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BackTable / Urology / Topic / Condition

Benign Prostate Hyperplasia (BPH)

Benign Prostate Hyperplasia (BPH) is the benign proliferation of tissue, specifically glandular epithelial tissue, smooth muscle, and connective tissue within the transition zone of the prostate. It occurs almost ubiquitously with aging in individuals with prostates, with an occurance of 60% by age 60, and 80% by age 80.

The causes of BPH are multifactorial, and may be related to changes in sex hormone balance. Other risk factors for BPH include a family history of BPH, a family history of bladder cancer, obesity, a lack of physical activity, and diabetes.

BPH is by definition benign, and is not a risk factor for prostate cancer. BPH may lead to an enlarged prostate, which then obstructs urine flow at the level of the bladder neck, and causes lower urinary tract symptoms (LUTS), such as increased urinary frequency, urgency, and nocturia.

Benign Prostate Hyperplasia (BPH) Condition Overview

Learn more on the BackTable Urology Podcast

BackTable is a knowledge resource for physicians by physicians. Get practical advice on Benign Prostate Hyperplasia (BPH) and how to build your practice by listening to the BackTable Urology Podcast, reading exclusing BackTable Articles, and following the work of our Contributors.

Ep 22 Collaborative Approach to Prostate Artery Embolization (PAE) for BPH with Dr. Claus Roehrborn and Dr. Sandeep Bagla
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Benign Prostate Hyperplasia Diagnosis

BPH is diagnosed by establishing the presence of storage voiding, and irritative symptoms in the absence of findings suggesting non-BPH LUTS causes. The diagnosis involves a thorough history, physical examination, and imaging to rule out other possible causes. The history evaluates both storage (frequency, urgency, nocturia) and voiding symptoms (weak urinary stream, hesitancy, intermittency, post-void dribbling). Presence of hematuria, incontinence, or urinary retention should prompt further urology work up. It is also important to elicit any history of neurological disease, cigarette smoking, urethral trauma, or certain medications. A digital rectal exam (DRE) should be performed as a part of the physical examination. A urinalysis should be ordered to identify pyuria, glucosuria, proteinuria, ketonuria, or bacteriuria, which may suggest alternative diagnoses. A PSA is also useful to evaluate prostate volume when considering certain treatments. A cystoscopy is not needed, unless planning surgical treatment or evaluating urethral strictures.

Differential Diagnosis: Urethral strictures, bladder neck contracture, bladder cancer, cardiovascular disease, neurologic disease, endocrine disease, polydipsia.

Benign Prostate Hyperplasia (BPH) Podcasts

Listen to leading physicians discuss benign prostate hyperplasia (bph) on the BackTable Urology Podcast. Get tips, tricks, and expert guidance from your peers and level up your practice.

Episode #148

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In this episode, Dr. Wayne Kuang (MD for Men LLC in Albuquerque, NM) discusses his initiative to redefine the benign prostatic hyperplasia (BPH) care pathway for patients, doctors, and the healthcare industry.

One of his main focuses is to prioritize bladder health and end the polypharmacy approach to BPH. Dr. Kuang also introduces the 5 Stages of Bladder Health, emphasizing the risks if BPH is not treated effectively and earlier. He underlines the importance of strategic treatment planning based on detailed data collection of the patient’s prostate and bladder health. Dr. Kuang also examines different surgical and medical treatments for BPH. He ends the episode by explaining the Man vs. Prostate initiative and the significant global impact of his advocacy.

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Episode #142

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In this episode of the Backtable Urology Podcast, Dr. Jose Silva invites Dr. Ali Kasraeian, urologic oncologist in Jacksonville, Florida, to discuss his experiences with the Aquablation technique for treating benign prostatic hyperplasia (BPH).

