Post-Finasteride syndrome is a more recently recognized phenomenon that has shown symptoms such as sexual dysfunction, depression, and abnormal MRI changes in the brain regions involved in depression and sexual arousal after discontinuation of these drugs.

Another concerning issue, is the fact that urologists are seeing a growing number of patients, who are on chronic medical therapy for BPH who later in life present with scarred bladders and become catheter dependent. This is likely due to the fact that the medication is simply managing symptoms and not treating the underlying obstructive process of the prostate. The bladder tries to work harder to compensate for the blockage until scar tissue starts forming along the bladder wall and function gets compromised.

Traditionally urologist have been reluctant to offer surgical therapy early in the disease process due to the inherent risk of surgery and anesthesia. Transurethral Resection of the Prostate (TURP), also known in the community as the “Roto-Rooter”, has been considered the gold standard for the treatment of BPH. However, this procedure has a substantial risk of bleeding, permanent sexual dysfunction, urinary incontinence, and need for short or long term catheterization, among others.

More novel procedures have been developed such as UroLift, Rezum, and Aquablation, which provide viable alternatives to traditional TURP. Out of these procedure, only UroLift has taken a new approach to BPH therapy that does not include cutting, heating, or cooling of tissue and thereby has been shown to be an overall safer and better tolerated procedure. In select patients it may also be done without the need for anesthesia.

A urological surgeon experienced in the UroLift procedure can offer immediate and long lasting results to patients suffering from BPH without the higher risk of side effects and complications seen with other available procedures.

The first step in the evaluation of a patient with BPH is a thorough history and physical examination. A validated questionnaire such as the International Prostate Symptom Score (IPSS) is also important to assess the severity of the symptoms. Your surgeon may recommend a blood test known as Prostate Specific Antigen (PSA) to rule out other pathology such as prostate cancer. An office based cystoscopic evaluation of the anatomy is also crucial to and allows the surgeon to better evaluate the lower urinary tract and rule out other pathology and evaluate the prostate further.

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As always, the information above is meant to be informative and does not replace your physician's recommendations or judgement. Each individual case has to be evaluated carefully to determine the best course of action. Call or use our contact page to request an appointment to further discuss your unique case.

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