BPH and Prostatitis

The prostate gland in men can have multiple problems: infection, enlargement, tumors or cancer, and others.In men under 50, the most common prostate problem is prostatitis. In men over 50, it is prostate enlargement. This condition is also called benign prostatic hyperplasia, or BPH. Older men are at increased risk for prostate cancer as well, but this disease is much less common than BPH.

What Are The Characteristics and Symptoms?

Prostatitis refers to an inflamed prostate. If you have prostatitis, you may have:

• Pain or burning when you urinate.
• Urinary urgency or frequency.
• Fever and fatigue; flu-like feeling.
• Pain in the prostate gland, lower back, or genital area.
• Painful ejaculation.

If you have bacterial prostatitis, it can be diagnosed by a urine culture to look for bacteria. Acute bacterial prostatitis usually originates in the prostate, but sometimes, the bacteria can spread there from the bladder or urethra.

If you keep getting infections, you may have a defect in your prostate that allows bacteria to grow. This defect can usually be corrected by surgery.

If you have urinary problems, the doctor will look for other possible causes, such as a kidney stone or cancer. If none are found, you have what’s called nonbacterial prostatitis.

BPH (benign prostatic hyperplasia) is the term for enlarged prostate. As the prostate enlarges, it squeezes the urethra; this pressure may affect bladder control. You may have:

• Urinary urgency and frequency; getting up several times a night to use the bathroom.
• Trouble starting a urine stream or a weak urine stream.
• A small amount of urine produced each time you go.
• A feeling that you still have to go, even when you have just finished urinating.
• Leaking or dribbling.
• Small amounts of blood in your urine.

Who Is Most Likely To Have These Conditions?

Prostatitis - You may be at risk for prostatitis if:

• You recently had a UTI (urinary tract infection).
• You recently had a urinary catheter inserted during a medical procedure.
• Stop and start while urinating.
• Jog or bicycle on a regular basis.
• You have strictures (structural abnormalities) in your urinary tract.
• Have a job that subjects you to strong vibrations, such as driving a truck or operating heavy equipment .

BPH – You may be at risk for BPH if:

• You are older than 50.
• You have a family history of prostatic enlargement.
• You are of American or European origin (as opposed to Asian).
• You are married vs. single – for unknown reasons, married men are more likely to have BPH.

What Are My Treatment Options?

Medication Treatment:

Prostatitis:

• Broad-Spectrum Antibiotics – kill a wide variety of bacteria which may be causing the problem.
• Alpha-Blockers - relax the muscles at the neck of your bladder, allowing for easier urination. These include drugs like Hytrin and Flomax.

BPH:

• Alpha Blockers
• Finasteride or Dutasteride – These medications shrink the prostate gland. Dutasteride is a newer drug, and may be more effective.

Surgery:

Bacterial Prostatitis – Your doctor may recommend surgery to open the blocked ducts in the prostate if antibiotics have not helped, or your fertility is affected.

BPH – There are a number of surgical procedures which may ameliorate BPH. These are described below.

What Does The Surgery for BPH Involve?

Laser Surgery:

There are several procedures that utilize lasers to treat BPH. These procedures are similar to other heat therapies, except they use a laser instead of microwave energy, radio waves or electrical current to produce heat. It generally doesn't cause impotence or prolonged incontinence. However, some laser procedures require lengthy use of a catheter. Laser therapy includes:

TUEP (transurethral evaporation of the prostate) – this is similar to electrovaporization. The difference is that your doctor destroys prostate tissue with laser energy instead of electrical current. The procedure is generally safe and causes limited bleeding. It's often effective, with noticeable improvement in urine flow soon after the procedure.

VLAP (noncontact visual laser ablation of the prostate) - VLAP involves applying laser energy to dry up and destroy excess prostate cells. Because of swelling and prolonged sloughing off of the dead tissue, you're likely to retain urine for several days and will need to wear a catheter. You may also experience a burning sensation during urination for days to weeks.

Interstitial laser therapy – directs laser energy inside the prostate growths rather than at the urethral surface. It safely increases the urinary flow rate and reduces the size of the prostate. It also seems to work well among men with large prostates. Because of inflammation after treatment, you may need to use a catheter for a week or two. Interstitial laser therapy is a good option if you can't have surgery because of other health complications. It doesn't cause any blood loss and uses a combination of local anesthesia and intravenous sedation to control pain during the procedure.

PVP (photosensitive vaporization of the prostate) - a newer form of laser treatment for prostate gland enlargement. This procedure is similar to transurethral resection of the prostate (TURP), described below. However, photosensitive vaporization uses laser energy (instead of the electrical current used by TURP) to destroy prostate tissue. In general, photosensitive vaporization is better for smaller prostates. PVP may also result in less bleeding and a shorter recovery time than with TURP.

Conventional Surgery:

Transurethral resection of the prostate (TURP) - This is the most common surgery for an enlarged prostate; general or spinal anesthesia is used. An instrument called a resectoscope is inserted into the urethra, and tiny cutting tools to scrape away excess prostate tissue. You can expect to stay in the hospital for one to three days after surgery. During your recovery, you'll have a urinary catheter in place for a few days.

Transurethral incision of the prostate (TUIP) -This surgery is an option if you have only a moderately enlarged or small prostate gland. It's also an option for men who aren't good candidates for more invasive surgery for health reasons or because they don't want to risk sterility. Like TURP, TUIP involves special instruments that are inserted through the urethra. But instead of removing prostate tissue, the surgeon makes one or two small cuts in the prostate gland. The cuts help enlarge the opening of the urethra, making it easier to urinate.

Open prostatectomy -This type of surgery is generally performed only if you have an excessively large prostate, bladder damage or other complicating factors, such as bladder stones or urethral strictures. It's called open because the surgeon makes an incision in your lower abdomen to reach the prostate rather than going up through the urethra. During an open prostatectomy, only the inner portion of your prostate gland is removed, leaving the outer portion intact.

What Are The Advantages Of Surgery for BPH?

Surgery is the most effective of all therapies for relieving symptoms of an enlarged prostate. It's the "gold standard" by which all other treatments are judged, and many doctors have extensive experience with it.

How Long Does It Take?

This is dependent on the individual treatment option chosen. Consult your physician.

How Many Treatments Are Required?

Usually, for surgery, one treatment is sufficient.

When Will I See Results?

You should start to see results in a few days with TURP. Other procedures may vary.

What Are My Alternatives?

The alternatives to surgery are medication-based, as described above.

Will I Have Pain?

You may have some post-operative pain, particularly on urination. However, pain relievers administered for a few days should alleviate this.

When Can I Go Back To Work Or School?

This depends on the procedure. With laser surgery, up to a few weeks. With conventional surgery, up to a month.

Who Will Perform My Treatment?

The surgery will be performed by one of our highly-trained specialists in the field.

How Much Does It Cost?

Please call TopSurgeons at 800-506-8084 for more information.

Will My Insurance Cover?

Most insurance companies will cover these procedures.