Benign Prostatic Hyperplasia Clinical insights

Clinical Insights: Benign Prostatic Hyperplasia (BPH)

Benign Prostatic Hyperplasia (BPH) is a common condition in men, particularly as they age. It involves the non-cancerous enlargement of the prostate gland, which can lead to urinary symptoms such as increased frequency, urgency, difficulty starting or stopping urine flow, weak stream, and incomplete bladder emptying.

Several studies have shown that ESWT can improve symptoms of non-bacterial prostatitis, which shares similar symptoms with BPH, including pain relief and improved urinary function. For example, a meta-analysis found that ESWT significantly improved the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) score, pain levels, and quality of life in patients compared to a placebo group. It concluded that ESWT is a safe and effective treatment option, although further long-term studies are necessary to establish standardized protocols(

Key Insights:

Pathophysiology: BPH occurs when prostate cells multiply, leading to the enlargement of the prostate gland. This growth can compress the urethra, causing urinary difficulties.
Risk Factors: Age, family history, hormonal changes, and lifestyle factors (like obesity or lack of exercise) can contribute to the development of BPH.
Symptoms: Common symptoms include frequent urination, especially at night (nocturia), weak or interrupted urine stream, urgency, and difficulty starting urination.
Diagnosis: Diagnosed through physical examination, digital rectal exam (DRE), PSA blood test, urinalysis, and possibly imaging (like ultrasound) or urodynamic tests.
Treatment Options:
- Medications: Alpha-blockers (e.g., tamsulosin) and 5-alpha reductase inhibitors (e.g., finasteride) to relax prostate muscles or shrink the prostate.
- Minimally Invasive Procedures: Such as UroLift, Rezūm, or laser therapy to remove or reduce excess prostate tissue.
- Alternative Treatments: Non-invasive therapies like Electromagnetic Transduction Therapy (EMTT), Focused Shockwave Therapy (ESWT), and lifestyle modifications (diet, exercise).
- Surgical Options: For severe cases, Transurethral Resection of the Prostate (TURP) or other surgical procedures may be required.
Management: Regular monitoring, lifestyle changes (diet, exercise), and medications or minimally invasive treatments can help manage symptoms effectively.

Understanding BPH's nature, risk factors, and treatment options allows for a personalised approach to managing symptoms and improving quality of life

The prostate is a walnut-sized gland that wraps around the urethra (the tube draining the bladder). The prostate functions in the production and delivery of the ejaculate to the penis. Almost all men will have growth of their prostate as they age, so benign prostatic hyperplasia (BPH), an enlarged prostate, is a common problem for men as they get older. Evidence of BPH can be seen in men aged 40-50, with more than 60% experiencing some degree of symptoms by age 60 and up to 80% by age 80. As the prostate grows, the enlarged tissue can obstruct the flow of urine by squeezing on the urethra, thereby increasing the resistance to the flow. While men with BPH may report a variety of symptoms, some of the most common include slow or interrupted stream, getting up at night (nocturnal) having to void more frequently or urgently, hesitancy in initiating a stream, incomplete emptying, and dribbling urine at the end of a void. Urinary symptoms related to an enlarged prostate requires treatment in up to about 20% of men and brings these men to seek medical treatment or relief.

The ESWT is an effective, safe, and noninvasive treatment for BPH in selected patients whose medical treatment has faced failure and are poor surgical candidates or they seek new alternative non invasive treatment.

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FAQ's

What is Shockwave Therapy?

Low-Intensity Shockwave Therapy (Li-SWT) is a treatment modality that utilizes acoustic (sound) waves to target damaged or impaired tissue to encourage the body to create healthier tissue. It also helps stimulate blood vessel growth. Shockwave therapy has been safely used for decades. Today it is being successfully used to treat conditions such as erectile dysfunction (ED), Peyronie’s Disease, and sometimes male or female pelvic pain.

How Does Shockwave for ED Work?

Shockwave therapy is an alternative to traditional treatments, such as oral medications (Viagra, Levitra, and Cialis), vacuum erection devices, injectable medications, and intra-urethral suppositories.

