DM BPH

Benign Prostatic Hyperplasia or BPH is something that affects all men, in that in all men the prostate continues to grow throughout life. Not all men are affected by symptoms of this condition, but eventually, most will have some problems and need medical assistance. The symptoms of BPH include slowing of urinary stream, intermittent stream (starts and stops) getting up at night to urinate (nocturia) sense of incomplete emptying, and occasionally urinary infections.The symptoms tend to occur almost insidiously and slowly over time, but when a man has any or all of these symptoms he should definitely see his urologist.

Evaluation can be as simple as a medical history and examination of the prostate to the need for more extensive testing. This can include blood tests of kidney function, the PSA test to rule out prostate cancer, to testing of bladder function called urodynamics. In the latter tests a small catheter is placed into the bladder to measure pressures and sensation. This is an out-patient test that often only takes a few minutes. Urodynamic testing does give us the most definitive diagnosis of BPH, but is only necessary in more complicated situations.

Once a man starts having BPH symptoms it may be wise to institute some form of treatment so that the condition does not worsen, which is usually inevitable in the absence of treatment.

Most men will respond favorably to medication for BPH. There are basically two categories of prescription medications for BPH. There are also herbal preparations that many men take, but there is really no scientific basis for any of these. The treatments that do work are in two categories. Proscar is a medication that works to shrink the prostate. One could say that this drug is the only “cure” for BPH, but it is curative only if one accepts this treatment for a lifetime. Proscar shrinks the prostate and keeps it smaller. It also lowers PSA and may reduce the risk for development of prostate cancer. Proscar’s dose is 5mg daily(one pill). Side effects are minimal. Some men may notice a decrease in the amount of semen ejaculated. Since Proscar actually causes the prostate to shrink in size, it does not provide symptom relief until this actually occurs. This is a process that can take from 6 months to a year. Another class of medications that are highly use for BPH are the alpha blockers. There are three prinicipal drugs used, Cardura (doxazosin-generic) Hytrin (terazosin-generic) and Flomax (no generic yet available). These medications work by relaxing the muscles within the prostate to promote more efficient urination. They have a more rapid onset of symptom improvement that does Proscar. They do not affect the prostate size or the PSA and do not have any benefit in reducing the risk for cancer development in the prostate.

Surgical treatment has long been the hallmark of treatment for BPH and TURP which is an acronym for TransUrethral Resection of the Prostate has been used successfully for over 50 years with very little change in the technology. The instruments we have now are more refined than in the past, but the procedure itself has changed only a little in this half-century. This procedure remains the “gold-standard” for treatment of BPH. All other treatments, surgical and medical tend to be compared to the TURP. There are minimally invasive surgical treatments such as Laser therapies, microwave therapy and the TUNA procedure to name a few. Some of these therapies are not right for everyone, and your doctor will discuss with your the specific benefits of each procedure. I personally believe there is a place for each of these therapies, but I do think the microwave therapy stands out above the others when it comes to minimally invasive, essentially non-surgical treatment. I do agree that the TURP remains the gold-standard however.

Most men will go home without a catheter, and passing urine normally. Since you have just had surgery on your prostate gland, your urination will be different than before. Each day will be a little different for 6 weeks to even 3 months. There is usually very little pain associated with this operation. There may be some blood or even clots in the urine from time to time even for a few weeks. I would like you to refrain from extensive physical activity for at least 2 to 3 weeks. You should abstain from sexual activity for this time as well. Things that should generate a call to my office would include blood in the urine to the point you can’t urinate, fever, or any distinct change that seems troubling to you. I recommend a normal diet, and a moderate degree of activity as soon as you are out of the hospital, and it is o.k. to drive your car after you have seen no blood in the urine for a period of a week. I usually see patients in the office about 2 weeks after surgery.