Dr. Steven Gange discusses the signs and treatments of BPH
I’m Dr. Steve Gange a urologist with Summit Urology Group here in Salt Lake City. So let’s talk about benign prostatic hyperplasia, otherwise known as BPH.
Every man’s prostate begins to grow in their adolescence and some of them get very large over the years. But it’s not really just about size. It’s about the makeup of the prostate and if there’s a lot of muscular tissue, which there can be in the prostate, it creates a tight squeeze on the urethra,which is the tube that we urinate through. What drives us to consider therapy is the degree of bother that it’s causing a patient.
The only exceptions to that are when the swelling of the prostate, the tightness of the prostate,is causing blood in the urine or leading to stones in the bladder or affecting kidney function. So there are some times where we need to say,”it’s time to start therapy”.
There are some things we can do in the office that are simple, straight forward ways to determine if the condition is progressing. And there’s two classes of drugs, the most effective of these are called alpha blockers and they specifically relax that muscle in the prostate,and they have a great response rate.
The other class of drugs is called bivalva reductase inhibitors and they shrink the prostate. They take a long time to work, three to six months and only benefit men who have really good size prostates. So smaller prostates, younger guys,almost are never a candidate for this therapy.
The traditional therapy beyond medications is a form of surgery ,and since the 1930’s that’s been what we call a TURP, transurethral resection of the prostate, and more recently a couple of interesting things have come along. One is called the Urolift. What it equates to is the insertion of little implants, so again the prostate’s this sphere around a tube, these implants grab the prostate tissue if you will and kind of pinch it, and when they pinch it the opening becomes larger and these are designed to be permanent implants, they’re placed strictly under local anesthesia. We can treat older folks who aren’t candidates for surgery. We can treat younger guys who just don’t want an anesthetic. This local anesthetic option appeals to a lot of men.
Treatments for Erectile Dysfunction
So ED stand for erectile dysfunction,and it wasn’t called that 20 years ago. It was called impotence,and the causes of ED, erectile dysfunction include mostly vascular things because an erection is just the influx of blood into the penis. So patients with heart disease or hypertension,even diabetes can affect blood flow. Beyond that, cigarette smoking. Every time one inhales a puff of a cigarette,there’s a constriction of blood flow. Low testosterone really mostly impacts libido or desire,not so much erections. And of all the people with erectile dysfunction,only a sliver of patients, five percent have as the cause of their erectile dysfunction a low testosterone level.
So prior to the 1990s, honestly the only real proven treatment was the insertion of a device inside the penis called an inflatable penial prosthesis. Those are still being performed today, but that’s a big step from a guy who’s just having a little trouble in the bedroom to undergo what sounds like a pretty big deal surgery. The thing you need to know about the medications that are all advertised is that they’re very expensive and that price just seems to be creeping uprather than declining.
The other thing to know before taking these drugs is only 60 or 70 percent of men will respond to the mand some insurance companies will pay for this and many will not. An alternative that’s recently become available in the last six months is that we are now able to work with some pharmacies to prescribe some generic versions and that seems a little more palatable for the patients. Instead of 30 dollars a pill, they’re five dollars a pill.
Beyond that, it’s sort of a conversation that has to happen with the patient and his partner. There are medications, there are drugs that when injected, literally into the side of the penis,will enhance the blood flow. In fact, you don’t have to have any erectile capabilities. This will almost always achieve a good response, and then should that fail or should patients just decide they don’t wanna have needles in their penis all the time,then we still revert to what was performed fist in the early 1970s and it’s the penial prothesis. In my practice, we’ve had a really good success rate with surgeries, meaning they work for a long time. They don’t cause infections, and honestly, they’re getting, the satisfaction rates are high.