Chesapeake Urology physicians are specially- trained in the most advanced, minimally invasive therapies for treating your enlarged prostate/BPH symptoms and restoring your quality of life. OVERCOMING Learn more about Chesapeake Urology ENLARGED PROSTATE/BPH and the diagnosis and treatment of enlarged prostate/BPH – visit A Patient’s Guide www.chesapeakeurology.com or call 877-422-8237 to schedule an appointment with one of our experienced urologists. 877-422-8237 www.chesapeakeurology.com ©8/2014 Chesapeake Urology Associates, PA Overcoming Enlarged Prostate/BPH Benign Prostatic Hyperplasia (BPH), also known as enlarged prostate, is a common, benign (not cancerous) condition in older men in which the prostate gland enlarges. The prostate is a walnut- sized gland that produces semen, the fluid that transports sperm. Located below the bladder and surrounding the urethra (the tube carrying urine out of the body), an enlarged prostate can squeeze the urethra and cause difficulty with urination. As many as 50% of men experience symptoms of an enlarged prostate by age 60, and 90% of men will report symptoms by age 85. Source: National Association for Continence Rest assured that when enlarged prostate affects your life, the specialists at Chesapeake Urology have the experience and the results that men want and need to restore quality of life and alleviate the symptoms of an enlarged prostate. From more conservative, non-surgical measures to innovative minimally invasive procedures, our urologists provide the most advanced care for men living with enlarged prostate. 1 What Causes an Enlarged Prostate? Symptoms of an Enlarged Prostate/BPH Benign Prostatic Hyperplasia (BPH) is related to the normal While some men with an enlarged prostate experience no aging process and is influenced by changes in the body’s symptoms, many others may experience a variety of urinary levels of the male hormone testosterone. In some cases, an symptoms that can range from mild and barely noticeable enlarged prostate may also be genetic. More than half of to severe and life-altering. men age 50 and older and 90 percent of men age 80 and older have enlarged prostate. Some of the more common symptoms men with enlarged Normal Prostate prostate experience include: • Recurring, sudden need to urinate. • Increasingly frequent urination, especially at night. • Weak or interrupted urine stream. • Difficulty starting urination. • Urine leakage (urinary incontinence). • Inability to completely empty the bladder. Caffeine, alcohol, spicy or acidic foods, certain cold and pain medications, and constipation can make symptoms worse. Left untreated, symptoms may worsen over time and can cause complications that may include inability to urinate (urinary retention), bladder or kidney damage, bladder stones or urinary tract infections. Enlarged Prostate / BPH Men experiencing any of these urinary symptoms should have a thorough evaluation performed by a urologist as other conditions such as a urinary tract infection, prostatitis (inflammation of the prostate), prostate cancer and diabetes can cause similar symptoms. 2 3 Diagnosing Enlarged Prostate/BPH Treatment for Enlarged Prostate/BPH The first step to diagnosing enlarged prostate is to see a Treatment for enlarged prostate focuses on alleviating urologist experienced in treating enlarged prostate. Your bothersome symptoms and will depend on the severity doctor will take a complete medical history and perform a of your symptoms and how much they interfere with your physical exam as well as a digital rectal exam (DRE). Your lifestyle. Men with minimal urinary issues may only need urologist may order a prostate specific antigen (PSA) test. to make lifestyle changes; those with more pronounced Elevated levels of PSA can indicate enlarged prostate, symptoms or complications from an enlarged prostate prostatitis (prostate inflammation) or prostate cancer. may require medication or a minimally invasive surgical Through this comprehensive evaluation, your urologist procedure to restore urinary function and quality of life. will determine whether your urinary symptoms are indeed Your doctor can help you determine which treatment is caused by enlarged prostate and next steps to treating most appropriate for you. your urinary symptoms. Lifestyle Changes Additional tests to make the most accurate diagnosis • Avoid caffeine, acidic drinks such as colas, tomato may include: and orange juices, and alcohol. Cold medications • Uroflow: Measures the flow of your urine stream containing antihistamines or pseudoephedrine can and is often performed in patients who have an cause urinary problems. Constipation can also make obstruction or other problems with urination. it more difficult to urinate. • Bladder Ultrasound (post void residual): A non- • Limit evening beverages and urinate when you first invasive ultrasound test that assesses the ability of feel the urge. the bladder to empty. • Cystoscopy: A small telescope is used to look inside the bladder to assess your internal prostate size and your bladder for stones, tumors, and signs of obstruction or other abnormalities that may cause your symptoms. • Urodynamics: A procedure which helps determine whether a blockage of the prostate is the cause of your urinary symptoms. This test is also useful to assess bladder function. • Pelvic ultrasound: Ultrasound to assess prostate size. This test is also useful to assess bladder function. 