Benign prostatic hyperplasia - BPH

Prostate

The prostate is a small, muscular gland in the male reproductive system. The prostate surrounds the urethra and produces most of the fluid in the sperm. The muscular action of the prostate helps to move fluid and sperm through the penis during sexual climax.

In many men, the prostate can become enlarged. Sometimes this leads to symptoms, and over time to other complications. However, there are treatments.

What is benign prostatic hyperplasia – prostate enlargement

Enlargement of the prostate is called benign prostatic hyperplasia (BPH). It occurs when prostate cells begin to multiply. These extra cells cause the prostate to swell, which compresses the urethra and restricts the flow of urine.

BPH is not the same as prostate cancer and does not increase the risk of cancer. However, it can cause symptoms that can affect your quality of life.

BPH is common in men over the age of 50.

Causes of prostate enlargement

Benign prostatic hyperplasia is considered a normal condition due to aging. Although the exact cause is unknown, the changes in male sex hormones that come with aging may be a factor.

Any family history of prostate problems or any abnormalities in the testicles can increase the risk of prostate enlargement. Men whose testicles were removed in their youth do not develop BPH.

Symptoms of benign prostatic hyperplasia

The symptoms of BPH are often very mild at first, but become more severe if left untreated. Common symptoms include: 

• incomplete bladder emptying
• nocturia, which requires urination two or more times a night
• dripping at the end of your urinary flow
• incontinence or leakage of urine
• straining when urinating
• weak urinary stream
• sudden urge to urinate
• slowed or delayed urinary flow
• painful urination
• blood in the urine

Talk to your doctor if you have any of these symptoms. They can be treated and their treatment can often help prevent dangerous complications.

People with a long history of BPH can develop the following complications:

• urinary tract infections
• urinary stones
• kidney damage
• bleeding in the urinary tract
• sudden inability to urinate

Sometimes urinary obstruction is so severe that urine cannot leave the bladder at all. This is called obstruction of urine output from the bladder. This can be dangerous because urine trapped in the bladder can cause urinary tract infections and damage the kidneys.

Benign prostate enlargement and prostate cancer do not share symptoms. Prostate cancer is almost always asymptomatic and is identified by elevated PSA or prostate nodule. It is also a much more serious condition than prostate enlargement. Your doctor may do tests to make sure your symptoms are not related to prostate cancer.

Enlarged Prostate Diagnosis

When examining and suspecting benign prostate enlargement, your doctor will usually start a physical examination and ask you about your medical history. A physical examination includes a rectal examination that allows the doctor to assess the size and shape of your prostate. Other tests may include:

Urine analysis. Your urine is tested for blood and bacteria.

Urodynamic testing. Your bladder is filled with fluid through a catheter to measure the pressure on your bladder during urination.

Prostate specific antigen (PSA). This blood test checks for tumor markers for prostate cancer.

Post-void residual urine test. This test measures the amount of residual urine that remains in your bladder after urination.

Cystoscopy. This is an examination of your urethra and bladder with a tiny illuminated catheter inserted into your urethra.

Your doctor may also ask you about medications you are taking that may affect your urinary system, such as:

• antidepressants
• diuretics
• antihistamines
• sedatives

Your doctor may make the necessary adjustments to your medication. Do not try to adjust medications or doses yourself.

Tell your doctor if you have taken self-help for at least 2 months for your symptoms without noticing an improvement.

Prostate enlargement treatment

Treatment of BPH can begin with care and lifestyle adjustments. Sometimes your doctor may want to see you regularly to monitor your symptoms and prostate size. Your doctor will work with you to create a treatment plan that will help you manage your symptoms and live a healthy life. That is why it is important to talk about your BPH symptoms with your doctor, no matter how underage you feel. Lifestyle changes, medications and surgery are all options for treating symptoms that affect your quality of life.

If symptoms persist, medication or intervention may be recommended. Your age and general health will also affect the prescribed treatment. A new method of treating BPH is prostate embolization.

Prostate artery embolization 

What is prostate artery embolization?

Prostate artery embolization is a minimally invasive treatment under local anesthesia that helps to improve the symptoms of the lower urinary tract caused by benign prostatic hyperplasia (BPH). BPH is a non-cancerous enlargement of the prostate and is the most common benign tumor in men.

Prostate embolization is performed by an interventional radiologist, a doctor who uses X-rays and other advanced images to see the inside of the body and treat conditions without surgery.

Why to do prostate artery embolization

As the prostate enlarges, it can constrict or partially block the urethra, causing lower urinary tract symptoms such as:

• Urinary incontinence, which can range from leakage to complete loss of bladder control
• Irritant symptoms of urine dripping
• Increased frequency of urination, urgency and pain when urinating

For some patients, these symptoms interfere with their quality of life.

Who is prostate embolization intended for?

Prostate artery embolization is a procedure for candidates who either do not meet the conditions or are not interested in traditional surgery. An examination by an interventional radiologist can determine if you are a candidate for prostate embolization. In this examination, you may be asked how often you have urinary symptoms of prostate enlargement, how serious they are and how much they affect your quality of life.

Tests before the embolization procedure may include:

• urine test (urine analysis)
• a rectal examination to help assess the size of your prostate
• in some cases, a prostate-specific antigen (PSA) test is performed to rule out prostate cancer
• MRI or ultrasound of the prostate

How prostate embolization is performed

Prostate artery embolization is performed by an interventional radiologist (IR). An interventional radiologist is a doctor who uses X-rays and other imaging techniques to see the inside of an organ and treat conditions without surgery. A Foley catheter (a thin, hollow tube that is held in place with a balloon at the end) can be inserted into your urethra and placed in the bladder to provide a reference point for the surrounding anatomy.

Embolization is performed through a small catheter inserted by an interventional radiologist into an artery in your wrist or groin. The interventional radiologist will then guide the catheter into the vessels that supply blood to your prostate. An arteriogram (an X-ray that injects dye into blood vessels) is used to map the blood vessels that feed your prostate. Tiny round microspheres (particles) are injected through a catheter and into the blood vessels that supply your prostate to reduce its blood flow. The interventional radiologist will move the catheter to treat the other side of your prostate, repeating the above steps.

After this procedure, the prostate will begin to shrink, relieving and improving the symptoms, usually within a few days of the procedure.

Risks of prostatic artery embolization

Prostate artery embolization should be performed only by professional and trained interventional radiologists. Patients may experience “post-embolization syndrome” for days after the procedure, which may include nausea, vomiting, fever, pelvic pain, or painful or frequent urination.

Other risks include hematoma at the incision site; blood in urine, semen or stool; bladder spasm; or infection of the puncture site or prostate.

A team of interventional radiologists from the Pulse Cardiology Center successfully treated a large number of men using this approach. Dr. Matija Miljević radiologist said about the results of the treatment:

“As doctors, we know how important it is to get the best diagnostic options, the right treatment and care in the future. We can say with certainty that embolization of the prostate arteries significantly improves the life of men.”