Benign Prostatic Hyperplasia

The prostate is a male reproductive organ involved in the production and secretion of semen. It is located behind the pubic bone and sits just below the bladder. When a man urinates, the prostate is the first part of the urethra through which urine passes.

BPH or Benign Prostatic Hyperplasia, is a condition in which the prostate enlarges as men get older. As the prostate enlarges, it presses on and blocks the urethra, causing bothersome urinary symptoms such as:

• Slowing of the urinary stream
• Incomplete emptying of the bladder
• Hesitancy when trying to start urinating
• An intermittent urinary stream
• Dribbling in your underwear when you thought you were finished

No. BPH is a benign, non-cancerous condition. Although both prostate cancer and BPH occur more frequently as men age, they are unrelated. Prostate cancer rarely causes any symptoms. This is why it is important that you screen for prostate cancer starting at age 50 or sooner if you have risk factors (e.g. family history, African American).

Our experts at Pazona MD Urology in Nashville can order a PSA blood test and perform a prostate exam (DRE - digital rectal exam), to ensure prostate cancer is not present.

Urologists measure the size of a prostate in grams. A normal size prostate is similar to a golf ball (20 g). In some cases a prostate may grow as large as a grapefruit (>100 g). Why one man’s prostate will grow bigger than another man’s is not entirely known. The male hormone testosterone and genetics likely play a key role.

While BPH is a benign condition and unrelated to prostate cancer, if left untreated, BPH can lead to serious issues. First, BPH may lead to permanent bladder damage where the bladder muscle is no longer capable of emptying urine (urinary retention). This requires a catheter or tube to be placed inside the urethra (penis) to help drain the urine. Other complications of BPH include:

• Blood in the urine (hematuria)
• Recurrent urinary tract infections
• Bladder stones
• Kidney blockage and damage

Although a man may have an enlarged prostate, we diagnose BPH based on urinary symptoms. In other words your prostate may be physically “big”, but if you don’t have any bothersome urinary symptoms, then we wouldn’t necessarily recommend any evaluation or treatment.

You can measure the severity of your BPH symptoms by taking the International Prostate Symptom Score (IPSS) questionnaire. This provides a baseline assessment of your urine symptoms.

We recommend that you share this information with the BPH experts at Pazona MD Urology to help us better understand the severity of your symptoms.

Your next step first depends on the severity of your symptoms. If you scored 8 or less on the IPSS questionnaire then you have mild BPH symptoms. You may want to consider lifestyle modifications (see below) to start. On the other hand if you have moderate to severe symptoms, then having an evaluation with a BPH expert like our team at Pazona MD Urology in Nashville, Brentwood, or Cookeville, will ensure that you get the care you deserve.

Realize that not all urinary symptoms are due to BPH. The first thing you can do is examine how much and what types of fluids you drink. What goes in has to come out. Excess fluid intake (>2L per day) is the #1 cause of urinary frequency.

Beverages with caffeine, acid, sugar and alcohol (all the fun stuff) also produce more urine and irritate the bladder. Limiting these drinks can improve urinary symptoms as well.

Lastly, your other medical conditions might be playing a role. Untreated or poorly controlled diabetes and obstructive sleep apnea can both contribute to bothersome urinary symptoms.

Water pills for high blood pressure or heart issues also cause your kidneys to make more urine.

If you have any of these medical conditions, we recommend speaking to your primary care physician to see if any adjustments in medications can be made. Don’t ever stop taking these medications without consulting with your doctor first.

A prostate healthy diet looks remarkably similar to a heart healthy diet. It should focus on the following foods:

• Fruits and vegetables with high levels of antioxidants (e.g. tomatoes, berries, broccoli)
• Lean proteins including fish with omega-3 fatty acids (e.g. salmon)
• Legumes (e.g. beans, lentils) and nuts
• Olive oil, avocados

This diet is primarily recommended for the prevention of prostate cancer. Nonetheless, these foods can minimize inflammation in your body and may help BPH symptoms.

