Lower Urinary Tract Symptoms
Lower urinary tract symptoms are divided into two categories: storage symptoms and voiding symptoms.
The course and severity of these symptoms can vary greatly.. They mainly affect older men, with prevalence increasing with age: on average, 50% of men over 60 years of age and 80% of men over 80 years of age experience LUTS caused by BPH . For this reason, symptomatic BPH is regarded as one of the most common disorders in men and, because it is widespread, one that has significant socioeconomic impact . Apart from increasing age, risk factors include metabolic syndrome , obstructive sleep apnea, and thyroid dysfunction .
Guidelines For The Treatment Of Benign Prostatic Hyperplasia
Yunuo Wu, PharmDCreighton University School of Pharmacy and Health Professions
Michael H. Davidian, MD, MSAssociate Professor of MedicineCreighton University School of Medicine
Edward M. DeSimone II, RPh, PhD, FAPhAProfessor of Pharmacy SciencesCreighton University School of Pharmacy and Health ProfessionsOmaha, Nebraska
US Pharm. 2016 41:36-40.
ABSTRACT:Benign prostatic hyperplasia is a common disorder in men with an incidence that increases with age. BPH often requires therapy when patients begin to experience lower urinary tract symptoms that affect quality of life. Current management strategies involve lifestyle modifications, pharmacotherapy, phytotherapy, and surgical interventions as indicated. Pharmacists are in the unique position of being accessible sources of healthcare information for the BPH patient population. Understanding the symptoms of this disorder and therapy options will be beneficial for pharmacists who have increased chances to answer BPH-related questions from their patients.
What Is The Difference Between Prostate Cancer And Benign Prostatic Hyperplasia
Prostate cancer is a common type of cancer that develops in your prostate gland. Early-stage prostate cancer rarely causes symptoms. However, as it progresses, it shares many of the same symptoms as BPH. These symptoms include a weak urine flow, pain when ejaculating or peeing and frequent urges to pee. Prostate cancer may spread to your bones, lymph nodes or other parts of your body. Treatment options include radiation therapy and surgery.
BPH symptoms are similar to prostate cancer symptoms. However, BPH isnt cancer, and it doesnt increase your risk of developing cancer. It wont spread to other parts of your body. Treatment options include medicines, surgery and minimally invasive procedures.
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Is Drinking Coffee Good For Your Prostate
Drinking four to five cups of coffee every day can lower your chances of fatal and high-grade prostate cancer, according to a 2014 review of clinical studies. Regardless of how many cups you drink overall, every three cups of coffee you drink can reduce your risk of fatal prostate cancer about 11 percent.
Why Is This Medication Prescribed
Finasteride is used alone or in combination with another medication to treat benign prostatic hypertrophy . Finasteride is used to treat symptoms of BPH such as frequent and difficult urination and may reduce the chance of acute urinary retention . It also may decrease the chance that prostate surgery will be needed. Finasteride is also used to treat male pattern hair loss Finasteride has not been shown to treat thinning hair at the temples and is not used to treat hair loss in women or children. Finasteride is in a class of medications called 5-alpha reductase inhibitors. Finasteride treats BPH by blocking the body’s production of a male hormone that causes the prostate to enlarge. Finasteride treats male pattern hair loss by blocking the body’s production of a male hormone in the scalp that stops hair growth.
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Treating Benign Prostate Enlargement
Treatment for an enlarged prostate is determined by the severity of your symptoms.
If you have mild to moderate symptoms, you won’t receive any immediate medical treatment, but you’ll have regular check-ups to carefully monitor your prostate.
As well as lifestyle changes, medication is usually recommended to treat moderate to severe symptoms of benign prostate enlargement. Finasteride and dutasteride are medications that are commonly used. They block the effects of a hormone called dihydrotestosterone on the prostate gland, which can reduce the size of the prostate and improve associated symptoms.
Alpha blockers may also be prescribed. They help to relax your bladder muscles, making it easier to pass urine. Tamsulosin and alfuzosin are two alpha blockers commonly used to treat benign prostate enlargement.
Surgery is usually only recommended for moderate to severe symptoms of benign prostate enlargement that have failed to respond to medication.
Read more about treating benign prostate enlargement
What Are The Warning Signs Of Benign Prostatic Hyperplasia
Your prostate surrounds your urethra. When BPH causes your prostate to grow, it can cause blockage in your urethra. As a result, early symptoms of BPH include:
- Slowness or dribbling when you pee.
- Difficulty starting to pee.
- Kidney damage due to pee backflow from your bladder up to your kidney. The pee backflow increases pressure on your kidney.
What Are Bph Symptoms
Men with BPH may experience these symptoms:
- frequent need to urinate
- blood in the urine
- urinary tract infections
When the prostate enlarges, not all men have significant symptoms. Several different conditions can lead to symptoms comparable to an enlarged prostate, such as inflammation of the prostate , kidney or bladder stones, prostate cancer, or narrowing of the urethra. If you experience any of these symptoms, be sure to consult with your doctor.
BPH is not a form of prostate cancer but symptoms can be similar. Having BPH does not increase your risk for prostate cancer, but they can occur at the same time.
