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What you need to know about benign enlargment of the prostate gland...


What is the most exciting, minimally invasive option for treating the symptoms of BPH?

Introducing...

The Urolift System

Click to see the procedure details...

 

 

For an overall understanding of the effects of an enlarging prostate, check out this website from the National Institute of Health: 

http://www/ncbi.nlm.nih.gov/pubmedhealth/PMH0001419/

 

Generally, as a man's prostate begins to enlarge, it can restrict the flow of urine through the urethra.  We have characterized the types of symptoms that a man with an obstruction prostate can experience into "Obstructive" and "Irritative" Symptoms.  These include:

Obstructive Symptoms:

Slowing of the Urine Stream 

A Sense of Retained Urine/Incomplete Emptying (Retention)

Difficulty Starting the Stream (Hesitancy)

A Urine Stream that Stops and Starts (Intermitency)

Nighttime Urination (Nocturia)

Irritative Symptoms:

Frequent Urination (Frequency)

Abnormal Urgency to Urinate (Urgency)

Inability to Delay Urination with Incontinence

Post Urination Dribbling

 

We can gauge the intensity of these symptoms by measuring your American Urological Association Urinary Symptom Index:

 

Questions

Scoring Key: 0 Indicates not at all; 1 Indicates less than 1in 5; 2 Indicates less than half the time; 3 Indicates about half the time; 4 Indicates mmore than half the time; 5 Indicates almost always

Over the past month, how often have you had a feeling of not emptying your bladder completely after you finished urinating?
0
1
2
3
4
5
Over the past month, how often have you had to urinate again less than two hours after you finished urinating?
0
1
2
3
4
5
Over the past month, how often have you stopped and started again several times when you urinated?
0
1
2
3
4
5
Over the past month, how often have you found it difficult to postpone urination?
0
1
2
3
4
5
Over the past month, how often have you had a weak urinary stream?
0
1
2
3
4
5
Over the past month, how often have you had to push or strain to begin urination?
0
1
2
3
4
5
Over the past month, how many times did you usually get up to urinate from the time you went to bed at night until the time you got up in the morning?
0
 

1
time

2
times

3
times

4
times

5
times

Calculate your score

I evaluate your symptoms by "scoring" your answers to a standard set of questions, called a Symptom Score Index. Your score will be between 0 and 35 points. Finding out whether your symptoms are mild (0 to 7), moderate (8 to 19), or severe (20 to 35) will help your doctor determine the best treatment for you.

 

 

 

Management Options:

1. Behavioural Modifications:

Benign prostatic hyperplasia, also called BPH, is the enlargement of the prostate gland. BPH is part of the normal aging process in men due to changes in hormonal balance and cell growth. BPH is more common in men over 60 years of age. Untreated BPH can cause bladder and kidney damage. Dietary modifications can help manage symptoms of BPH.

 

 

 

 

Limit Fluids

Patients with BPH should avoid excess fluid intake, especially after dinner, according to MayoClinic.com. BPH causes urination problems. The prostate gland surrounds the urethra, a tube that transports urine from the bladder out of the body. When the prostate gland enlarges, it may squeeze the urethra and prevent the normal flow of urine.Drinking fluids after dinner causes increased urination at night, which may disturb sleep. Patients with BPH should also avoid caffeine and alcohol after dinner because they also increase urine production at night.

 

 

 

 

Fruits and Vegetables

Patients who consume plenty of fruits and vegetables are less likely to suffer from BPH, according to the University of Maryland Medical Center. Fruits and vegetables contain antioxidants, which are protective substances that may slow the enlargement of the prostate gland. Examples of fruits and vegetables suitable for patients with BPH include citrus fruits, tomatoes, berries, squash, green leafy vegetables such as spinach, kales and collard greens.

 

 

 

 

 

 

 

 

Zinc

A diet high in zinc may cause BPH, according to the University of Maryland Medical Center. Zinc is an essential mineral that is necessary for proper immune functioning, protein synthesis and support of normal growth and development. Zinc-rich foods include beef, cheese, oysters, chicken, pork, milk, yogurt, lobster, beans, peas, nuts, bran, oatmeal, fortified breads and cereals.

