In the early stages of BPH, there are no signs and symptoms. These appear when the prostate puts pressure on the urethra and bladder and cause changes in urination.

• More frequent urination (urinary frequency), especially at night
• A strong or sudden urge to urinate (urinary urgency)
• Difficulty starting or stopping the urine stream (called straining)
• Weak or slow urine stream
• Interrupted urine flow
• Being unable to empty the bladder completely
• Difficulty controlling the bladder (leaks)
• Pain or a burning sensation during urination
• Difficult or painful ejaculation
• Blood in the urine or semen (rare)

Risks and complications

• Urinary tract infection
• Urinary calculus
• Acute urine retention (emergency)
• Chronic urine retention
• Renal insufficiency if not cared for

Diagnosis

If you have unusual symptoms of BPH or if your doctor thinks you might have BPH, you will be sent for tests. They could include the following:

Medical history and physical examination

• A digital rectal exam (DRE) to ascertain the size of the prostate
• A questionnaire to assess the severity of the bladder disorder and how they affect the man’s quality of life

Urine Tests

• Urine analysis
• Urinary flow measurement (urodebitometry)
• Keeping a urination journal over several 24-hour periods

Blood tests

• Prostatic antigen specific (PSA)
• Blood urea nitrogen
• Creatinine

Imaging

• Ultrasound of the kidneys, bladder and prostate
• Ultrasound to determine how much urine remains in the bladder after urination (residual urine)
• These tests and examinations are used to confirm a BPH diagnosis, to rule out other problems such as urinary tract infection or prostate cancer, and to check for any BPH-related complications.

Treatments will be proposed based on the type of enlarged prostate and may vary from one man to another.

Watchful waiting & lifestyle changes

Watchful waiting consists in carefully observing the person without administering any treatment, since a certain proportion of men may see a spontaneous improvement in symptoms. Changes in lifestyle habits include avoiding certain foods (coffee, tea, alcohol), decreasing the amount of fluids ingested before bedtime, moderating daily fluid intake (1.5-2.0L / day), and avoiding constipation.

5-alpha-reductase inhibitors

These drugs block the transformation of testosterone into dihydrotestosterone in the prostate. Dihydrotestosterone appears to be the cause for enlargement of the prostate. They take several months to reduce the size of the prostate and relieve symptoms. These medications can prevent secondary BPH complications (acute urinary retention, bleeding, etc.). By reducing the size of the prostate, they also decrease the level of PSA that will need to be closely followed. The two drugs in this category are:

• finasteride (Proscar)
• dutasteride (Avodart)

Side effects may include:

• • decreased sexual desire
  • erectile dysfunction
  • reduced amount of semen in ejaculation
  • breast swelling or tenderness

Alpha-blockers:

They are drugs that relax the muscles around the prostate to reduce pressure on the urethra and decrease symptoms affecting urine flow. They have a quick effect (24-72 hours) on urinary symptoms. The most common alpha-blockers used for BPH are:

• • terazosine (Hytrin)
  • doxazosine (Cardura)
  • tamsulosine (Flomax)
  • alfuzosine (Xatral)
  • silodosine (Rapaflo)

Side effects may include:

• • dizziness
  • fatigue
  • headache
  • low blood pressure
  • Nasal congestion and rhinorrhea (runny nose)

Surgery

Surgery may be used to treat BPH in cases where the symptoms are severe severe, if the man is totally unable to urinate, when drug therapy has been ineffective, or if the man does not want to take daily medication.

Transurethral resection of the prostate (TURP)

TURP removes prostate tissue in order to reduce the size of the prostate. It is the surgery most commonly used to treat BPH. The usual procedure:

• It is performed under general or spinal anesthesia.
• A special tube with light and a camera (resectoscope) is inserted into the urethra into the prostate.
• The surgeon can observe the inside of the urethra, prostate and bladder.
• The excess tissue of the prostate is removed in the region that surrounds the urethra. The excision can be done using a variety of techniques (electric, laser, etc.)
• A catheter is placed in the bladder to allow the urine to flow.
• The catheter is removed as soon as there is no more blood in the urine (usually after 24 hours).

Side effects of a TURP may include:

• bleeding
• infection
• retrograde ejaculation
• new or minimally improved irritative urinary symptoms (frequent urination, urgency, etc.)
• erectile dysfunction – rare
• incontinence – rare

Some men may have to undergo a second intervention (10% of men after 10 years). Other surgical or radiological techniques performed under local anesthesia may be performed, but their long-term effectiveness remains to be determined. Talk to your urologist.