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Enlarged Prostate (BPH)

Benign prostatic hyperplasia (BPH) is a common condition in men caused by non-cancerous enlargement of the prostate gland. The prostate is a walnut-shaped gland that surrounds the urethra at the neck of the bladder, in front of the rectum.

The main function of the prostate is to supply fluid for the semen. As men get older, the prostate enlarges and can squeeze down on the urethra, causing lower urinary tract symptoms associated with BPH where men have difficulty urinating.

Symptoms of an Enlarged Prostate

  • The need to urinate frequently, especially at night
  • Difficulty starting the flow of urine
  • Having to force urination
  • A feeling that the bladder does not completely empty, even after urinating
  • Dribbling after urination
  • A slow or weak stream of urine
  • Inability to hold the urine once the urge to urinate begins

If you are unable to urinate at all, this is an emergency situation that requires immediate medical attention.

Causes of Enlarged Prostate

Aging is the leading cause of enlarged prostate, which affects more than 50% of men age 50 and older and 90% of men age 80 and older. Other risk factors include a family history of BPH and obesity caused by lifestyle choices such as a diet high in fat and animal protein and physical inactivity.

Diagnosing BPH

The doctor will take a detailed health history and perform a physical exam that includes checking your prostate with a digital rectal exam (DRE). Other tests may or may not be ordered. These tests include:

  • Prostate-specific antigen (PSA): a blood test to screen for prostate cancer
  • Cystoscopy: a small flexible scope that is passed through the penis to look in the urethra and/or bladder to determine if there is evidence of urethral prostate enlargement
  • Post-void residual volume (PVR): determines how much urine is left in the bladder after urinating
  • Ultrasound of the kidney or prostate: used to view the prostate and ensure kidneys are not being affected by blockage
  • Urine collection: tests for infection or screens for bladder cancer
  • Urine flow study: measures how quickly urine flows while you are urinating
  • Urodynamic pressure-flow study: tests the pressures inside the bladder during urination

Treatment for BPH

Treatment for BPH depends on the severity of symptoms. Treatment may entail only making lifestyle changes. If medication is required, your doctor may prescribe medicine that helps relax the smooth muscles of the urethra or shrink the prostate to improve your symptoms. When medication is not sufficient, surgery may be required.

Microwave Therapy

Microwave Therapy for BPH

Many men suffer from urinary incontinence or pain during urination, and in most cases the cause of lower urinary tract symptoms is an issue with the prostate. Prostate cancer can be one cause, but a more common reason for these pelvic issues is an enlarged prostate, also known as benign prostatic hyperplasia (BPH).

Microwave therapy, also called transurethral microwave therapy (TUMT), is a one-time outpatient procedure that uses high temperatures to kill tissue inside the prostate. TUMT for an enlarged prostate is only used when the enlarged prostate is not cancer-related. It is an alternative to medication, which would shrink the prostate, or surgery which would remove some or all of the prostate.

During TUMT, a catheter is inserted into the urethra and prostate. A microwave antenna inside the catheter emits energy to heat the interior of the prostate, and as the treated tissue heals, it shrinks to reduce the blockage of urine flow and painful side effects of the condition.

A cooling substance flows around the antenna so as to not burn the walls of the urethra, and a temperature sensor allows the outside temperature of the prostate to stay at reasonable levels.

Microwave therapy accomplishes results similar to the traditional surgical treatment for enlarged prostate, which uses an electronic knife to resect the prostate. Because TUMT usually does not affect the walls of the prostate, however, there is often a minimized amount of irritation and fewer urinary side effects from this procedure.

Post-Procedure Instructions

You should schedule your follow-up within 24-48 hours of the procedure and make an appointment with your physician within two weeks of the procedure.

Diet: In most instances you will be able to eat a regular meal on the evening of the procedure. However, there will be some difficulty with urination and possibly bowels for a short time after the procedure, while the prostate and urethra heal, so your physician may discuss a dietary regimen that would reduce these side effects.

Exercise: As with most procedures, you will experience soreness and irritation after your microwave therapy, and you should follow your physician’s guidance regarding when to resume strenuous activity. In most cases it will be at least several days before you will be able to return to normal activity, and you should like refrain from sex for at least two weeks.

Side Effects: The most serious side effect of microwave therapy is that you will not be able to void urine for a period of time – in some cases up to a week. This can be treated by medication but should be reported immediately to avoid serious complications or infection, and will likely be treated by the temporary insertion of a catheter to release urine.

Other side effects of microwave therapy may include:

  • Frequent urination
  • Blood in the urine
  • Irritation and burning with urination
  • Erectile dysfunction

Transurethral Prostatectomy (TURP)

Transurethral Prostatectomy for BPH

Transurethral resection of the prostate (TURP) is a surgical treatment to remove all or part of the prostate gland.

This prostate surgery requires very special post-hospital care. Despite the fact that no skin incisions are used, the area around the prostate is quite raw and is covered with a large scab to promote healing and prevent bleeding. Certain precautions are needed to ensure that this scab is not disturbed over the next six weeks while the healing proceeds.

Because of the raw surface around your prostate and the irritating effects of urine, you may expect frequency of urination and/or urgency (a strong desire to urinate) and perhaps even more getting up at night. This will usually resolve or improve slowly over the healing period.

You may see some blood in your urine over the first six weeks. Do not be alarmed, even if the urine was clear for a while. If you should have bleeding, decrease your activity and drink plenty of fluids until clearing occurs.

Post-Procedure Instructions

Call to schedule a follow-up appointment in 7-14 days.

Diet: You may return to your normal diet immediately. Because of the raw surface around your prostate, alcohol, spicy foods, and drinks with caffeine, carbonation, etc. may cause some irritation or frequency, and should be used in moderation. To keep your urine flowing freely and to avoid constipation, drink plenty of fluids during the day (8-10 glasses).

Activity: You will need to restrict physical activity, especially during the first two weeks.

  • No heavy lifting or straining (anything greater than 10-15 lbs.) for 3 weeks
  • No driving a car, and limit long car rides for the first several days
  • No strenuous exercise
  • No sexual intercourse until cleared by one of your doctors
  • No severe straining during bowel movements - take a laxative if necessary

Medication: You should resume your pre-surgery medication unless told otherwise. In addition, you will likely be given an antibiotic to prevent infection. These should be taken as prescribed unless you are having an unusual reaction to the antibiotic.

Side Effects

It is important to keep your bowels regular during the post-operative period. The rectum and the prostate are next to each other and any very large and hard stools that require straining to pass can cause bleeding.

A bowel movement every other day is reasonable. Use a mild laxative if needed (such as Milk of Magnesia or Dulcolax tablets) and call if you are having problems such as:

  • Fevers over 101.3
  • Heavy bleeding or clots (see notes above about blood in your urine)
  • Inability to urinate
  • Drug reactions (hives, rash, nausea, vomiting, diarrhea)
  • Severe burning or pain with urination that is not improving

Miami urologist Dr. Marvin Bondhus diagnoses and treats BPH in our South Miami office. For a consultation, call (305) 661-9692 or request an appointment online.