First, Dr. Kasraeian shares the process of learning Aquablation, the initial challenges he faced, and the benefits it offers patients. He explains that Aquablation is a procedure that democratizes the treatment of any size of the prostate by removing inconsistencies in management and offering a consistent, reproducible method. The doctors also discuss Aquablation outcomes and patient considerations, focusing on quality of life improvement and preserving ejaculatory function. Dr. Kasraeian also shares some insights on insurance coverage and billing for this procedure.

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Episode #138

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In this episode of BackTable Urology, Dr. Jose Silva and Dr. Bilal Chughtai discuss their workup for benign prostate hyperplasia (BPH) and how they use GreenLight Laser therapy and pharmacologic interventions to treat this common condition.

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Episode #101

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This week on the BackTable Urology Podcast, Dr. Jose Silva invites Dr. Seth Bechis onto the show to discuss the diagnosis and treatment of BPH with Rezum, a minimally invasive surgical that uses water vapor to dissolve prostate tissue.

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Episode #edición-esp-01

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En el primer episodio en español de BackTable Urology, yo y Dr. Francisco Gelpi discutimos los tratamientos mínimamente invasivos para HPB, específicamente Urolift, Rezum, y GreenLight. Escucha el episodio completo para aprender más sobre la transición de Dr. Gelpi desde práctica oncológica académica a práctica privada enfocada en HPB, evaluación inicial de los HPB pacientes, factores importantes en la toma de decisión de un tratamiento de HPB, y beneficios y complicaciones de cada tratamiento.

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Episode #22

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Urologist Dr. Claus Roehrborn and Interventional Radiologist Dr. Sandeep Bagla discuss the pros and cons of Prostate Artery Embolization (PAE) compared to other Minimally Invasive Surgical Treatments (MISTS) for Benign Prostate Hyperplasia (BPH). They also discuss the importance of a collaborative, multidisciplinary approach when offering these treatment options, including agreeing on the best treatment for the patient.

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Episode #14

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Urologist Dr. Francisco Gelpi discusses surgical treatments for BPH with a special focus on the minimally-invasive GreenLight Laser prostatectomy. Listen to hear more about Dr. Gelpi’s transition from an oncology-focused practice to a BPH-focused practice, initial BPH patient workup , using prostate anatomy to choose a BPH surgical treatment, GreenLight Laser postoperative care, and the importance of BPH patient involvement and expectations.

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Episode #6

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In Part II, Dr. Aditya Bagrodia talks with Dr. Claus Roehrborn of UT Southwestern Medical Center about the surgical management of benign prostatic hyperplasia (BPH).

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Episode #5

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In Part I, Dr. Aditya Bagrodia talks with Dr. Claus Roehrborn of UT Southwestern Medical Center about the medical management of benign prostatic hyperplasia (BPH).

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Benign Prostate Hyperplasia Treatment

Medical treatment for BPH may include alpha-adrenergic receptor blockers, PDE5 inhibitors, 5-alpha reductase inhibitors, and in patients with overactive bladder symptoms, beta-3 adrenergic agonists and anticholinergics. In patients that fail medical therapy, surgical intervention may be indicated, especially if patient suffers from refractory urinary retention, recurrent UTIs, recurrent gross hematuria, and recurrent bladder stones.

Benign Prostate Hyperplasia (BPH) Articles

Read our exclusive BackTable Urology Articles for quick insights on benign prostate hyperplasia (bph), provided by physicians for physicians.

Rezum Post-Procedure: Symptoms, Recovery, & Medications

Rezum post-procedure practices consist of catheterization, antibiotics such as Bactrim and Celebrex, anti-inflammatory drugs including steroids, and patient counseling. Learn more about Rezum recovery timelines.

Rezum Prostate Procedure Technique: ‘Less is More’

The Rezum procedure uses steam that is injected into the prostate to relieve benign prostate hyperplasia (BPH) symptoms. Urologist Dr. Seth Bechis describes his experience with Rezum treatment techniques.

Rezum Treatment for BPH: Who Is The Ideal Patient?