4 5 Medications for Enlarged Prostate/BPH Your doctor may prescribe one, or a combination of, medications that can help alleviate many of your urinary symptoms caused by your enlarged prostate. Medications often have some side effects, so talk to your urologist about which medication is right for you. Medications for enlarged prostate may include: • Alpha blockers to relax the smooth muscle tissue in the bladder and prostate, increasing urinary flow. • Enzyme (5-alpha reductase) inhibitors, such as Avodart and Proscar shrink the prostate by preventing the conversion of testosterone to dihydrotestosterone, a key ingredient in prostate enlargement. It’s important to note that Avodart and Proscar are only indicated for men with extremely enlarged prostates. These medications work by reducing the size of the prostate to help alleviate symptoms such as difficulty beginning urine flow, weak stream and urinary urgency.* • Anticholinergics to relax the bladder muscle and reduce frequency and urgency. * Your urologist may prescribe a combination of an alpha- blocker and a 5-alpha reductase inhibitor, which has been shown to be more effective in reducing symptoms of an enlarged prostate than either medication taken on its own. 6 7 Minimally Invasive Treatments for Advantages of Laser Vaporization Therapy: Enlarged Prostate/BPH • The procedure is minimally invasive and performed Specialized procedures to treat enlarged prostate are on an outpatient basis. excellent and effective alternatives to long-term medication • Most men return home only a few hours after the therapy, often with quick results, fewer side effects and procedure. improved quality of life. Your urologist can work with you to determine the best treatment option, which can include one • Quick recovery and return to normal activities. of the following minimally invasive procedures: • Normal urine flow is restored quickly. • Very few long term side effects. Laser Vaporization of the Prostate • Long-lasting relief from bothersome urinary Laser vaporization of the prostate (utilizing GreenLight™ symptoms. Laser Therapy) is a technique that uses a special laser to Risks: heat and vaporize the prostate tissue that is obstructing Some patients may experience side effects from laser part of the urethra. In studies comparing the laser technique vaporization treatment such as: with the more traditional surgical procedure called • Urinary tract infection (UTI). Transurethral Resection of the Prostate (TURP), GreenLight Laser Therapy improves symptoms of an enlarged prostate • Retrograde ejaculation (semen released through and quality of life as effectively, but with fewer side effects. ejaculation goes into the bladder rather than out of the penis, which can inhibit fertility). This results in a dry climax. Most men are good candidates for laser vaporization therapy, which is an outpatient procedure performed in one of Chesapeake Urology’s Summit Ambulatory Surgery Centers. In this procedure, a small fiber is inserted into the urethra through a cystoscope. Laser energy is delivered through the fiber to remove the enlarged prostate tissue, restoring natural urine flow and relieving symptoms of enlarged prostate quickly. 8 9 Minimally Invasive Treatments for Transurethral Microwave Therapy (Cooled Enlarged Prostate/BPH ThermoTherapyTM) – This is a non-surgical, in-office Radio Frequency (RF) Therapy, also known as therapy that delivers targeted microwave energy to heat Transurethral Needle Ablation (TUNA), is an in-office and reduce excess prostate tissue. A urethral cooling therapy utilizing targeted, low-level radio frequency energy system helps protect the urethra from the heat waves. that produces heat to effectively shrink the prostate tissue, Transurethral Microwave Therapy (TUMT), also called allowing men to urinate more normally. RF therapy is an Cooled ThermoTherapy, usually results in decreased excellent alternative for men who do not wish to take daily urinary urgency and is often performed in about 30 minutes. medications for the long-term and who wish to avoid the Microwave energy is delivered to the