Benign Prostatic Hyperplasia
(BPH; Benign Prostatic Hypertrophy; Prostatism; Bladder Outlet Obstruction)
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- Difficulty starting to urinate
- Weak urination stream
- Dribbling at end of urination
- Sensation of incomplete bladder emptying
- Urge to urinate frequently, especially at night
- Deep discomfort in lower abdomen
- Urge incontinence
- Your age
- Digital rectal exam—the doctor inserts a gloved finger into the rectum to examine the area
- Urine flow study
- Cystometrogram (a functional study of the way your bladder fills and empties)
- X-ray of the urinary tract
- Transrectal ultrasound
- Post-void residual volume test—measures whether you can empty your bladder completely
- Cystoscopy—this test allows a doctor to look inside the urethra and bladder
- 5 alpha-reductase inhibitors (finasteride, dutasteride)—These drugs are taken to improve symptoms, like the urge to urinate frequently and difficulty starting to urinate.
- Alpha-blockers (eg, tamsulosin, alfuzosin, doxazosin, terazosin)—These drugs are taken to reduce bladder obstruction and improve urine flow.
- Antimuscarinics (oxybutynin, solifenacin, tolterodine, darifenacin, trospium, fesoterodine)—These drugs are taken to relax the bladder muscles, which helps to reduce the urge to urinate frequently.
Phosphodiesterase-5 enzyme inhibitor (tadalafil
drug can also be prescribed to improve the symptoms of BPH.
- Note: You should not take tadalafil if you are also taking nitrates (eg, nitroglycerin) because your blood pressure may become dangerously low. Also, tadalafil should not be taken in combination with alpha blockers.
Minimally Invasive Interventions
- Transurethral microwave thermotherapy (TUMT)—uses microwaves to destroy excess prostate tissue
- Transurethral needle ablation (TUNA)—uses low levels of radio frequency energy to burn away portions of the enlarged prostate
- Transurethral laser therapy—uses highly focused laser energy to remove prostate tissue
- Transurethral surgical resection of the prostate (TURP)—a scope is inserted through the penis to remove the enlarged portion of the prostate
- Transurethral incision of the prostate (TUIP)—small cuts are made in the neck of the bladder to widen the urethra
- Open surgery—removal of the enlarged portion of the prostate through an incision, usually in the lower abdominal area, much more invasive then TURP or TUIP
Prostatic stents—tiny metal coils that are inserted into urethra to widen it and keep it open
- Usually used for men who do not wish to take medication or have surgery
- Does not appear to be a good long-term option
- Saw palmetto—Results from studies vary on how useful saw palmetto is in reducing symptoms.
- Beta-sitosterol—Some studies suggest that this may help reduce symptoms.
- Pygeum—Some studies suggest that this may help reduce symptoms.
National Kidney and Urologic Diseases Clearinghouse http://kidney.niddk.nih.gov/
The Prostate Institute of America http://pioa.org/
Prostate Cancer Research Institute http://prostate-cancer.org/
Canadian Urological Association http://www.cua.org/
Prostate Centre http://www.prostatecentre.ca/
Berkow R, et al. The Merck Manual of Medical Information. 17th ed. Simon and Schuster, Inc.; 2000.
Beta-sitosterol. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/healthLibrary/. Updated August 2011. Accessed October 7, 2011.
Fagelman E, Lowe FC. Saw palmetto berry as a treatment for BPH. Rev Urol. 2001 Summer;3(3):134-8.
Fried NM. New laser treatment approaches for benign prostatic hyperplasia. Curr Urol Rep. 2007 Jan;8(1):47-52.
Guideline on the management of benign prostatic hyperplasia. American Urological Association. Available at: http://www.auanet.org/content/clinical-practice-guidelines. Updated 2006. Accessed June 30, 2008.
Greco KA, McVary KT. The role of combination medical therapy in benign prostatic hyperplasia. Int J Impot Res. 2008 Dec;20 Suppl 3:S33-43.
Marberger M. Drug insight: 5-alpha-reductase inhibitors for the treatment of benign prostatic hyperplasia. Nat Clin Pract Urol. 2006 Sep;3(9):495-503.
Prostate enlargement: Benign prostatic hyperplasia. National Kidney Urologic Diseases Information Clearinghouse website. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/prostateenlargement/. Accessed July 26, 2010.
Pygeum. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/healthLibrary/. Updated August 2011. Accessed October 7, 2011.
Roehrborn CG, Siami P, Barkin J, et al; CombAT Study Group. The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study. Eur Urol. 2010 Jan;57(1):123-31. Epub 2009 Sep 19.
Saw palmetto. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/healthLibrary/. Updated August 2011. Accessed October 7, 2011.
Ulbricht C, Basch E, Bent S, et al. Evidence-based systematic review of saw palmetto by the Natural Standard Research Collaboration. J Soc Integr Oncol. 2006;4(4):170-86.
10/7/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Barry MJ, Meleth S, Lee JY, et al. Effect of increasing doses of saw palmetto extract on lower urinary tract symptoms: a randomized trial. JAMA. 2011;306(12):1344-1351.
10/14/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: US Food and Drug Administration. FDA approves Cialis to treat benign prostatic hyperplasia. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm274642.htm. Updated October 6, 2011. Accessed October 14, 2011.
- Reviewer: Adrienne Carmack, MD
- Review Date: 09/2012 -
- Update Date: 00/92/2012 -