How Is Benign Prostatic Hyperplasia Diagnosed
Your healthcare provider will review your medical history, ask you questions and perform a physical examination. Part of the physical exam involves a digital rectal exam.
During a digital rectal exam, your healthcare provider will carefully insert their gloved digit into your rectum. Theyll feel the edges and surface of your prostate, estimate the size of your prostate and detect any hard areas that could be cancer.
Your healthcare provider may also order:
- A survey to evaluate the severity of your symptoms.
- A urine flow test to measure the speed of your pee stream.
- A study to detect how much pee remains in your bladder after youve finished peeing.
- A cystoscopy to look into your bladder.
Alternative Minimally Invasive/surgical Procedures To Turp
For patients that have failed medical therapy or were unable to handle the sideeffects, historically the next step would be to undergo TURP. However, TURP requiresgeneral anesthesia and has been associated with unwanted side effects of retrogradeejaculation and ED. In the past decade, there has been a push for minimallyinvasive, office-based procedures that do not require general anesthesia or hospitalstay, and do not have the side effects associated with TURP. New surgical therapieshave also been designed in the hopes of similar efficacy with decreased side effectsand retreatment rates.
Overall, surgical therapy is recommended in patients with recurrent urinary tractinfections secondary to BPH, renal insufficiency secondary to BPH, recurrent bladderstones or gross hematuria from bladder outlet obstruction due to BPH, refractoryurinary retention secondary to BPH, and/or patients with LUTS that have failed orthose whoe are unwilling to consider other therapies. Prior to starting anyprocedural or surgical therapy, clinicians should obtain a PVR, assess prostate sizeusing either ultrasound , pre-existing cross-sectionalimaging, or cystoscopy, and should consider uroflow or pressure flow studies in theappropriate patient.
What Does Treatment In Europe With Booking Health Mean
Booking Health ensures optimal travel planning for men with BPH and accompanying persons. We assist in obtaining a medical entry visa to a specific European country, coordinate appointments with European hospitals, and schedule visits to clinics so that even a short stay in Europe is medically effective.
Cooperating directly with clinics, Booking Health can minimize the prices for services and offer individually designed diagnostic and treatment programs for benign prostatic hyperplasia in European hospitals.
All you need to do is fill in the request form on the Booking Health website for us to contact you!
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What Are The Types Of Prostate Surgery For Benign Prostatic Hyperplasia
Several minimally invasive surgeries may be used for benign prostatic hyperplasia. These include:
GreenLight laser: Photoselective vaporization of the prostate is a treatment that vaporizes prostate tissue to create a channel in the urethra for free urination. This is surgical treatment performed in the operating room under general anesthesia.
Plasma button electrovaporization: Prostate tissue is removed using low temperature plasma energy. Tissue is vaporized. This is an operating room-based therapy and requires an anesthetic.
Water vapor therapy : Water vapor is directly delivered to the prostate tissue. Over a 3-month period the tissue is destroyed and reabsorbed by the body. This is an office-based therapy and is performed under a local nerve block.
UroLift®: A mechanical approach that places implants to pin the lateral prostate lobes out of the way to reduce obstruction. This is an office-based procedure performed under a local nerve block.
Prostatic artery embolization: This approach uses catheters to deliver agents that block blood flow to the prostatic artery to reduce symptoms of BPH by shrinking tissue. This prostate procedure uses local anesthesia and doesnt require a hospital stay.
Search Strategy And Selection Criteria
This study followed PRISMA recommendations .9 The method and analysis were prespecified in advance and registered on the PROSPERO website . To identify published and unpublished trials, we used electronic databases including PubMed , Embase , and Cochrane clinical trial registers without language or date restriction, as well as performing a manual literature search. The detailed study protocol including search terms and strategy is provided in the supplementary material and supplementary table 1. Randomised parallel group design clinical trials comparing any two of the different surgical methods were eligible for inclusion. All methods are listed in table 1. Inclusion criteria were patients with a Qmax lower than 15 mL/s and an IPSS greater than 8. Exclusion criteria were patients with neurogenic bladder previous urethral, prostate, or bladder surgeries and suspected prostate cancer.
