BPH can result in complete blockage of the urethra. Complete blockage results in a condition known as acute urinary retention. Acute urinary retention may result from taking over-the-counter decongestants, which contain an ingredient that can prevent the bladder neck sphincter from opening and allowing urine to empty. Nonacute urinary retention can be caused by cold temperature, extended periods of immobility, and alcohol consumption. Patients who are unable to urinate must go immediately to an emergency room and be catheterized, which means having a tube placed in the penis to drain urine. Being unable to urinate increases the risk of acute kidney failure, a serious disease.
Lifestyle changes may make you more comfortable. If your prostate is enlarged, you should avoid such bladder irritants as caffeine, alcohol, and spicy food. Limit fluids in the evening to decrease the need to urinate during the night.
Your doctor is the best source of information on the drug treatment choices available to you.
Watchful waiting is an option for mild cases. If you have mild symptoms of BPH (ISPS test score 8 or less), your doctor will probably recommend a course of watchful waiting, or deferred therapy. Your doctor will tell you about lifestyle changes that can reduce symptoms, such as cutting down on caffeine, spicy foods, and alcohol, all of which can be bladder irritants. Decreasing fluid intake in the evening can reduce the need to urinate during the night. Your doctor will continue to monitor your symptoms and status, probably annually.
Minimally invasive techniques are available for moderate cases. Drug treatment is not always effective in moderate cases of BPH. In such cases, some minimally invasive therapies, which shrink the gland and relieve BPH symptoms, are available. These therapies include transurethral microwave thermotherapy (TUMT) and transurethral needle ablation (TUNA). In TUMT, microwaves heat and destroy excess prostate tissue. The TUNA system delivers low-level radiofrequency energy to burn away a defined portion of the prostate.
Surgical options are available Figure 02. In advanced BPH, symptoms are usually sufficiently severe to affect quality of life and mandate aggressive therapy. When recurrent urine retention, urinary tract infection, blood in the urine, bladder stones, or renal failure is present, surgery is indicated.
The most common surgery for BPH is transurethral resection of the prostate (TURP), in which a surgeon threads an instrument up the urethra and cuts away part of the prostate to make the opening bigger for the urethra. Other surgical options are transurethral incision of the prostate (TUIP), in which the surgeon makes a cut in the neck of the bladder; transurethral electrovaporization of the prostate (TVP), in which excess tissue is vaporized; laser prostatectomy (removal of the prostate); and balloon dilation of the prostate. Possible complications of surgery include bleeding, urinary tract infection, retrograde ejaculation, sexual dysfunction, urinary incontinence, and, in rare cases, death. As previously mentioned, recurrence of BPH occurs in about 12% of patients during an eight-year follow-up. Therefore, patients who do have TURPs should be followed very closely and certainly put on medical therapy if there is any indication of regrowth of the prostate.
Figure 02. Transurethral resection of the prostate (TURP) (animation and audio)
Certain herbs and minerals have shown good results with BPH. Saw palmetto is the most popular herb being taken for BPH. Its effects include increased urine flow, decreased residual urine, and less frequent urination. Licorice has also been recommended, as it contains a compound that prevents the conversion of testosterone to DHT. Large doses of zinc may also help to shrink the prostate. Talk to your doctor if you are interested in trying these alternatives. Although herbs are used widely in Europe and to some extent in the U.S. for the treatment of BPH, the medications used are questionable since it is not yet known how they work. For instance, there is no demonstrated effect of saw palmetto on either prostate size or alpha-adrenergic tone. It remains for future studies to establish whether or not these alternative herbs are of any real value or not.
BPH is very rarely a life-threatening disease. It can, however, have a profound effect on quality of life. Urine retention and strain on the bladder can lead to uncomfortable urinary tract infections in addition to bladder and kidney damage. Inability to completely empty the bladder and inability to urinate despite having the urge can also be very uncomfortable. Incontinence can lead to reduction in social activities, and frequent sleep interruption can result from the need to urinate throughout the night.
More tests will follow to chart your progress. Digital rectal examination and plasma PSA measurements should be done every six months for the first year after the diagnosis. (Blood for the test should be drawn before the digital rectal examination.) Your doctor may continue to monitor you after that period.
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