Benign Prostatic Hyperplasia Treatment Side Effects


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Benign Prostatic Hyperplasia Treatment Side Effects

Benign Prostatic Hyperplasia Treatment Side Effects

Dr. Siegel discusses the management of prostate enlargement.

Benign Prostatic Hyperplasia Treatment Side Effects

Benign Prostatic Hyperplasia Treatment Side Effects

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Benign Prostatic Hyperplasia Treatment Side Effects

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Benign prostatic hyperplasia (BPH), also known as benign prostatic hypertrophy, is a histologic diagnosis characterized by proliferation of the cellular elements of the prostate. Chronic bladder outlet obstruction (BOO) secondary to BPH may lead to urinary retention, renal insufficiency, recurrent urinary tract infections, gross hematuria, and bladder calculi.
Essential update: New laser shortens surgery time in benign prostatic hyperplasia

In a study of 200 consecutive patients with BPH and secondary lower urinary tract symptoms, Ben-Zvi and colleagues found that the GreenLight (GL) XPS 180W laser system was comparable to an older system, GL-HPS 120W, in the treatment of BPH obstructions, but with the advantages of less operative time and fiber use and with greater reduction of prostate-specific antigen (PSA). In the study, 120 patients underwent treatment with the newer system, and 80 patients were treated with the older one.[1]

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Signs and symptoms

When the prostate enlarges, it may constrict the flow of urine. Nerves within the prostate and bladder may also play a role in causing the following common symptoms:

Urinary frequency
Urinary urgency
Hesitancy – Difficulty initiating the urinary stream; interrupted, weak stream
Incomplete bladder emptying – The feeling of persistent residual urine, regardless of the frequency of urination
Straining – The need strain or push (Valsalva maneuver) to initiate and maintain urination in order to more fully evacuate the bladder
Decreased force of stream – The subjective loss of force of the urinary stream over time
Dribbling – The loss of small amounts of urine due to a poor urinary stream

See Clinical Presentation for more detail.
Diagnosis

Digital rectal examination

The digital rectal examination (DRE) is an integral part of the evaluation in men with presumed BPH. During this portion of the examination, prostate size and contour can be assessed, nodules can be evaluated, and areas suggestive of malignancy can be detected.

Laboratory studies

Urinalysis – Examine the urine using dipstick methods and/or via centrifuged sediment evaluation to assess for the presence of blood, leukocytes, bacteria, protein, or glucose
Urine culture – This may be useful to exclude infectious causes of irritative voiding and is usually performed if the initial urinalysis findings indicate an abnormality
Prostate-specific antigen – Although BPH does not cause prostate cancer, men at risk for BPH are also at risk for this disease and should be screened accordingly (although screening for prostate cancer remains controversial)
Electrolytes, blood urea nitrogen (BUN), and creatinine – These evaluations are useful screening tools for chronic renal insufficiency in patients who have high postvoid residual (PVR) urine volumes; however, a routine serum creatinine measurement is not indicated in the initial evaluation of men with lower urinary tract symptoms (LUTS) secondary to BPH[2]

Ultrasonography

Ultrasonography (abdominal, renal, transrectal) and intravenous urography are useful for helping to determine bladder and prostate size and the degree of hydronephrosis (if any) in patients with urinary retention or signs of renal insufficiency. Generally, they are not indicated for the initial evaluation of uncomplicated LUTS.

Endoscopy of the lower urinary tract

Cystoscopy may be indicated in patients scheduled for invasive treatment or in whom a foreign body or malignancy is suspected. In addition, endoscopy may be indicated in patients with a history of sexually transmitted disease (eg, gonococcal urethritis), prolonged catheterization, or trauma.

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IPSS/AUA-SI

The severity of BPH can be determined with the International Prostate Symptom Score (IPSS)/American Urological Association Symptom Index (AUA-SI) plus a disease-specific quality of life (QOL) question. Questions on the AUA-SI for BPH concern the following:

Incomplete emptying
Frequency
Intermittency
Urgency
Weak stream
Straining
Nocturia

Other tests

Flow rate – Useful in the initial assessment and to help determine the patient’s response to treatment
PVR urine volume – Used to gauge the severity of bladder decompensation; it can be obtained invasively with a catheter or noninvasively with a transabdominal ultrasonic scanner
Pressure flow studies – Findings may prove useful for evaluating for BOO
Urodynamic studies – To help distinguish poor bladder contraction ability (detrusor underactivity) from BOO
Cytologic examination of the urine – May be considered in patients with predominantly irritative voiding symptoms

See Workup for more detail.
Management

Pharmacologic treatment

Agents used in the treatment of BPH include the following:

Alpha-1–receptor blockers
Alpha-adrenergic receptor blockers
Phosphodiesterase-5 enzyme inhibitors
5-alpha reductase inhibitors
Anticholinergic agents

Surgery

Transurethral resection of the prostate (TURP) – The criterion standard for relieving BOO secondary to BPH
Open prostatectomy – Reserved for patients with very large prostates (>75 g), patients with concomitant bladder stones or bladder diverticula, and patients who cannot be positioned for transurethral surgery

Minimally invasive treatment

Transurethral incision of the prostate (TUIP)
Laser treatment – Used to cut or destroy prostate tissue
Transurethral microwave therapy (TUMT) – Generates heat that causes cell death in the prostate, leading to prostatic contraction and volume reduction
Transurethral needle ablation of the prostate (TUNA)
High-intensity ultrasonographic energy therapy – Currently in the clinical trial stage
Prostatic stents – Flexible devices that expand when put in place to improve the flow of urine past the prostate
Laparoscopic prostatectomy

Benign Prostatic Hyperplasia Treatment Side Effects

Starting Point in BPH Treatment Should Be Side Effect Free Thermobalancing …
DigitalJournal.com (press release), on Mon, 10 Jun 2013 00:25:55 -0700
Fine Treatment recommends Dr. Allen’s natural device for the termination of prostate enlargement by enhancing blood circulation inside the prostate locally. In contrast, BPH drugs fail to prevent prostate surgeries. However, the article ‘Prostate

Male Urinary Problems Can Be Treated with Dr. Allen’s Device Naturally Without …
PR Web (press release), on Mon, 03 Jun 2013 00:26:00 -0700
Nevertheless, the use of risky medication is on the rise. A recent article on ‘BPH Drug Prescribing Increasing in the U.S.’ in Renal and Urology News, May 05, 2013 says, the proportion of visits in which physicians prescribed alpha blockers alone rose

Urologix In-Office BPH Therapy Featured on The Balancing Act on Lifetime …
Watch List News (press release), on Wed, 29 May 2013 09:21:59 -0700
The show is set to discuss Benign Prostatic Hyperplasia (BPH) and educate BPH sufferers and their significant others on effective non-surgical, in-office treatment options as an alternative to BPH medications. Minneapolis, MN (PRWEB) May 29, 2013

BPH Medications – What Medications Are Used to Treat BPH
http://drugs.about.com/od/faqsaboutyourdrugs/f/flomax_faq.htm
Oct 16, 2008 BPH medications – There are two types of medications used to treat an enlarged prostate (a condition known as benign prostatic hyperplasia,

Enlarged prostate – National Library of Medicine – National Institutes …
http://www.nlm.nih.gov/medlineplus/ency/article/000381.htm
An enlarged prostate is often called benign prostatic hyperplasia (BPH) or benign Treatment options include “watchful waiting,” lifestyle changes, medication,

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