“ I’ve got troubles peeing doc” Assessment and management of Benign Prostatic Hyperplasia from General Practice through to specialist practice.
Benign Prostatic Hyperplasia (BPH), or benign prostate enlargement, is a common condition among older men, characterised by an increase in the size of the prostate gland. This enlargement can lead to a series of urinary symptoms that affect quality of life. Often a patient may present to their GP because of issues with urination, which will lead to an investigation and possible referral to a urologist like Dr Deanne.
Symptoms
Common symptoms of BPH often include frequent urination, especially during the night, a condition known as nocturia. Individuals may also experience difficulty initiating or halting urination, which can be frustrating and disruptive. Additionally, those affected might notice a weak or interrupted urine flow, making the process less efficient. Many also report a persistent feeling of incomplete bladder emptying, leaving them with discomfort and the urge to urinate more often. These symptoms can significantly impact daily life and may indicate underlying health concerns that should be addressed.
BPH Diagnosis
Diagnosing Benign Prostatic Hyperplasia (BPH) typically begins with a comprehensive assessment by a specialist like Dr Deanne, often initiated during a patient’s visit for urinary concerns. The process may start with a detailed medical history review and a physical examination, including a digital rectal exam (DRE) to evaluate the size and shape of the prostate. Various questionnaires, such as the International Prostate Symptom Score (IPSS), can help quantify the severity of symptoms and their impact on quality of life.
To further assess the condition, urologists may request additional tests. This can include a urinalysis to rule out infections or other underlying issues, a prostate-specific antigen (PSA) test to measure the level of PSA in the blood, which can indicate prostate conditions, and imaging studies like ultrasound if necessary. Urodynamic tests (often performed in the clinicians practice) may also be employed to measure the rate of urine flow, providing insight into the severity of urinary obstruction. Together, these diagnostic tools enable healthcare providers to confirm BPH, assess its impact on the patient's health, and determine the best management approach.
Treatment Options
When it comes to managing BPH, treatment options are typically categorised based on the severity of symptoms. For mild symptoms, lifestyle adjustments such as reducing fluid intake before bedtime and limiting caffeine can provide relief. However, for moderate to severe cases, medication is often required. Alpha-blockers and 5-alpha-reductase inhibitors are commonly prescribed to relax prostate muscles and shrink the prostate, respectively.
In cases where medication is ineffective or symptoms are significantly impacting a patient’s life, surgical options may be considered.
Surgical Options
Transurethral Resection of the Prostate (TURP): This is the most common surgical procedure for BPH. Using a resectoscope, surgeons remove a portion of the prostate tissue that is pressing against the urethra. While effective, TURP may have risks such as bleeding or sexual dysfunction.
REZUM: This innovative procedure uses steam to ablate prostate tissue, allowing for a less invasive option with a shorter recovery time. It is associated with fewer complications compared to traditional surgeries and is particularly appealing for those who want to avoid the risks related to more invasive procedures.
UROLIFT: The UROLIFT system involves the placement of permanent sutures to hold the prostate tissue away from the urethra, thereby improving urine flow. This technique preserves sexual function and offers a quick recovery, making it an attractive option for many patients.
Prevention
While there is no fool-proof way to prevent BPH, maintaining a healthy lifestyle can mitigate risk factors associated with prostate enlargement. This includes staying physically active, eating a balanced diet rich in fruits and vegetables, and managing weight. Regular check-ups with a healthcare provider can help detect any changes in prostate health early.
In summary, BPH is a manageable condition with various treatment options available. By understanding symptoms and available treatments, Australian men can approach their health proactively and seek timely care.