2. Medical Management of BPH

 

What are some of the medical treatments available for BPH?

Oftentimes, your symptoms can be reduced to satisfactory levels with simple behavioral and dietary alterations. 

If your symptoms are of sufficient "Bother" we can intiate Medical Therapy that act in various ways, including:

1. Relaxing the muscles of your prostate (Flomax, Uroxatral, Tamsulosin, Rapaflo, etc), 

2. Shrink your prostate gland (Proscar, finasteride, Avodart), or

3. Help your bladder relax when it is overactive (Ditropan, Oxybuytinin, Detrol, Vesicare, Enablex, Sanctura, etc.)

 

Alpha blockers: These drugs, originally used to treat high blood pressure, work by relaxing the smooth muscle of the prostate and bladder neck to improve urine flow and reduce bladder outlet obstruction. Although alpha blockers may relieve the symptoms of BPH, they usually do not reduce the size of the prostate. They are usually taken orally, once or twice a day and they work almost immediately. Commonly prescribed alpha blockers include: alfuzosin, terazosin, doxazosin and tamsulosin. Side effects can include headaches, dizziness, lightheadedness, fatigue and ejaculatory dysfunction.

 

5-alpha-reductase inhibitors: Finasteride and dutasteride are oral medications that work completely different then alpha blockers. In select men, finasteride and dutasteride can relieve BPH symptoms, increase urinary flow rate and actually shrink the prostate though it must be used indefinitely to prevent recurrence of symptoms. Studies suggest that these medications may be best suited for men with relatively large prostate glands. It may take as long as six months to a year, however, to achieve maximum benefits from this drug. . These drugs reduce the risk of BPH complications such as acute urinary retention (suddenly being unable to urinate) and the eventual need for BPH surgery. Side effects can include impotence, decreased libido and reduced semen release during ejaculation.

 

Combination Therapy: The use of both alpha blockers and 5-alpha-reductase inhibitors result in better amelioration of symptoms and long term benefits than using only one type of drug.

However, this improved benefit may be associated with more side effects (possible side effects from both medications).

 

Phytotherapies: These compounds, also known as herbal therapies, are very popular self treatment remedies. However their effectiveness is not really known but if they provide benefit, it is much less than other medical therapies.

3. "Minimally Invasive" surgical procedures for BPH, the Microwave and the Plasma Button procedures..

When medications are not effective or side effects limit their use, we can employ state of the art technology to help a man deal with his enlarged prostate gland.  Two very effective and exciting treatments are described below.

 

 

 

Microwave Thermotherapy:

http://www.medscape.com/viewarticle/717874

Cooled Thermotherapy is an office based therapy to relieve the obstruction caused by prostate enlargement from BPH (Benign Prostatic Hyperplasia).  It is performed under local anesthesia.

Click on the ARROW below to see the video of the procedure and click on the website below to learn more about it.

 

http://www.urologix.com/

 

"Plasma Button" Vaporization of the Prostate

The Plasma Button Vaporization Procedure, performed under a light anesthesia as an Outpatient procedure in the hospital.  It offers practically bloodless surgery and most patients go home the very same day of the procedure.

The website below will link you with the Olympus Corporation page regarding this technology.

www.plasmabutton.com

 

 

Some men will require a standard TURP or Trans-Urethral Resection of the Prostate or even an "Open" Prostatectomy based on their specific anatomical issues.  However, the vast majority of my patients are successfully treated with minimally invasive, safe and effective therapy for the symptoms of BPH.

http://men.webmd.com/prostate-enlargement-bph/transurethral-resection-of-the-prostate-turp-for-benign-prostatic-hyperplasia

 

 

 

 

 

 

 My philosophy is to begin with the least invasive, cost effective measures and climb the ladder of invasiveiness until your symptoms are controlled.