My Doctor Online The Permanente Medical Group

Symptoms

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Lower urinary tract symptoms may occur with an enlarged prostate. They include:

• Frequent need to urinate
• Difficult to start and stop stream (dribbling)
• Weak or intermittent urine stream
• Feeling of incomplete emptying of the bladder
• Blood in the urine, leading to possible clots
• Burning during urination, bladder stones
• Urinary retention, which can lead to bladder infection, kidney stones, or kidney damage

Tests and Diagnosis

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We can diagnose BPH by reviewing your symptoms, asking you questions, doing a physical exam, and assessing lab test results. This may include:

• Digital rectal exam. This test gives your doctor an idea of the size and condition of the prostate.
• Urinalysis to identify any infection and/or blood in your urine.
• Blood test for serum creatinine to check kidney function.
• Prostate-specific antigen (PSA) test is done to rule out prostate cancer. BPH is not cancer. Some symptoms are common to both conditions. Your physician may choose to order this test.

In some cases we may decide you need additional testing. This may include:

• A post-void residual urine test (PVR Bladder Scan) measures how well your bladder empties, using an ultrasound.
• Cystoscopy involves a thin tube, or cytoscope, inserted into the bladder through the urethra. This allows us to see a blockage caused by an enlarged prostate.
• A urine flow study measures the rate that your bladder empties while urinating, by having you urinate into a special device.

Causes

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BPH is a normal part of aging in men. The enlarged prostate is thought to be caused by changes in hormone balance and cell growth. There may be a genetic role in the case of severe BPH requiring surgery prior to age 60. Men older then 50 have a greater chance of developing BPH. Why severe symptoms occur in some men and not in others is unknown. Ongoing research will add to our understanding of what causes BPH to develop.

Treatments and Medications

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Watchful waiting is recommended when symptoms are mild and not affecting your quality of life. If your symptoms are moderate to severe, treatment will depend on how much they bother you personally and may include medications or surgery.

Medications

Medicines are available to ease symptoms and/or to reduce the size of the prostate. Most men respond well to these medications. Once started, they need to be taken regularly to maintain the benefit.

Alpha-blockers relieve symptoms within a few weeks but do not stop prostate enlargement. Possible side effects include dizziness, lower blood pressure leading to fainting or light-headedness when standing up, ejaculation problems, headache, and nasal congestion. If you are having cataract surgery, we need to take that into consideration. Alpha-blockers can cause a pupil disorder (floppy iris) that interferes with eye surgery.

5-Alpha reductase inhibitors work to reduce the size of the prostate. They may take up to 6 months to improve your symptoms. One possible side effect, occurring in 6 out of 100 men, is a decreased desire for sex.

Many men benefit from combining alpha-blockers and 5-alpha reductase inhibitors over a period of time. The combination may be more effective than either medication alone.

Alternative medicine

According to the National Center for Complementary and Alternative Medicine at the National Institutes of Health, herbal remedies such as saw palmetto and pygeum have not been proven to be effective.

Catheterization

This minimally invasive procedure is used short-term in case of urinary retention (inability to urinate). A urinary catheter is a small tube that is passed through the penis into the bladder, allowing the bladder to be drained. This is usually done while waiting for medications to start working, surgery to be scheduled, or an infection to clear up. Catheterization can be intermittent (every 6 to 8 hours) or left in place for weeks at a time before it needs to be changed. In rare cases, it may be used as a long-term solution, with monthly adjustments.

Surgical Procedures

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There are 3 surgical treatments for BPH that do not require an incision but are regarded as invasive because it is necessary to go through the urinary opening in the penis in order to reach the prostate. All of these procedures are performed in the operating room under anesthesia.

Transurethral prostatectomy (TURP) is most commonly used. An instrument is inserted through the urethra. The section of the prostate that blocks the urine flow is removed using an electrocautery loop (hot wire).

Laser prostatectomy uses a laser beam to remove the part of the prostate that blocks the urethra.

Both procedures can effectively improve symptoms. Patients are able to leave the hospital within 1 to 2 days. The laser prostatectomy has a reduced risk of complications, but there is an increased chance for a second surgery and a longer period of discomfort with urination after the procedure. Both procedures have the potential to cause various complications, including: 

• Dry or reduced ejaculation (very common).
• Failure to improve urination.
• Incontinence (inability to hold urine). 
• Erectile dysfunction.
• Infection.
• Bleeding complications (less likely with laser).
• TURP syndrome (absorption of fluid leading to temporary chemical imbalance in the body). This is not a risk with laser. 

Transurethral incision (TUIP) of the prostate is used for smaller prostates. This procedure widens the prostate in order to help reduce the pressure on the urethra caused by the prostate.

Simple open prostatectomy is for very large prostates, too large for TURP. This surgery involves:

• An incision above the base of the penis or in the lower abdomen
• A hospital stay of 3 to 4 days
• A catheter for 1 to 2 weeks
• Several weeks to recover

Open prostatectomy improves symptoms but carries a higher risk of complications compared to other procedures. This includes an increased risk of bleeding, with the possible need for a blood transfusion, erection difficulties, and difficulty holding urine.

In deciding to have any of these procedures, you should consider your expectations for the results, the severity of your symptoms, and the possibility of developing complications.

Lifestyle Management

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Making lifestyle changes may help control symptoms and prevent your condition from worsening. Consider these changes:

• Avoid drinking fluids 2 to 3 hours before bedtime
• Use less caffeine and alcohol
• Empty your bladder twice before bed or going out
• Limit decongestants or antihistamines
• Discuss your prescription medications with your doctor

Your Care with Me

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If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

During your office visit, we will discuss your medical and family history and I will perform a physical exam. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, and together we will create a treatment plan that is right for you. I may recommend other diagnostic studies, as needed. We can discuss surgery or less invasive therapies that may be appropriate. If you have severe symptoms, surgical treatment may be offered.

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If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

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Coordinating Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the "After Visit Summary" that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

If surgery or a procedure is a treatment option

I will recommend you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.

If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.

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Convenient Resources for You

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As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions.
• View your past visits and test results.
• View your preventive services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at every medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

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