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Comparative Efficacy And Safety Of New Surgical Treatments For Benign Prostatic Hyperplasia: Systematic Review And Network Meta
- Accepted 27 September 2019
Options For Conservative Treatment And Medical Therapy
The main factor in the decision about treatment is, in the first place, the patients perceived burden of suffering, which is best assessed using the IPSS and Quality of Life score. Uroflowmetry results, PVR measurements, and IPSS and ICIQ are all included in the overall assessment, making cut-off values for treatment decisions impracticable. In patients with mild distress, the natural course of the BPH can be initially monitored by watchful waiting . Patients can also be offered counseling on lifestyle and nutritional changes. The following suggestions can, if followed, have a positive impact on BPH-related symptoms and may potentially slow disease progression :
- Avoiding alcohol and caffeine
- Adjusting timing of fluid intake to daily routine
- Ongoing monitoring of symptoms
- Using relaxation exercises and distraction techniques
- Adjusting other medications
Drug therapy should be considered if the patients symptom burden requires it or if initial watchful waiting has not led to satisfactory improvement in symptoms. The choice of drug therapy depends on the symptoms. The most important clinical effects of the various drug classes, their respective adverse effects profile, and recommended follow-up schedules can be found in Table 2.
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When Is Bph Treatment Necessary
The course of BPH in any individual is not predictable. Symptoms, as well as objective measurements of urethral obstruction, can remain stable for many years and may even improve over time for as many as one-third of men, according to some studies. In a study from the Mayo Clinic, urinary symptoms did not worsen over a 3.5-year period in 73% of men with mild BPH. A progressive decrease in the size and force of the urinary stream and the feeling of incomplete bladder emptying are the symptoms most correlated with the eventual need for treatment. Although nocturia is one of the most annoying BPH symptoms, it does not predict the need for future intervention.
If worsening urethral obstruction is left untreated, possible complications are a thickened, irritable bladder with reduced capacity for urine infected residual urine or bladder stones and a backup of pressure that damages the kidneys.
- Inadequate bladder emptying resulting in damage to the kidneys
- Complete inability to urinate after acute urinary retention
- Incontinence due to overfilling or increased sensitivity of the bladder
- Recurrent severe hematuria
- Symptoms that trouble the patient enough to diminish his quality of life
Diagnosis Of Enlarged Prostate
BPH Diagnosis
The symptoms of BPH will often bring patients to their doctor, although the enlarged prostate can also be diagnosed during a routine digital rectal examination. Other common tests used to diagnose BPH include a urinalysis a urine flow study, which uses a device that measure the speed of the stream a transrectal ultrasound, which measures the size of the prostate gland and can help to rule out prostate cancer and a cystoscopy, in which a tube attached to a miniature camera enables the urologist to view the inside of the bladder and urethra to determine the prostates size and the level of obstruction.
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Can You Explain Why You Use Pae To Treat Bph
At ECCO Medical, we offer prostate artery embolization as a treatment for frequent urination caused by benign prostatic hyperplasia . PAE is one of the best BPH treatment options for an enlarged prostate gland. Most patients will have tried medications first, such as an alpha blocker. However, these medications can have side effects such as sexual dysfunction, dry mouth and dizziness.
As the prostate enlarges, it puts pressure on the urinary tract making it difficult to urinate. This can lead to frequent urination in the day or night, and it can even lead to urinary tract infections. Urinary urgency, a weak stream and incontinence are common urinary symptoms associated with benign prostatic hyperplasia. PAE is a minimally invasive procedure that shrinks the previously enlarged excess prostate tissue, relieving many of the bothersome urinary issues.
