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Glamorgan Urology: Benign Prostatic Hyperplasia (BPH)

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Benign Prostatic Hyperplasia (BPH)

The prostate is a gland the size of a chestnut. It is only present in men, and it is situated under the bladder surrounding the urethra, the passageway that takes the urine to the outside. The gland produces seminal fluid, which is mixed with sperm to make semen.

With age, the gland may begin to grow - this happens to most men. The growth may eventually cause problems with urination, because the gland pinches off the urethra as it increases its size.

The growth in itself is harmless and so the condition is called benign prostate hyperplasia (BPH). It occurs most often in men over the age of 60. Up to 30 per cent of men in their 70s have BPH that causes them symptoms.

What kinds of problems can an enlarged prostate cause?

The enlargement of the prostate gland stretches and distorts the urethra and so obstructs the urine flow. Symptoms include:

  • A weak or interrupted urinary stream - several attempts to empty the bladder may be necessary.
  • Difficulty starting the urine flow, even when the bladder feels full.
  • A feeling the bladder is not completely empty.
  • A need to urinate often during the day and during the night. Increased need to urinate at night is usually a very early symptom.
  • A need to urinate right away - some men may experience involuntary discharge of urine.
  • Dribbling of urine after urination.
  • Burning sensation or pain during urination.

Different men get different symptoms - the symptoms may also vary with each individual throughout the course of the disease. It is important to emphasise that the above symptoms do not necessarily prove that the prostate is enlarged. Other diseases may cause similar symptoms. Should you have any concerns then we would be happy to assess you at our one visit clinic for BPH (can you put a link here to Janine telephone no 07592 446220).

Can other problems arise?

There are further complications with this disease.

  • For some men, it suddenly becomes impossible to urinate (known as acute retention). Studies have shown that acute retention affects between 1 and 2 per cent of men with BPH each year. This condition is very painful and demands immediate medical treatment to avoid damage to the kidneys, among other things.

  • Other men find it gradually harder to empty the bladder. As the condition develops, more and more urine is left in the bladder after urination (known as chronic retention).

Other complications of the disease include: repeated attacks of cystitis (infection of the bladder) and the development of stones in the bladder.

How does a Glamorgan Urologist diagnose the disease?

We can make the diagnosis with the following information:

  • You will be asked about their symptoms and asked to fill out a symptom questionnaire (The IPSS score), to assess the nature and severity of the symptoms.
  • You may also be asked to record your drinking and urination pattern over a period of three days ( A frequency voiding chart)
  • By carrying out a rectal examination, we can feel through the rectum wall whether or not the prostate is enlarged.
  • Your urine will be examined and may be sent for culture, when it will also be tested for sensitivity to antibiotics. Kidney function will also be examined by a blood test.

You may require further tests and Glamorgan Urology will be happy to arrange any of the following per requirement;

  • A Flow rate, to test the speed of the urinary flow or stream.
  • An ultrasound scan of the bladder - this assess how well the bladder has emptied.
  • An ultrasound scan of the prostate to assess its size and 3D anatomy.
  • PSA blood test, to exclude prostate cancer.

How is benign prostate hyperplasia treated?

There are a variety of treatment strategies for this condition and the following factors should be considered.

Treatment is only necessary if the symptoms are bothersome or complications are present.

Each treatment has advantages and disadvantages. A Glamorgan Urology Consultant will be happy to discuss the options with you in detail.

If there are only a few minor symptoms it might be best to wait and see (watchful waiting) how it develops. We will review you at set times to ensure that no complications of BPH develop.

What kinds of medicines are used?

There are two types of medication for this problem.

  • Alpha blockers. These medicines help to relax muscle fibres within the prostate, thereby reducing the obstruction to the urine flow. They do not reduce the size of the prostate. Examples include terazosin (Hytrin), alfuzosin (Xatral) and tamsulosin (Flowmax). Patients occasionally experience side effects. Dizzyness, especially when getting up after lying down, can occur especially in the first few days. Headache, drowsiness and dry or retrograde ejaculation can also occur.

  • 5-alpha-reductase inhibitors - dutasteride (Avodart) or finasteride (Proscar) inhibit the growth of the prostate and decrease the size of the gland.

Research studies have shown that both types of medical treatment are effective at improving urinary symptoms in men with BPH.

There are also different kinds of over-the-counter herbal medicine on the market. These preparations are not generally recommended because their effect has not been completely documented. Those which do have some supporting evidence are saw palmetto and beta-sitosterol plant extracts and rye grass pollen extract.

What kind of BPH surgery is available with Glamorgan Urology?

Glamorgan Urology offer 4 different procedures:

Green Light Laser XPS.
This minimally invasive technique uses a laser with a 532nm wavelength to vaporise the prostate tissue with no bleeding.

TURIS resection of the prostate
(a TURP in safer saline fluid)
This is an endoscopic surgical procedure where parts of the enlarged tissue are peeled off.

TURIS vaporisation of the prostate
(using saline and a 'button' type electrode)
This is simialr to TURIS, but the prostate tissue is vaporised rather being peeled off.

Open (Millin) Prostatectomy
This technique is used on very large prostate glands (> 200mls in size).

The benefits of surgery are long lasting, but because only part of the prostate is removed, some men may eventually need another operation.

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