BPH Symptoms

Question

Hello. I'm in a difficult situation with BPH symptoms.

Recently, my urine stream has become noticeably weaker, and I'm experiencing severe residual urine sensation that doesn't feel refreshing even after using the bathroom, causing major inconvenience in my daily life. I'm curious if these are BPH symptoms and if they're a natural aging phenomenon that comes with getting older.

Especially, I can't sleep well because of nocturia symptoms where I wake up frequently at night to urinate, and I'm also experiencing urgency where it's suddenly hard to hold it in. I desperately need an accurate diagnosis and treatment method.

I'm curious what tests are needed for BPH symptoms. Should I consider surgery if it becomes chronic or worsens?

Kyung-ho Ryu · Accepted Answer

Hello, this is Dr. Kyung-ho Ryu, a Doctalk-Naver KnowledgeiN consulting physician.

You're considering tests for BPH symptoms. First, benign prostatic hyperplasia is a very common condition where the prostate tissue gradually enlarges as aging progresses, compressing the urethra and causing various urinary dysfunction symptoms.

Generally, the prevalence rate increases rapidly after the 50s, but recently, due to various environmental factors such as westernized eating habits, stress, and prolonged sedentary lifestyle, symptoms can also appear in relatively younger age groups.

✔️ Weak stream: The urine stream becomes thin and weak.

✔️ Hesitancy: It's difficult to start urinating and requires straining.

✔️ Intermittency: The urine flow stops and starts.

✔️ Delayed urination: It takes a long time to urinate.

✔️ Frequency: You go to the bathroom frequently.

✔️ Nocturia: You wake up multiple times at night to urinate.

✔️ Urgency: Sudden urge to urinate that's hard to hold.

✔️ Residual urine sensation: Feeling like urine remains in the bladder after urinating.

BPH Tests

Diagnosing BPH is a comprehensive process that goes beyond simply checking the size of the prostate, including the severity of symptoms the patient experiences, bladder function status, and ruling out other serious conditions.

✔️ Interview and symptom questionnaire: Check how often you urinate, how urgent it is, how many times you wake up at night, etc., based on the International Prostate Symptom Score (IPSS).

✔️ Digital rectal examination (DRE): A test where the prostate is directly felt through the anus. It's a necessary basic examination that can simply check size, firmness, and abnormalities.

✔️ Uroflowmetry + residual urine measurement: Measures urine stream strength, urination time, and how much urine remains in the bladder after urination to identify functional problems.

✔️ Urinalysis and blood test (PSA): Checks for infection or prostate cancer possibility through basic urinalysis and prostate-specific antigen (PSA) levels.

BPH patients can effectively control symptoms through medication. However, if symptoms don't improve despite long-term medication, or if complications such as acute urinary retention, recurrent urinary tract infections, bladder stones, or kidney function decline occur, surgical treatment is considered.

Currently, surgical treatments for BPH range from relatively minimally invasive procedures like UroLift to highly effective HoLEP surgery.

It's important to comprehensively consider the patient's prostate size, symptom severity, and preferences to select the most suitable treatment that will yield the best results for the individual.

BPH Surgical Treatments

✔️ Waterjet robotic surgery: Can be performed regardless of prostate size or shape, using high-pressure spray to precisely and consistently ablate prostate tissue with micro-level minimal invasion without heat energy generation.

✔️ HoLEP surgery: Uses holmium laser to separate between hyperplastic tissue and capsule, removing hyperplastic tissue entirely like peeling an orange, leaving no hyperplastic tissue with minimal bleeding, side effects, and low recurrence rate.

✔️ UroLift: Instead of ablating or burning the prostate with laser, this surgical method simply binds and fixes the left and right sides of the enlarged prostate tissue to widen the urethra. No hospitalization needed and can be easily performed under local anesthesia, making it suitable for those with heart disease or other conditions where anesthesia is burdensome.

✔️ Plasma TURis: Surgery that uses low-temperature plasma to instantly vaporize and remove blood vessels and hyperplastic tissue.

✔️ Rezum procedure: Transurethral prostate ablation using steam, can proceed under local anesthesia, making it possible even for elderly or those with underlying conditions. Also gaining attention as a promising procedure with low possibility of retrograde ejaculation while having treatment effects comparable to surgery.

✔️ iTind surgery: Surgical method that widens narrowed prostate urethra area with a stent, removed within 5-7 days after surgery. Even after device removal, the prostate urethra area remains in an expanded state, allowing normal urination. Same-day discharge is possible with minimal retrograde ejaculation and low possibility of long-term complications.

I recommend seeing a urologist for diagnosis if BPH symptoms persist. Thank you.