Taking a Look at BPH
Benign prostatic hyperplasia (BPH) – an enlarged prostate – is a common condition for older men. According to the American Urological Association, more than half of men have an enlarged prostate by the time they’re 60 years old. About 90 percent will have BPH by age 85.
Not all men have problems because of an enlarged prostate. Those that do often have lower urinary tract symptoms (LUTS), which can be frustrating and uncomfortable. They might have trouble urinating. Or, they might urinate more frequently. Some men with BPH feel like they can’t empty their bladder or must strain to do so.
Erectile dysfunction (ED – an inability to get or maintain an erection suitable for sex) often accompanies LUTS in men with enlarged prostates. Generally, ED will worsen as LUTS worsen, leaving men feeling even more frustrated.
If you work with older men, it’s helpful to know more about BPH. Today, we’ll go over some BPH basics, give an overview of treatment options, and suggest ways to reassure your older patients.
BPH Basics
The prostate is a walnut-sized gland that sits between the bladder and the base of the penis. It produces the fluid that carries sperm out of the penis during ejaculation. The urethra – the tube that emits both urine and semen – runs directly through it.
When the prostate enlarges, it does so from the inside. During this process, the prostate cells can compress the urethra, making urination difficult. Eventually, the enlargement lead to bladder or kidney damage and the formation of kidney stones.
Having an enlarged prostate does not raise a man’s risk for prostate cancer, although it’s possible to have both conditions simultaneously. The main difference between the two is the location of the cells. With BPH, cells grow on the inside of the prostate. Cancer cells tend to grow on the outside and can spread to other organs.
BPH Treatment
Not all men with BPH need treatment. Some don’t have any urinary symptoms. Others don’t find the symptoms bothersome enough to undergo treatment. But for those that do, there are a number of options available. Choosing an effective treatment depends on the man’s personal situation.
Medication
Some of the traditional medications used to treat BPH are as follows:
· 5-alpha reductase inhibitors. These drugs trigger hormonal changes that make the prostate shrink.
· Alpha blockers. These medicines work to relax the smooth muscle cells in the prostate. With these cells relaxed, there is less pressure on the urethra.
· Cialis (tadalafil). Cialis was originally approved for treatment of erectile dysfunction (ED). In October 2011, the U.S. Food and Drug Administration (FDA) approved Cialis to treat ED and BPH when the two conditions occur together. Patient taking nitrates (such as nitroglycerin) should not take Cialis because of possible serious blood pressure drops.
Some doctors prescribe a combination of medications to help men with BPH.
Minimally Invasive Therapies
These treatments are riskier than medications, but they can also be more effective. They often involve using heat or lasers to reduce prostate tissue.
Heat treatments include:
· Transurethral microwave thermotherapy of the prostate (TUMT). This treatment sends computer-regulated microwaves through a catheter to heat areas of the prostate. The heated tissue then shrivels away. (A cooling system protects the urethra.)
· Transurethral radio frequency needle ablation of the prostate (TUNA). Like TUMT, TUNA involves heating prostate tissue and making it shrink. However, this technique uses radio frequency energy delivered through needles inserted into the prostate itself.
Laser treatments include:
· Holium laser treatment. A surgeon uses an instrument called a resectoscope, through which a holium: YAG laser vaporizes prostate cells.
· Interstitial laser coagulation. In this procedure, prostate tissue is burned away by laser energy sent through a cytoscope.
Stenting is another minimally invasive option. This involves placing a stent (similar to a spring) into the urethra to keep it open.
Surgery
Generally, three types of surgery are used to treat BPH.
· Transurethral resection of the prostate (TURP). In this procedure, tissue from the inner prostate is removed through the urethra with an endoscope.
· Transurethral incision of the prostate (TUIP). This technique involves making cuts in the prostate tissue instead of removing it.
· Prostatectomy. This is an open surgical procedure. The surgeon removes the inner portion of the prostate through an incision in the lower abdomen. Usually, prostatectomy is performed on men with prostates weighing over 80 grams.
Sexual Implications of Treatment
Usually, a man’s sexual functioning isn’t affected by BPH treatment. Chances are, if a man has normal erections before treatment, they will return after treatment. Some men do have erectile difficulties, however, and may need treatment for ED. Many men who have the TURP procedure have retrograde ejaculation (when semen moves backward into the bladder instead of forward out of the penis) after treatment.
How To Help
If you suspect that a patient or client has an enlarged prostate, encourage him to see a urologist. Assure him that this is common for men as they get older. Your patient may feel that he should just accept the symptoms. Let him know that there are treatments available and many are routine. He should not let the symptoms interfere with his quality of life.
Also, assure him that an enlarged prostate is not the same as cancer, but emphasize that it is still important to have prostate cancer screenings. A urologist can advise on the best screening intervals.
