A common condition affecting men, benign prostatic hyperplasia (BPH) is an enlargement of the prostate gland, which is located below the bladder surrounding the urethra and plays a critical role in men’s reproductive systems. BPH typically affects men as they age and their quality of life. As men grow older, the prostate can enlarge, leading to various urinary symptoms due to the pressure it exerts on the urethra. Common symptoms of BPH include the frequent urgent need to urinate, nocturia (nighttime urination), bladder damage, urinary tract infections, blood in the urine, incontinence and more. Other symptoms include a weak urine stream and incomplete bladder emptying, which can both cause discomfort.
The prevalence of BPH and lower urinary tract issues rises markedly with increased age, affecting 70% of men 60-69 years of age and 80% of those 70 years of age or older. Despite its high prevalence, not all men with an enlarged prostate will experience symptoms severe enough to require medical intervention.
Of note: BPH and prostate cancer are two distinctly different conditions. The common factor is they both involve the prostate gland, but having BPH does not increase the risk of developing prostate cancer. However, a man can have both conditions simultaneously, so it’s important to have regular check-ups and screenings.
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While the precise cause of BPH is not known, several factors may contribute to its development. The hormonal changes related to aging, such as increased levels of dihydrotestosterone (DHT) which can lead to prostate growth, play a significant role in a BPH diagnosis. Further, those with a family history of BPH increase their likelihood of developing the condition. Finally, as with many medical conditions, lifestyle factors related to poor diet, a lack of physical activity and obesity may increase the risk.
To diagnose BPH, urologists typically look at a patient’s medical history, complete a physical examination and run specific tests, including:
BPH itself is not life threatening, although it can lead to complications if left untreated. Some complications come on suddenly and can be painful, such as urinary retention, or an inability to urinate. Untreated BPH can also lead to lasting damage to the bladder because of it stretching and weakening the bladder muscles. More serious complications include bladder stones and kidney damage.
Fortunately, BPH is a treatable condition that can be effectively managed and get men back to their lives. Treatment options for BPH depend on the severity of symptoms and the impact on the patient’s quality of life. They range from lifestyle changes and medications to minimally invasive, as well as more invasive surgical interventions.
Healthy choices like exercising regularly, following a healthy diet, maintaining an ideal weight, staying hydrated and getting enough sleep are good for everyone, but can also help patients with BPH manage symptoms.
Patients with BPH are also encouraged to drink less fluids in the evening to potentially reduce the occurrence of nocturia, while also avoiding bladder irritants like caffeine, alcohol and nicotine. Regular urination is also encouraged to help maintain a state of emptiness in the bladder and avoid discomfort. Another recommended practice is “double voiding,” which is waiting a few moments after urinating and trying to urinate again – which also helps to ensure an empty bladder.
Medication has long been the go-to treatment to manage benign prostatic hyperplasia symptoms, with the most common categories of medication including a1-blockers, 5-alpha reductase inhibitors, phosphodiesterase-5 inhibitors, Beta-3 agonists, Muscarinic receptor antagonists (MRAs) and combination therapy.
Some patients have found success with medications in providing symptom relief but they are also associated with a number of serious side effects like cardiovascular events (postural hypotension, asthenia and dizziness), ejaculatory dysfunction, decreased libido, gynecomastia, erectile dysfunction, acute urinary retention, urinary tract infection, hypertension, headache, constipation and nasopharyngitis (Frontiers in Pharmacology, 2020). These side effects and a difficulty maintaining proper adherence has led to patients struggling to find true relief from BPH symptoms with medication.
For many years, the transurethral resection of the prostate (TURP) surgical procedure was considered the “gold standard” in benign prostatic hyperplasia treatments. However, TURP is an invasive surgery and patients started asking for other options that didn’t have as many significant risks involved, like sexual side effects, incontinence, bleeding and long recovery time. Today there are safe and effective, minimally invasive technologies that don’t cause the same side effects as medications, don’t impact men’s sexual function and actually address bladder obstruction, the root issue of BPH.
This new category of BPH treatments called minimally invasive surgical therapies (MISTs) has emerged over the past 10-15 years. It was created to provide treatment options with benefits when compared to medication therapy, including a one-time treatment versus a lifetime of medications, lower risk for side effects, and improved efficacy because they can fix the problem instead of just kicking the can down the road with medication.
The Optilume BPH catheter system is the newest MIST available, which combines mechanical dilation with concurrent delivery of paclitaxel for treating BPH. Mechanical dilation with a double-lobe balloon technology achieves an anterior commissurotomy (split) releasing the constricting lateral lobes, while the delivery of paclitaxel prevents re-fusion of the lobes during healing, keeping the prostate open, restoring the flow of urine and relieving bothersome BPH symptoms. With this procedure, there is no cutting, heating, burning, lasering, steaming or implantations. It’s also FDA approved and two main clinical trials with five- and two-year positive outcomes have demonstrated safety and efficacy, including:
If you or a loved one is experiencing symptoms of BPH, contact a urologist to get evaluated. To learn more about the Optilume BPH catheter system and find a provider, visit Laborie.com/find-a-provider.
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