BPH and Urinary Retention

The prostate is an essential male reproductive gland that provides a vital fluid that mixes with sperm and becomes semen. This prostatic fluid helps nourish and transport sperm to its final destination during ejaculation. When a young man is going through puberty, the prostate gland is experiencing its first major growth phase. This growth is natural and beneficial in aiding reproduction. However, when a man’s prostate begins its second substantial growth phase in his mid to late 20s and continues growing for the rest of his life, this excess prostatic growth can become a liability. When most men reach their 40s, 50s, 60s, and beyond, benign prostatic hyperplasia or BPH is often diagnosed. Even though an enlarged prostate or prostatic hyperplasia is benign and non-cancerous, and it’s not believed to lead to prostate cancer, BPH can still wreak havoc with a man’s urinary system when given the chance. Fortunately, not all men will be diagnosed with benign prostatic hyperplasia, but most will if they live long enough. Often a man will experience lower urinary tract symptoms or LUTS before being diagnosed with BPH. Symptoms such as starting and stopping, incomplete emptying, frequent urination (especially at night), urgency, and urinary retention are but a few of the many BPH symptoms a man may experience.

Although benign prostatic hyperplasia is a common condition in aging men, there are numerous ways to address and combat BPH symptoms like urinary retention. Depending upon urinary symptom severity, a man can employ watchful waiting (possibly combined with simple lifestyle changes) before considering medication or surgery. The important consideration regarding BPH and urinary retention is the severity. The type of urinary retention is defined by the consistent inability of the bladder to empty fully over time (chronic) or suddenly not at all (acute).

Chronic Urinary Retention and BPH

Chronic urinary retention is a long-term urologic condition that occurs because the bladder consistently fails to fully empty during urination. The most common cause of bladder outlet obstruction (BOO), which often causes a man’s bladder to not fully eliminate all of the urine during each urination cycle, is BPH¹, which is both chronic and progressive. “For men with benign prostatic hyperplasia and BOO, the obstruction slowly gets worse over time, causing a progression from initial obstructive symptoms (e.g., urinary hesitancy) to early-stage irritative problems such as urinary frequency that can be quite bothersome.”² “Over many years or decades this disorder can progress to a chronic stage characterized by bladder decompensation with urinary retention and overflow incontinence.”²

The more often the bladder has to work hard to fully empty, the greater the chance the bladder walls will thicken (trabeculation) and lose some or most of their elasticity and ability to expand and contract.⁸ If the bladder’s detrusor muscle fails and results in a decompensated bladder, use of the bladder could be jeopardized, resulting in the need for a permanent catheter.⁹

As a man’s prostate continues to grow larger as he ages, the prostate can encroach on both the urethra and bladder in a progressive manner. It is estimated that roughly 10% of all men will experience urinary retention by the time they reach their 70s. That figure jumps to 30% as men age into their 80s³

With chronic urinary retention being an ongoing issue with many men, it not surprising that it can lead to a variety of symptoms such as a weak urinary stream, difficulty starting urination, and a feeling of incomplete bladder emptying.

Acute Urinary Retention and BPH

Acute urinary retention (AUR) is a sudden and severe inability to urinate. It is considered a medical emergency and requires immediate attention. As acute urinary retention relates to benign prostatic hyperplasia, the prostate may have enlarged enough, or grown sufficiently toward the bladder to completely or significantly block the passage of urine through the bladder neck, to create a BOO.⁴

A man experiencing AUR may encounter severe pain or discomfort as urine continues backing up and as the bladder tries to expand to accommodate the additional urine. BPH is the cause in 65% of all men who present with AUR.⁵ Men who experience AUR have, on average, been presenting with LUTS for an average of 32 months before the onset of AUR.⁶ And men who experience an occurrence of AUR are at a higher risk for subsequent episodes of AUR⁷

Treatment Options for BPH and Urinary Retention

BPH and urinary retention treatment options can be effective for most men depending on each man’s respective symptoms and how large and in what orientation the prostate has grown. These options may include the following:

