About BPH

BPH (benign prostatic hypertrophy), also known as enlarged prostate, is common as men age into their late forties and beyond. This often causes men to develop difficulty urinating with symptoms including nocturia (waking up at night to urinate), a weak stream, straining to empty the bladder, delayed onset of urination, urgency, frequency, starting and stopping of flow, incomplete emptying and urinary tract infections.

Anatomy

The bladder and urethra are essentially a pump and a tube. When the prostate enlarges, it will often create pressure against the tube (the urethra), causing resistance to urine flow. The bladder must then pump harder to push urine out against resistance. Eventually, the bladder can no longer empty, and the urine that remains in the bladder is known as the post void residual. Generally, once the post void residual is greater than 50 cc or mL, there is irreparable harm being caused to the bladder. Treatment can help partially reverse bladder damage, but more importantly, it will usually prevent further bladder damage

The post void residual urine (that is left in the bladder after urinating) is essentially stagnant urine, which like stagnant water, is prone to infection. This is why some men who previously never had a urinary tract infection (UTI) can start to get them after developing BPH.

The initial treatment of BPH is generally with a medication called an alpha blocker (e.g., Flomax, alfuzosin, Rapaflo). These medications help to relax smooth muscles in the prostate to take some of the pressure off the urethra. Unfortunately, these medications often have side effects including dizziness, decreased energy, and/or retrograde ejaculation.

Another class of medications is 5α-reductase inhibitor (e.g., finasteride or dutasteride). Unfortunately, these medications have a high rate of causing decreased erectile function, decreased energy, and decreased libido.

When a patient cannot or chooses not to tolerate the side effects of BPH medications, or if they are not effective, the next step is to look into a BPH treatment procedure.