High Residual Urine Volumes
Two large studies on BPH showed that high residual urine volumes were associated with significantly faster progression of BPH-related symptoms.
Interventional diagnostic techniques should only be used after noninvasive techniques have been exhausted. Interventional techniques include urethrocystoscopy, which is used, for example, in patients with hematuria, urethral stricture, bladder carcinoma, or known anomalies of the lower urinary tract, or those who have previously undergone surgery relevant to the condition. Urethrocystoscopy as a diagnostic procedure should never be considered routine before interventional procedures . The same is true of noninvasive urodynamic testing, where pressure sensors are placed in the bladder and rectum and electrodes are placed in the pelvic floor region to measure functional parameters of the lower urinary tract in real time. Although it provides the most detailed description so far of pathological function in BPH, this technique should be reserved for selected cases only . The much-respected recent Upstream study showed that measuring bladder pressure does not lead to a reduction in BPH-related surgery .
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Medicines For Benign Prostatic Hyperplasia
This type of treatment is generally indicated for men with mild to moderate symptoms and may include the use of different medications such as:
- Alpha blockers, such as Tamsulosin or Doxazosin: relax the muscles of the bladder and the fibers of the prostate, facilitating the act of urinating
- 5-alpha-reductase inhibitors, such as Finasteride or Dutasteride: reduce the size of the prostate by inhibiting some hormonal processes
- Tadalafilo: It is a very used drug for erectile dysfunction, but it can also reduce the symptoms of prostatic hyperplasia.
These medications can be used separately or in combination, depending on the type of symptoms. Find out more about the treatment background.
Sidebar 1 Bph Case Report
Chief Complaint: LF is a 64-year-old white male presenting with fatigue and sleep pattern changes that have lasted over the past several years. He believes his poor sleep habits are due to frequent nighttime urination, occurring three to four times per night. He denies drinking any fluids in the evening. LF also complains of difficulty starting a stream, especially in public restrooms, and notes that this stream has become weaker over time. He also feels that it takes him longer to completely empty his bladder. He admits to âgoing a little in his shortsâ after urinating and confirmed postvoid dribbling. He experiences some mild urgency but denies dysuria. He also confirms knowledge of all of the bathroom locations in his office building.
Past Medical History:LF denies blood in his urine, a past history of STDs, or other UTIs. He reluctantly reports difficulty keeping firm erections during sexual intercourse compared to when he was younger. However, he maintains that this issue is not one of his major concerns.
Family History: Negative family history of prostate cancer
Social History: Nonsmoker, no illicit drugs, mild alcohol consumption
Physical Examination: Male pattern baldness
Vital Signs: WNL
â¢ Niacin 1,000 mg 1 daily
â¢ Cinnamon tablet 1 daily
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Surgery Surgery Is Used To Treat Bph When Drug Therapy Stops Workingor To Treat Those Who Can’t Urinate At All It Can Also Be Used To Relievesevere Symptoms
Transurethral resection of the prostate
Transurethral resection of the prostate removesprostate tissue through the urethra. It is the surgery most commonly used totreat BPH. While TURP relieves urinary symptoms in most men, urinary problemscan come back over time if the prostate starts to grow again. This is why youngermen may need to have this surgery more than once.
This surgery is done in an operating room. The doctor passes a resectoscope through the urethra to reach the prostate. A resectoscope is a type of endoscope . It has a thin wire that carries an electric current. The doctor uses the electric current to cut away prostate tissue around the urethra. The doctor then removes this tissue through the resectoscope.
The most common side effects of TURP include:
In rare cases, you may develop erectile dysfunction orincontinence after TURP. But this surgery has a lower risk of these sideeffects than surgery to remove the prostate .
Options For Conservative Treatment And Medical Therapy
The main factor in the decision about treatment is, in the first place, the patients perceived burden of suffering, which is best assessed using the IPSS and Quality of Life score. Uroflowmetry results, PVR measurements, and IPSS and ICIQ are all included in the overall assessment, making cut-off values for treatment decisions impracticable. In patients with mild distress, the natural course of the BPH can be initially monitored by watchful waiting . Patients can also be offered counseling on lifestyle and nutritional changes. The following suggestions can, if followed, have a positive impact on BPH-related symptoms and may potentially slow disease progression :
- Avoiding alcohol and caffeine
- Adjusting timing of fluid intake to daily routine
- Ongoing monitoring of symptoms
- Using relaxation exercises and distraction techniques
- Adjusting other medications
Drug therapy should be considered if the patients symptom burden requires it or if initial watchful waiting has not led to satisfactory improvement in symptoms. The choice of drug therapy depends on the symptoms. The most important clinical effects of the various drug classes, their respective adverse effects profile, and recommended follow-up schedules can be found in Table 2.
Causes Of Benign Prostate Enlargement
The exact cause of benign prostate enlargement is unknown, but research suggests that hormones probably play an important role in the condition’s development.
Hormones are powerful chemicals that can have a wide range of effects on the cells of the body.
One theory is that as some men and anyone with a prostate gets older, the levels of a type of hormone called dihydrotestosterone increases, which may stimulate the growth of the prostate.
