Benign Prostatic Hyperplasia (BPH) is a condition in which the prostate gland enlarges, commonly occurring as men age, particularly in those over 50 years old. The prostate gland surrounds the urethra, and when it enlarges, it can exert pressure on the urethra, causing urinary symptoms.
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Causes of Benign Prostatic Hyperplasia
The primary cause of BPH is the hormonal changes that occur in men as they age. Although testosterone levels decrease with age, the number of prostate cells continues to increase. At the same time, estrogen levels may rise, which may also contribute to the prostate’s enlargement.
Conditions and Diseases with Symptoms Similar to BPH
- Prostate Cancer
Prostate cancer often presents with symptoms similar to BPH, such as frequent urination, weak urine stream, or incomplete emptying of the bladder. However, diagnosing prostate cancer requires a digital rectal exam along with specific tests such as blood tests to check PSA (Prostate-Specific Antigen) levels and a biopsy.
- Urinary Tract Infection (UTI)
A urinary tract infection can cause frequent urination, painful urination, or difficulty urinating. These symptoms are similar to BPH but often include a burning sensation during urination or fever.
- Prostatitis (Prostate Inflammation)
Prostatitis is the inflammation of the prostate, which may be due to infection or other causes. Patients may experience pain in the lower abdomen or back, and have difficulty urinating or frequent urination, similar to BPH.
- Bladder or Urethral Stones
Stones in the bladder or urethra can cause urinary obstruction, painful urination, or blood in the urine, which are symptoms similar to BPH.
- Overactive Bladder
Overactive bladder can cause frequent urges to urinate, and sometimes involuntary urination. These symptoms can resemble BPH but are not caused by prostate enlargement.
- Urethral Stricture
A narrowing of the urethra, often resulting from injury, infection, or surgery, can slow urine flow or cause urinary obstruction, which mimics the symptoms of BPH.
Diagnosis of Benign Prostatic Hyperplasia (BPH)
There are several methods used by doctors to assess prostate size and patient symptoms, including physical exams and various tests:
- Medical History and Physical Examination
The doctor will begin by taking a medical history, particularly focusing on urinary symptoms, such as how often you urinate, whether there is difficulty starting urination, or whether the bladder feels completely empty afterward. A physical exam follows to assess the prostate’s size.
- Digital Rectal Examination (DRE)
The doctor will perform a DRE by inserting a finger into the rectum to check the size and characteristics of the prostate. This test helps the doctor determine the extent of prostate enlargement and check for other conditions.
- PSA (Prostate-Specific Antigen) Blood Test
A PSA test measures the level of PSA in the blood, a substance produced by the prostate. Elevated PSA levels may indicate BPH, prostate cancer, or prostatitis. This test helps differentiate between BPH and prostate cancer.
- Urinalysis
The doctor may perform a urinalysis to check for infections or other abnormalities that could cause urinary symptoms similar to BPH
- Uroflowmetry
This test measures the speed and volume of urine flow. You will be asked to urinate into a machine that measures the flow. Slow urine flow may indicate a blockage in the urethra due to BPH.
- Post-Void Residual Volume Test
After urination, the doctor may use ultrasound to measure how much urine remains in the bladder. If a significant amount remains, it may indicate that BPH is obstructing urine flow, which might require further treatment such as surgery.
- Transrectal Ultrasound (TRUS)
TRUS is used to accurately measure the size and shape of the prostate by inserting an ultrasound probe into the rectum. This test helps provide precise information about prostate size
- Cystoscopy
A small camera called a cystoscope is inserted into the urethra to view the bladder and urethra. This test allows the doctor to visually assess any blockages or abnormalities caused by BPH.
- Urodynamic Testing
This test measures bladder pressure during urination, helping the doctor assess bladder function and identify any issues related to urethral obstruction caused by BPH.
Treatment for Benign Prostatic Hyperplasia (BPH)
There are several methods to treat benign prostatic hyperplasia, depending on the severity of symptoms and what is suitable for the patient. Treatment can generally be divided into three main categories: lifestyle modifications, medication, and surgery or other techniques. Below are the details of each method:
- Lifestyle Modifications
This is suitable for those with mild symptoms or those whose quality of life is not significantly affected. These modifications can help alleviate symptoms:
- Reducing water intake before bedtime to minimize nighttime urination.
- Avoiding caffeinated and alcoholic beverages, which can stimulate urination.
- Training to urinate at scheduled intervals and ensuring complete bladder emptying by waiting a few moments after the first urination and then urinating again.