When is Rezum treatment appropriate, where does it sit within the BPH treatment algorithm, and who is the ideal candidate? To answer these questions, Urologist Dr. Seth Bechis describes his approach to Rezum workup, including his process of initial treatment for BPH, and identifying ideal Rezum patients.

bipolar turp procedure device

The bipolar TURP procedure involves the use of a bipolar current to resect excess prostate tissue, alleviating symptoms in patients with benign prostate hyperplasia (BPH). Learn about Bipolar TURP surgery, advantages of bipolar TURP, and potential complications.

urolift procedure device

Learn about the UroLift procedure pros and cons. It is a minimally invasive, non-ablative BPH treatment that places permanent implants to pull the prostate lobes away from the urethra.

HoLEP procedure surgery

The HoLEP procedure, or holmium laser enucleation of the prostate, is a new BPH treatment that is widely used because of its minimal invasiveness and quicker recovery times. However, urologists should evaluate the HoLEP procedure pros and cons before they decide on the surgery.

5-alpha reductase inhibitors for BPH

5-alpha reductase inhibitors are a class of medications commonly used to treat BPH. They are most effective in BPH patients with large prostates. Learn more about using 5-alpha reductase inhibitors for BPH.

Urologist using the IPPS to evaluate patient with BPH

The International Prostate Symptom Score (IPSS) is a universal assessment endorsed by the AUA. The IPSS questionnaire consists of 7 questions and evaluates BPH patients from a score of 0 to 35.

References

[1] Platz EA, Joshu CE, Mondul AM, et al. Incidence and progression of lower urinary tract symptoms in a large prospective cohort of United States men. J Urol 2012; 188:496.
[2] Marshall LM, Holton KF, Parsons JK, et al. Lifestyle and health factors associated with progressing and remitting trajectories of untreated lower urinary tract symptoms among elderly men. Prostate Cancer Prostatic Dis 2014; 17:265.
[3] Foster HE, Barry MJ, Dahm P, et al. Surgical Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline. J Urol 2018; 200:612.
[4] McVary KT, Roehrborn CG, Avins AL, et al. Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol 2011; 185:1793.
[5] Foster HE, Dahm P, Kohler TS, et al. Surgical Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline Amendment 2019. J Urol 2019; 202:592.

Disclaimer: The Materials available on https://www.BackTable.com/ are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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Podcasts

Defending the Detrusor: A Clinician’s Perspective with Dr. Wayne Kuang on the BackTable Urology Podcast)
Aquablation: Expanding BPH Management Options with Dr. Ali Kasraeian on the BackTable Urology Podcast)
Hood-Sparing & Greenlight Laser Therapy in BPH Management with Dr. Bilal Chughtai on the BackTable Urology Podcast)
Treating BPH with Rezum with Dr. Seth Bechis on the BackTable Urology Podcast)
Tratamientos Mínimamente Invasivos para HPB con Dr. Francisco Gelpi on the BackTable Urology Podcast)
Perfecting Rectal Spacer Placement for Optimal Care with Dr. Neil Taunk on the BackTable Urology Podcast)

Articles

Rezum Post-Procedure: Symptoms, Recovery, & Medications

Rezum Post-Procedure: Symptoms, Recovery, & Medications

Rezum Prostate Procedure Technique: ‘Less is More’

Rezum Prostate Procedure Technique: ‘Less is More’

Rezum Treatment for BPH: Who Is The Ideal Patient?

Rezum Treatment for BPH: Who Is The Ideal Patient?

Contributors

Dr. Sandeep Bagla on the BackTable Urology Podcast

Dr. Sandeep Bagla

Dr. Seth Bechis on the BackTable Urology Podcast

Dr. Seth Bechis

Dr. Bilal Chughtai on the BackTable Urology Podcast

Dr. Bilal Chughtai

Dr. Francisco Gelpi on the BackTable Urology Podcast

Dr. Francisco Gelpi

Dr. Wayne Kuang on the BackTable Urology Podcast

Dr. Wayne Kuang

Dr. Claus Roehrborn on the BackTable Urology Podcast

Dr. Claus Roehrborn

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