Another theory suggests that two hormones, testosterone and oestrogen, play a role. Younger men and anyone with a prostate produce high levels of testosterone and much smaller levels of oestrogen. But as they get older, levels of testosterone decrease, which means they then have a higher proportion of oestrogen in their body. It’s been suggested that the relative increase in oestrogen may stimulate prostate growth.
How Can Steam Be Used To Treat Benign Prostatic Hyperplasia
The method for treating an enlarged prostate is minimally invasive. It is performed by going up through the urethra and using an instrument that turns water into steam. The steam delivery lasts only seconds. The procedure is designed to be done in a doctors office. You will not need general anesthesia. You will receive only local anesthesia.
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Prostatic Hyperplasia: What It Is Symptoms Causes And Treatment
Benign prostatic hyperplasia, also known as benign prostatic hyperplasia or just called BPH, is the enlargement of the prostate that arises naturally with the age in the majority of men, being a very common male problem after 50 years .
Prostate hyperplasia is usually diagnosed when symptoms such as frequent urination make it difficult to completely vaccinate the bladder or the presence of a weak urine stream. However, an evaluation with a urologist is necessary to rule out other problems that can cause similar symptoms such as prostate infection or even cancer. See which are the main signs of prostate cancer.
Depending on the degree of alteration of the prostate and the symptoms, the treatment can only be carried out with medications or the surgery may be necessary, considering that to select the best option it is important to talk to the doctor,
The most common symptoms in cases of benign prostatic hyperplasia generally include:
Frequent and urgent needs to urinate
Difficulty to start to urinate
Wake up frequently during the night to urinate
Weak urine cry, which is stopped and recomienza
Full bladder sensation even after breathing.
These symptoms generally appear after 50 years of age and it is common to get worse over time, according to the increase in the size of the prostate, which ends up tightening the urethra and affecting the urinary system. See more about prostate enlargement.
Watch the following video and find out how these exams are carried out:
B Searching For The Evidence: Literature Search Strategies For Identification Of Relevant Studies To Answer The Key Questions
We will search Ovid Medline, Ovid PsycInfo, Ovid Embase, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials for primary health outcomes published and indexed in bibliographic databases. We will attempt to assess long-term or rare harms with nonrandomized controlled trials and large controlled observational studies if RCTs are not available. Our search strategy includes relevant medical subject headings and natural language terms for LUTS/BPH . These concepts were combined with filters to select trials. We will supplement the bibliographic database search with forward and backward citation searching of relevant systematic reviews and other key references. We will update searches while the draft report is under public/peer review.
We will search for grey literature in ClinicalTrials.gov and to identify completed and ongoing studies. We will search for conference abstracts from the past three years to identify ongoing studies. Grey literature search results will be used to identify studies, outcomes, and analyses not reported in the published literature. Information from grey literature will also be used to assess publication and reporting bias and inform future research needs. Additional grey literature will be solicited through a notice posted in the Federal Register and Scientific Information Packets and other information solicited through the AHRQ Effective Health Care Web site.
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Are Alpha Blockers For Me
Depending on the severity of your prostate symptoms and your overall health, Alpha Blockers may be an appropriate treatment option. Men who are considering cataract surgery would be at risk from this class of BPH medications. In addition, men who take beta blockers or medication for erectile dysfunction must be evaluated before starting this treatment.
What Are The Types Of Prostate Surgery For Benign Prostatic Hyperplasia
Several minimally invasive surgeries may be used for benign prostatic hyperplasia. These include:
GreenLight laser: Photoselective vaporization of the prostate is a treatment that vaporizes prostate tissue to create a channel in the urethra for free urination. This is surgical treatment performed in the operating room under general anesthesia.
Plasma button electrovaporization: Prostate tissue is removed using low temperature plasma energy. Tissue is vaporized. This is an operating room-based therapy and requires an anesthetic.
Water vapor therapy : Water vapor is directly delivered to the prostate tissue. Over a 3-month period the tissue is destroyed and reabsorbed by the body. This is an office-based therapy and is performed under a local nerve block.
UroLift®: A mechanical approach that places implants to pin the lateral prostate lobes out of the way to reduce obstruction. This is an office-based procedure performed under a local nerve block.
Prostatic artery embolization: This approach uses catheters to deliver agents that block blood flow to the prostatic artery to reduce symptoms of BPH by shrinking tissue. This prostate procedure uses local anesthesia and doesnt require a hospital stay.
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Review Of Key Questions
AHRQ posted the key questions on the Effective Health Care Web site for public comment. The EPC refined and finalized the key questions after review of the public comments, and input from Key Informants and the Technical Expert Panel . This input is intended to ensure that the key questions are specific and relevant.
Is Red Wine Good For Prostate
A new study shows men who drink four or more glasses of red wine per week have a nearly 50% lower risk of prostate cancer than non-drinkers. In addition, researchers found that red wine’s protective effects appear to be even stronger against the most dangerous and aggressive forms of prostate cancer.
A Criteria For Inclusion/exclusion Of Studies In The Review
Studies will be included in the review based on the PICOTS framework outlined above and the study-specific inclusion criteria described in Table 3.
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