Treating Bph With Rezm Water Therapy
Rezm water therapy is a great option to provide lasting relief for those who do not want to treat BPH with medication or invasive surgery. This is a non-surgical treatment that uses the power of water, vapor, or steam, to remove excess prostate tissue that is pressing against the urethra, causing lower urinary tract symptoms.
Rezm is a non-invasive, quick procedure that is usually performed in a urologists office. The treatment itself only lasts about nine seconds. During these nine seconds, sterile water vapor is released throughout the target prostate tissue. When the steam contacts the tissue, it kills the excess prostate cells blocking the urethra. Eventually, the bodys natural healing response absorbs the treated tissue. When the extra tissue is removed, the urethra opens and therefore, reduces BPH symptoms. Patients have reported feeling relief in as soon as two weeks with this treatment.
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What Questions Should I Ask My Healthcare Provider
- How can you tell that I have BPH?
- If I dont have BPH, what other condition might I have?
- What can I do to help reduce the size of my prostate?
- Do I need treatment?
- Whats the best treatment for me?
- What supplements do you recommend?
- Will these supplements affect any other medications or supplements that Im taking?
- Should I see a urologist?
Diagnosing Benign Prostate Enlargement
To find out whether your prostate gland is enlarged, you’ll need to have a few tests.
Some tests will be carried out by your GP and others will be carried out by a urologist .
First, your GP will ask about your symptoms. If it seems that you have symptoms of benign prostate enlargement, the next stage is to calculate your International Prostate Symptom Score .
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Why Would You Have Surgery For A Benign Prostate Condition
The prostate is the walnut-sized gland that surrounds the urethra in a male. The urethra is the tube that carries urine from the bladder to outside the body. One of the non-cancerous conditions that can affect the prostate is called benign prostatic hyperplasia , which is also known as enlarged prostate.
BPH is the most common prostate problem in men over age 50. About half of men in their 50s and as many as 90% of men in their 70s and 80s have enlarged prostates.
Enlarged prostate surgery is recommended if less invasive treatments have failed, or if you have severe symptoms such as:
- An inability to urinate.
- Excessive blood in the urine.
- Bladder stones.
Prostate cancer and infertility arent symptoms or causes of BPH. Benign prostatic hyperplasia doesnt cause erectile problems.
Prostate procedures for BPH range from minimally invasive treatments to more extensive surgeries. Your healthcare provider will help you decide which type of prostate surgery is best for you.
Symptoms Of Benign Prostate Enlargement
The symptoms of benign prostate enlargement are caused by the enlarged prostate placing pressure on the bladder and urethra .
This can affect urination in a number of ways. For example, it can:
- make it difficult for you to start urinating
- weaken the flow of urine or cause “stopping and starting”
- cause you to strain to pass urine
- cause you to need to urinate frequently
- cause you to wake up frequently during the night to urinate
- cause a sudden urge to urinate, which can result in urinary incontinence if you can’t find a toilet quickly enough
- cause you to not be able to empty your bladder fully
- cause blood in the urine
In the later stages, benign prostate enlargement can cause urine retention and other complications such as bladder stones, bladder infections and kidney damage.
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Other Available Bph Treatments
Although Rezm and UroLift are the best treatment for enlarged prostate, they arent the only methods available to you. The severity of BPH varies from person to person, so not every treatment will be effective for every patient. Discussing the different treatment options with your doctor to identify the best course of action for you is always your best bet in finding symptom relief. Other available treatments for BPH include:
- Lifestyle changes: These lifestyle changes can include reducing liquid intake, bladder training, abstaining from alcohol and caffeine, and regularly exercising the pelvic muscles.
- Medication: There are two main types of medications used to treat BPH, alpha blockers and five-alpha-reductase inhibitors. Alpha blockers work by relaxing the prostate bladder muscles to encourage urine flow. Five-alpha reductase inhibitors partially shrink the prostate by reducing levels of dihydrotestosterone.
- Surgery: Since there are other less invasive options with a shorter recovery time, surgery is only typically recommended for patients with more severe BPH symptoms. Surgery involves making incisions inside the prostate to remove the excess prostate tissue blocking the urethra.
