Benign Prostatic Hyperplasia (Part Two)
Examinations and diagnosis
Initially, the doctor asks about the patient's medical history and listens to complaints related to urination. At the same time, he inquires about other health problems the patient may have, medications being taken, and family history. Then, he proceeds with a physical examination.
Digital rectal examination of the prostate. This examination is performed with a finger which is inserted into the rectum to touch the prostate. The examination allows the doctor to assess the size of the prostate, its consistency, and to discover any abnormal areas that might indicate prostate cancer.
Neurological examination. This serves to evaluate the nervous system. It can reveal other causes of urinary issues that are not related to the prostate.
Urine analysis. This can reveal an infection or other conditions that produce similar symptoms.
Prostate-Specific Antigen (PSA). The prostate gland normally produces PSA which helps in liquefying sperm. When the prostate enlarges, the level of PSA in the blood also increases. However, PSA increases more significantly as a result of prostate cancer, infection (prostatitis), and surgical interventions.
Uroflowmetry. This is used to see how quickly urine flows during urination. Repeating this examination over time helps to see if the situation has improved or worsened.
Measurement of urine volume left in the bladder after urination (residual urine). This assesses whether the bladder empties completely or not. This is achieved through Echo or by inserting a catheter into the bladder after urination.
Transrectal ultrasound. With a transrectal Echo probe, the prostate's size, anatomy, and structure are measured.
Prostate biopsy. This procedure involves taking material from the prostate with a needle that is mounted on a transrectal echo probe. It serves to exclude prostate cancer.
Cystoscopy. This allows for the direct viewing of the urethra and the inside of the bladder using a thin, flexible probe equipped with a camera.
Urodynamic study. Determines the pressure inside the bladder during urination and assesses how well the bladder muscles function.
Intravenous pyelography or CT Scan. These are used to discover stones in the urinary tract, tumors, or obstructions above the level of the bladder.
Other possible causes of urinary symptoms
Problems that can cause urinary symptoms similar to those of benign prostatic hyperplasia include:
- Bladder stones
- Bladder and urinary tract infections
- Diabetes
- Neurological issues
- Inflammation of the prostate (prostatitis)
- Prostate cancer
- Cerebral hemorrhage or thrombosis
- Neuromuscular disorders
- Narrowing of the urethra
Treatment
There are multiple options for treating benign prostatic hyperplasia, such as medication, conventional surgery, and minimally invasive surgery. The best treatment choice for each person depends on several factors like: how bothersome the urinary symptoms are, the size of the prostate, other accompanying illnesses, age, and patient preference. If symptoms are not very bothersome, the patient may choose not to be treated and wait to see if the signs worsen over time.
Medication treatment
The use of medications is the most common treatment in cases of prostate presenting moderate symptoms. For this purpose, the following medications are used:
Alpha blockers. These relax the muscles of the bladder neck and the prostate's muscle fibers, easing urination. Alpha blockers do not cure prostate enlargement but alleviate symptoms. This group includes: terazosin, doxazosin (Cardura), tamsulosin (Omnic), alfuzosin (Xatral), and silodosin (Rapaflo).
Alpha blockers act quickly, within one or two days, urine flow increases and urination becomes less frequent. They may be accompanied by a harmless condition called retrograde ejaculation, meaning that sperm flows backward into the bladder instead of out of the penis.
5-alpha-reductase inhibitors. These medications reduce the prostate by altering the hormones involved in its growth. These include finasteride (Proscar) and dutasteride (Avodart). They work better in very large prostates and results are seen after several weeks or months. These can cause sexual side effects such as impotence, decreased sexual desire, or retrograde ejaculation.
Combined medication. Taking the two aforementioned medications, alpha blockers and 5-alpha-reductase inhibitors, at the same time is more effective than taking them separately.
Tadalafil (Cialis). This is usually used for treating impotence but can also be used in treating prostate enlargement. It can be used in combination with alpha blockers.