You’ve seen them on TV and at your local pharmacy. 'Super Beta Prostate' and other 'natural' remedies to help men with enlarged prostates. Prostate supplements have been used to treat BPH symptoms for many years. Some of these supplements include:

• Saw Palmetto
• Pygeum Africanum
• Selenium
• Lycopene
• ß-Sitosterol

Unfortunately most studies involving these supplements were poorly designed. Therefore it is difficult to make treatment recommendations about these compounds. In my experience, some men with mild symptoms may see a benefit when taking a prostate health supplement. However, nutritional supplements are not regulated by the FDA in the same rigorous fashion as prescription medications. Please use caution if you choose to take any of these supplements.

Yes. There are several classes of medications that can be used to improve BPH symptoms.

Alpha blockers (e.g. tamsulosin): These medications act by relaxing the smooth muscle of the prostate which in turn relieves the blockage of the bladder. Although some men do well on these medications, there are possible side effects. These include:

• Stuffy nose
• Dizziness
• Decreased ejaculation
• Erectile dysfunction
• Possible association with dementia

5-alpha reductase inhibitors (e.g. finasteride): are a different class of medications that aim to shrink the physical size of the prostate. Although theoretically this makes sense, these medications usually do not make significant improvements to a man’s urinary stream or quality of life. They also can have sexual side effects that are sometimes permanent.

Tadalafil: normally used for erectile dysfunction (ED), this generic version of Cialis can be prescribed on a daily basis to improve urinary symptoms. It can lead to headaches, backaches and changes in vision.

Our BPH experts at Pazona MD Urology can help you determine if a medication is right for you.

An evaluation always starts with a thorough history. Next we will perform the following tests:

• Digital rectal exam to rule out prostate nodules (a sign of prostate cancer).
• Urinalysis to rule out blood in the urine or a urinary tract infection.
• Pelvic ultrasound to measure the size of the prostate and amount of urine left in the bladder.

Depending on the severity of the urinary symptoms and above testing, we may then recommend a follow up visit to perform:

• Bladder pressure study (Urocuff) to measure the flow of urine and the health of the bladder.
• Cystoscopy - a direct visualization of the urethra, prostate and bladder with a sterile camera scope.

A cystoscopy is necessary in select men to ensure the following:

• Rule out more serious medical conditions like bladder cancer.
• Assess if any permanent bladder damage has occurred due to BPH.
• Better assess the size and shape of the prostate internally to determine the best surgical option for your BPH.

At Pazona MD Urology we offer lidocaine jelly and nitrous oxide (laughing gas) to make the cystoscopy experience less painful. The exam is usually completed in the office in less than 2 minutes.

At the moment there are over 10 surgical procedures that can be performed for BPH. These include: Minimally invasive surgical therapies typically performed in the office or as an outpatient:

• Urolift
• Rezum
• iTind
• Optilume
• Transurethral incision of the prostate (TUIP)

Transurethral ablation procedures performed in a hospital or surgery center to remove BPH tissue:

• Transurethral resection of the prostate (TURP)
• Laser ablation of the prostate (Greenlight or Holmium laser)
• Laser enucleation of the prostate (HoLEP)
• Robotic aquablation

Simple prostatectomy performed with an abdominal incision with or without the aid of a robotic surgical system. This involves removal of the BPH portion of the prostate.

Prostatic artery embolization (PAE): a procedure performed by an interventional radiologist to selectively occlude or stop blood flow to the prostate so it shrinks.

Deciding on the best BPH surgery or treatment can be confusing. There is a lot of misinformation and bias in treatments. That’s why our trusted team of BPH experts at Pazona MD Urology are here to guide you to the best BPH therapy for you. Allow us to complete a thorough BPH evaluation and then we can personalize the BPH therapy for you.

Dr. Pazona’s philosophy as a surgeon is to only perform the best surgeries for patients. With over 10 options for treating your BPH, it’s not possible for any surgeon to be an 'expert' in all surgeries. Instead Dr. Pazona has focused on two of the better options available for treating BPH: the Urolift system and Robotic aquablation.

We are constantly evaluating all of the BPH options available and can help guide you to the best therapy.