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FROM UVA RADIOLOGY & MEDICAL IMAGING

Condition: Benign Prostatic Hyperplasia (BPH)

A graphic showing a stylized bladder, prostate with bph

The prostate is an important gland of  the male reproductive system that produces seminal fluid, the fluid that carries sperm. The prostate surrounds the urethra, the tube that carries urine from the bladder out through the penis. Because the prostate gland directly surrounds the urethra, as the prostate enlarges, it can press on the urethra, causing difficulty with urination. This enlarging of the prostate is a condition called Benign Prostatic Hyperplasia, or BPH for short.

Article Reviewed by Ziv Haskal, M.D.  


What is Benign Prostatic Hyperplasia (BPH)?

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Benign Prostate Hyperplasia (BPH) is a non-cancerous condition in men in which the prostate gland is enlarged due to an increase in cell number. As the prostate grows larger, it squeezes the urethra and may cause problems with urination.

BPH  is the most common prostate problem for men over the age of 50, as the prostate tends to become larger as men age. BPH is found in nearly 50% of men between the ages of 51 and 60 and is found in up to 90% of men over the age of 80.  Conditions such as erectile dysfunction, obesity, diabetes, or a genetic history of BPH can increase your risk of developing BPH. The exact cause of BPH is unknown.

 

Symptomsa grey cross on a blue background

 

Some patients do not have any symptoms of BPH.  Patients who have symptoms most often report the following:

  • Frequent urge to urinate, particularly at night
  • Urgency and difficulty controlling urine
  • Sensation of Incomplete bladder emptying
  • Straining to start urination or weak urine flow
  • Leakage or dribbling either before or after urination
  • Blood in urine
  • Frequent urinary tract infections (UTI) due to incomplete emptying of bladder or retention

 

Diagnosis

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Diagnosing BPH begins with your doctor asking detailed questions about your medical history as well as your current symptoms. Your physician may then perform a physical exam to check for an enlarged or tender scrotum, or enlarged lymph nodes in the groin. The physical exam may include a digital rectal exam in which your doctor inserts a lubricated, gloved finger into the rectum to check for an enlarged prostate.

If your doctor determines you have an enlarged prostate, they may order more tests to pinpoint exactly what is causing your symptoms. While a long list of tests can seem overwhelming, it is important to remember that your doctor wants to rule out prostate cancer before diagnosing you with BPH. It is likely that only a few of these tests may be performed,  including:

    • MRI of the prostate to obtain non-invasive, detailed pictures of the prostate
    • Urinalysis to check for infection in the urine
    • Uroflowmetry to test the strength of your urine stream
    • Prostate Specific Antigen (PSA) blood test to check for elevated levels of PSA in the blood as this substance can indicate an enlarged prostate
    • Cystoscopy allows the physician to see inside the prostate, urethra, and bladder by inserting a thin, flexible tube called a cystoscope into the urethra
    • Transrectal ultrasound to evaluate the prostate using an ultrasound probe inserted into the rectum
    • Prostate biopsy to take sample tissues of the prostate to be examined for prostate cancer

 

Treatment Options

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The symptoms of BPH can range from mild and uncomfortable to severe and debilitating. Many mild cases are not treated immediately, but are monitored regularly with yearly exams to make sure symptoms are not worsening. There are many treatment options for BPH, including various medications, surgeries, and minimally invasive procedures. You and your medical provider should work together to find the best treatment path for you.

Sometimes traditional surgeries are a necessity due to the severity of BPH symptoms. However, surgeries come with increased risks as well as longer recovery times. Fortunately, Interventional Radiology provides a minimally invasive treatment option to BPH called Prostate Artery Embolization (PAE). This evidence-proven procedure has been performed in thousands if men worldwide.

During PAE, an interventional radiologist makes a very small incision into the upper thigh/groin and uses image guidance to guide a tiny catheter (the size of a spaghetti noodle) into the arteries that supply the prostate with blood. The interventional radiologist then injects small particles that block the blood flow to the prostate. This starves the prostate of blood, oxygen, and other nutrients which causes the prostate to shrink in place. This can relieve or lessen all urinary symptoms caused by BPH without the need for surgery or the risks of incontinence or sexual dysfunction.

The highly skilled Interventional Radiologists at UVA offer PAE as a minimally invasive treatment for BPH. If you notice urination symptoms similar to those of BPH, call 434-924-9401 to schedule a consultation with Dr. Ziv Haskal or one of our interventional radiologists to help determine if PAE is the right option for you .

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