1. Medications: BPH medications such as alpha-blockers or 5-alpha reductase inhibitors (5-ARI’s) are typically prescribed to help with or alleviate bothersome urinary symptoms by relaxing the smooth muscles in the prostate and bladder neck (alpha-blockers) or reducing the size of the prostate (5-ARI’s).
2. Minimally Invasive Procedures: Numerous minimally invasive BPH procedures can be utilized to address prostate obstruction, improve urinary flow, and relieve lower urinary tract symptoms like urinary retention that are brought on by benign prostatic hyperplasia.
3. Surgery: In severe or difficult BPH and urinary retention cases when other treatments are not effective, surgical intervention may be recommended to remove part or all of the enlarged prostate.
4. Catheterization: In cases of acute urinary retention, a catheter may need to be inserted to relieve the sudden blockage of urine and allow the bladder to fully empty.

 

In Summary

 

The relationship between BPH and urinary retention is based on the enlarged prostate’s compression of the urethra and/or the bladder which can obstruct the flow of urine. As a man gets older and the prostate continues to enlarge, it can cause changes in bladder function and lead to problems with the storage and emptying of urine. Urinary retention can be classified as chronic, acute, or both depending on how it presents at any given moment.

Whether medicine or a corrective procedure is desired for the treatment of benign prostatic hyperplasia and accompanying symptoms such as urinary retention, medical assistance must be sought. A urologist can assess BPH severity and recommend an appropriate course of action or treatment plan based on symptoms experienced and overall health.

 

References:

 

• aigal CS, Joyce G. Economic costs of benign prostatic hyperplasia in the private sector. J Urol173: 1309–1313, 2005. doi: 10.1097/01.ju.0000152318.79184.6f.
• Hughes FM Jr, Sexton SJ, Ledig PD, Yun CE, Jin H, Purves JT. Bladder decompensation and reduction in nerve density in a rat model of chronic bladder outlet obstruction are attenuated with the NLRP3 inhibitor glyburide. Am J Physiol Renal Physiol. 2019 Jan 1;316(1):F113-F120. doi: 10.1152/ajprenal.00400.2018. Epub 2018 Oct 24. PMID: 30353742; PMCID: PMC6383202.
• https://www.yalemedicine.org/conditions/urinary-retention
• https://my.clevelandclinic.org/health/diseases/15181-bladder-outlet-obstruction
• Elhilali M, Vallancien G, Emberton M, et al. Management of acute urinary retention (AUR) in patients with BPH: A worldwide comparison. J Urol. 2004;171:407. A1544.
• McNeill SA, Hargreave TB; Members of the Alfaur Study Group. Alfuzosin once daily facilitates return to voiding in patients in acute urinary retention. J Urol. 2004;171:2316–20.
• Muruganandham K, Dubey D, Kapoor R. Acute urinary retention in benign prostatic hyperplasia: Risk factors and current management. Indian J Urol. 2007 Oct;23(4):347-53. doi: 10.4103/0970-1591.35050. PMID: 19718286; PMCID: PMC2721562.
• https://www.webmd.com/urinary-incontinence-oab/what-is-bladder-trabeculation
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5522790/

 

Important Safety Information

All surgical treatments have inherent and associated side effects. Individual’s outcomes may depend on a number of factors, including but not limited to patient characteristics, disease characteristics and/or surgeon experience. The most common side effects are mild and transient and may include mild pain or difficulty when urinating, discomfort in the pelvis, blood in the urine, inability to empty the bladder or a frequent and/or urgent need to urinate, and bladder or urinary tract infection. Other risks include ejaculatory dysfunction and a low risk of injury to the urethra or rectum where the devices gain access to the body for treatment. Further, there may be other risks as in other urological surgery, such as anesthesia risk or the risk of infection, including the potential transmission of blood borne pathogens. For more information about potential side effects and risks associated with Aquablation therapy for Benign Prostatic Hyperplasia (BPH) treatment, speak with your urologist or surgeon. Prior to using our products, please review the Instructions for Use, Operator’s Manual or User Manual, as applicable, and any accompanying documentation for a complete listing of indications, contraindications, warnings, precautions and potential adverse events. No claim is made that the AquaBeam Robotic System will cure any medical condition, or entirely eliminate the diseased entity. Repeated treatment or alternative therapies may sometimes be required.

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