When treating ED with shockwave therapy, low-intensity shock waves are applied to different treatment zones on the penis and on the perineum. Using targeted high-energy sound waves, Li-ESWT can speed up tissue repair and improve blood flow, nerve regeneration, and cell growth. This helps improve the strength and quality of erections.

Is Shockwave Therapy Painful?

While “shockwave” on the surface may sound unpleasant, patients typically tolerate it well. It applies short, frequent, and high-intensity bursts of energy (in the form of ultrasonic sound waves) into soft tissue. Some patients may experience mild discomfort during or after their procedure.

What Should I Expect for My Appointment?

Prior to your appointment, you may be instructed to shave the affected area. For example, you may be asked to shave the testes and penis prior to treatment for ED. There are no other preparations needed for your procedure.

Appointments take approximately 30 minutes, and the procedure itself usually takes about 15-20 minutes. However, sessions may be longer depending on the customised treatment for each individual. Patients usually require six (6) treatments, with the effects expected to last for two to three years. The treatment may be repeated, if needed, after that timeframe.

Treatments are not uncomfortable, and people do not require pain relief or aesthetic; however, patients may have soreness, redness, or some bruising in the treatment area. There are no restrictions following the therapy, but you should take it easy for the rest of the day.

How Much Does Shockwave Therapy Cost?

Medical aid do not cover Shockwave Therapy, and patients should expect to pay out-of-pocket. At Shockwave Clinic, the cost pr treatment is Rand 2400.00 and 6-8 weekly treatments are normally required as the minimal about of treatments to get the full benefit.

Is Shockwave Therapy Right For You?

Your urologist will discuss your individual situation and help you determine if shockwave therapy is an appropriate treatment option for you.

Erectile Dysfunction

Erectile dysfunction (ED) is a very common sexual disorder affecting more than 1 in 5 men. ED is the inability to achieve and/or maintain an erection for sexual intercourse. While most often associated with older men, ED affects a significant proportion of younger men. When treating ED with shockwave therapy, low-intensity shockwaves are applied to different treatment zones on the penis and on the perineum

“Erectile dysfunction is a common disorder of men that increases with age and may profoundly affect their quality of life. Low-intensity shock wave therapy has been proven to be effective treatment for erectile dysfunction. We use the DUOLITH® SD1 to treat patients with vascular erectile dysfunction with good success”
Milad Hanna, M.B., B.Ch. FRCS – NHS Trust, London.

Peyronie’s Disease

Peyronie’s disease is a condition that causes bending of the penis. The problem is caused by scar tissue, called plaques, that forms inside the penis. The disease is generally progressive, most men first notice the presence of the disease when they feel thickened areas (plaques) under the skin of the penis. As the disease progresses further, pain may occur with or without an erection as the penis becomes more curved. The condition can make sexual intercouse difficult or impossible. Shockwave therapy directly targets the pain points and breaks down the plaques within the penis.

“We use the DUOLITH® SD1 to treat several andrological conditions such as erectile dysfunction (ED), chronic pelvic pain syndrome (CPPS) and Peyronie’s. The DUOLITH® SD1 is very easy to operate and provides excellent results. Patients experience safel and gentle treatments”
Professor Lars Lund, MD, DMSci, Head of Research Department of Urology Odense University Hospital and University Denmark.

Chronic Pelvic Pain Syndrome / Prostatitis

Also known aschronic prostatitis, Chronic Pelvic Pain Syndrome (CPPS)is characterized by pain in the region of the pelvic floor and / or urination problems without evidence of urinary tract infection. Some patients experience erectile dysfunction. CPPS is found in men of any age, with the peak incidence in men aged 35 – 45 years. Extracorporeal shockwave therapy (ESWT) is performed using a perineal approach, treating both the prostate and the pelvic floor.

Hard-Flaccid Syndrome

Hard flaccid syndrome is a condition which causes men’s penises to be permanently semi-erect, even if they are not aroused. Erections are typically difficult to achieve, may not be as rigid and men with the condition may find they require more stimulation or arousal than they did before. The condition can be quite painful for those who have it, particularly during ejaculation, urination and erection.

Shockwave therapy for hard flaccid is a treatment that can help treat erection problems associated with the condition and can also relieve pain and repair some of the damage done to the penis.