If youre suffering from symptoms of BPH, contact your nearest Urology Specialist of the Carolinas to schedule a visit with our incredible and experienced staff.
Diagnosis Of Benign Prostatic Hyperplasia
At The Center for Prostate Health and Male Voiding Dysfunction at Columbia University Irving Medical Center Department of Urology at NewYork-Presbyterian Hospital, we offer every method available for making a painless diagnosis of BPH.
- A history, physical and simple non-invasive urine tests can help us confirm an enlarged prostate.
- We can also measure urine flow and bladder pressure using urodynamic studies to determine the degree of obstruction.
- Using cystoscopy, an examination of the prostate using a small flexible telescope, we can evaluate the size of the prostate, examine the bladder, and help plan potential treatment options in patients where medication alone does not alleviate symptoms.
These advanced tests are performed on an outpatient basis, with little or no discomfort.
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Treatments For Benign Prostatic Hyperplasia
There are a range of treatments for BPH. To begin, your doctor may recommend changes to your diet, exercise, or medication. If your symptoms get worse, your urologist will work with you to determine if a minimally invasive procedure is right for you based on the size of your prostate and how it affects your quality of life. Inpatient surgeries are only suggested as a last resort.
What Is The Outlook For Men Who Have Benign Prostatic Hyperplasia Surgery
Benign prostatic hyperplasia surgery has a very high success rate. However, for the best results from treatment, you should seek medical help at the earliest signs of a problem. Also, talk with a doctor if you are experiencing symptoms of BPH after surgery.
There is no evidence that BPH increases the risk of developing prostate cancer. However, the symptoms of BPH and prostate cancer are similar. The American Urological Association and the American Cancer Society recommend annual prostate screenings for men ages 55 to 69. Men at high risk such as African-American men and men with a family history of prostate cancer should begin screening at age 40.
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Why Does Bph Occur
The exact reason why benign prostatic hyperplasia develops is still unknown. There are many theories, all of which have the right to exist and have been confirmed in studies, but none of them can claim to be the ultimate truth. Benign prostatic hyperplasia is likely a polyetiological disease, that is, it has many developmental factors. Nevertheless, several factors have been established with certainty. Age and the increased amount of male sex hormones androgens, formed in the testicles, are major factors for the development of benign prostatic hyperplasia.
Benign prostatic hyperplasia is nodular hyperplasia of prostate cells. It is believed that the primary changes appear in the connective tissue, and then already affect the prostate gland. At the beginning small nodules are formed, consisting of rapidly multiplying cells. For a long time, there may be just an increase in the number of nodules, and after a certain period their gradual growth in size occurs. At the same time, the ratio of connective tissue to glandular tissue in the nodules varies, but more often the former prevails. At the same time, the following dependence was revealed: the larger the nodes , the greater the part of them is occupied by glandular components. It seems to be important because different structure leads to different effects of different drugs in conservative treatment.
Guidelines For The Treatment Of Benign Prostatic Hyperplasia
Yunuo Wu, PharmDCreighton University School of Pharmacy and Health Professions
Michael H. Davidian, MD, MSAssociate Professor of MedicineCreighton University School of Medicine
Edward M. DeSimone II, RPh, PhD, FAPhAProfessor of Pharmacy SciencesCreighton University School of Pharmacy and Health ProfessionsOmaha, Nebraska
US Pharm. 2016 41:36-40.
ABSTRACT:Benign prostatic hyperplasia is a common disorder in men with an incidence that increases with age. BPH often requires therapy when patients begin to experience lower urinary tract symptoms that affect quality of life. Current management strategies involve lifestyle modifications, pharmacotherapy, phytotherapy, and surgical interventions as indicated. Pharmacists are in the unique position of being accessible sources of healthcare information for the BPH patient population. Understanding the symptoms of this disorder and therapy options will be beneficial for pharmacists who have increased chances to answer BPH-related questions from their patients.
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