- Medication
Doctors may prescribe medication based on what is suitable for the patient. There are several types of drugs used to treat BPH, including:
- Alpha-blockers : These help relax the muscles around the urethra and prostate, making it easier to urinate. Examples include Tamsulosin and Alfuzosin.
- 5-alpha-reductase inhibitors : These reduce the size of the prostate and help prevent blockages, such as Finasteride and Dutasteride.
- Bladder control medications : Used when there is an overactive bladder causing frequent and urgent urination. Medications include Oxybutynin and Tolterodine.
- Surgery or Technological Treatment
For those with severe symptoms or who do not respond to medication, surgical or technological treatment may be necessary, such as:
- Transurethral Resection of the Prostate (TURP) : This is the most common surgical procedure where an instrument is inserted through the urethra to remove excess prostate tissue.
- Laser Surgery : This uses lasers to cut or reduce the enlarged prostate tissue, such as Photoselective Vaporization of the Prostate (PVP).
- Rezum Water Vapor Therapy : This is a newer method that uses steam to destroy excess prostate tissue without surgery. It is ideal for those who want to avoid traditional surgery, especially elderly patients or those with multiple chronic conditions or on blood thinners.
- Open Prostatectomy : This is used when the prostate is very large and may be accompanied by bladder stones. The surgery is performed through the abdomen to remove part or all of the prostate.
- Other Techniques
- Catheterization : This is used in emergency cases or for those unable to urinate on their own. A catheter is inserted into the urethra to drain urine from the bladder.
- Prostatic Urethral Lift (PUL) : This technique uses a balloon or supporting material to help widen the urethra, reducing blockages without removing prostate tissue.
If you experience any of the following symptoms that affect your quality of life or cause discomfort, you should see a doctor for further examination and treatment:
- Frequent urination , especially at night (nocturia), waking up multiple times at night to urinate, disrupting sleep.
- Weak urine flow or slow urination, having to strain or feeling like you haven’t completely emptied your bladder.
- Incomplete bladder emptying , with the sensation of urine remaining in the bladder after urinating.
- Inability to urinate or urinating only in small amounts, even when the urge to urinate is strong.
- Urinary incontinence or the inability to control urination.
- Blood in urine : This may indicate a more serious condition and requires immediate medical attention.
- Lower abdominal or groin pain along with difficulty urinating or discomfort during urination.
Rezum Therapy Process: From Preparation to Completion
- Initial Evaluation and Examination
During the first consultation, the doctor will ask about symptoms such as urinary retention, frequent urination, or weak urine flow. A physical exam, including a digital rectal exam (DRE), may be performed to assess the size of the prostate. Additional tests may include a urine test and a PSA blood test to determine whether the symptoms are truly due to BPH and to assess the risk of prostate cancer.
- Pre-Treatment Preparation
Minimal preparation is required for Rezum therapy. However, if the patient is on certain medications that may affect the treatment, such as blood thinners, they will be advised to temporarily stop them as appropriate. On the day of the treatment, patients can eat as usual.
- Rezum Treatment Procedure
Rezum therapy uses steam to reduce the size of the prostate. The procedure is quick and does not require hospitalization. The steps include:
- Preparation : You will receive a local anesthetic, or mild sedation may be used to help you relax during the procedure.
- Instrument Insertion : A small tube connected to the Rezum device is inserted through the urethra to the prostate. This tube delivers steam into the prostate tissue.
- Steam Release : Once the device is in the correct position, steam is released into the prostate tissue for only 9 seconds per site. The steam destroys the excess prostate tissue through a process that changes the steam into water, breaking down the tissue.
- Treating All Necessary Sites : Steam is released into the various enlarged or obstructive areas of the prostate. The number of treatment sites depends on the size of the patient’s prostate.
- Completion: After all the sites are treated, the device is removed. Patients may need to use a temporary urinary catheter following the treatment to help drain urine.
- Post-Treatment
Recovery after Rezum is relatively quick, and patients can go home on the same day.
If a catheter is inserted, it will need to remain in place for at least 5 days or longer if the prostate is large.
Some patients may experience mild discomfort during urination or frequent urination initially, but these symptoms will gradually improve within 1–2 weeks after treatment.
The doctor will schedule a follow-up appointment about 2–4 weeks after the procedure to evaluate the treatment results and monitor for any further symptoms.
- Recovery and Results
Within 3–6 months, you will begin to see more noticeable results as the damaged prostate tissue is gradually absorbed and reduced in size. This will help relieve the obstruction in the urethra, and urinary symptoms will significantly improve.
The effects of Rezum are long-lasting, and many patients do not require repeated treatment for several years after the initial procedure.
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