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What Is an Enlarged
Prostate (BPH)?
The prostate gland is
located below the bladder in men and produces fluid components of semen. Over
half of men ages 60 and above have enlargement of the prostate gland. This
condition is sometimes called benign prostatic hyperplasia or benign prostatic hypertrophy
(BPH). It is not known exactly why this enlargement occurs. However, BPH is not
cancer and does not cause cancer. Some men have BPH symptoms while others do
not.
BPH Symptoms: Frequent Urination
The
most common symptom of BPH includes having to urinate more, often at night. The
reason is that the enlarged prostate gland presses on the urethra, which
carries urine out of the body. Because of this pressure, the bladder muscles
have to work harder to excrete urine. The bladder eventually may start to
contract even when only a small amount of urine is present, creating the urge
to urinate more often.
BPH Symptoms: Difficulty Urinating
Pressure
on the urethra from the enlarged gland and the additional work required of the
bladder muscles lead to other symptoms of BPH as well. These include taking
longer to initiate a urine stream and urinating with a weaker flow than before.
Urine may dribble, or you may feel that there is still urine inside the bladder
even after you have finished urinating.
BPH Symptoms: Inability to Urinate
If
BPH completely blocks the urethra, inability to urinate may result. This can
also happen as a result of infections or if the bladder muscles become
excessively weak. The inability to urinate is a serious condition that can
permanently damage the kidneys or bladder. If this comes on suddenly, go to a
hospital emergency department. If you start to have symptoms of BPH, see your
doctor right away in order to prevent worsening of the symptoms.
Who Gets an Enlarged Prostate (BPH)?
The
prostate gland grows throughout a man's life, starting at puberty and again
from age 25 onward. Typically, there are no symptoms from an enlarged prostate
before age 40. Up to 90% of men have symptoms of BPH by age 85, but only about
one-third of men with BPH symptoms are bothered by the symptoms.
What Causes BPH Prostate Growth?
No
one knows why the prostate continues to enlarge throughout a man's life.
Hormones like testosterone, dihydrotestosterone (DHT), and estrogen may be
involved in regulating the growth of the prostate. Having a vasectomy and
sexual activity do not increase the risk of getting BPH. It is also not
understood why some men have symptoms with BPH while others do not.
Enlarged Prostate: Early BPH Diagnosis
The
symptoms of BPH may mimic symptoms of other conditions, including tumors and
infections. A digital rectal exam can detect BPH in many patients. If you have
symptoms, you should see your doctor to rule out other possible causes of the
symptoms.
Ruling Out Prostate Cancer
Some
of the symptoms of BPH are the same as those of prostate cancer, so many men
are fearful of the symptoms. However, BPH is far more common than prostate
cancer. Men with BPH are no more likely than other men to develop prostate
cancer. However, it's important to have your doctor perform a thorough
examination because the two conditions share symptoms and can even coexist.
How Doctors Diagnose Enlarged Prostate (BPH)
Diagnosis
of BPH is based upon taking a history of your symptoms.
BPH Enlarged Prostate Tests
·
A rectal examination to assess the size and shape of the prostate
·
Ultrasound examination
·
Biopsy of the prostate
·
Urine flow studies
·
Cystoscopy, in which the doctor can see and evaluate the inside of
the bladder
When Should BPH Be Treated?
Whether
or not BPH must be treated depends on the symptoms and their severity.
Recurrent infections, problems urinating, leakage of urine, and kidney damage
can all significantly impact your quality of life. Medications or surgical
treatments may help if you are having severe symptoms.
BPH Treatment: Watchful Waiting
Your
doctor may suggest watching the condition if you have only mild symptoms. You
may need to visit the doctor for a checkup once a year or more often. You may
never need treatment if the symptoms do not worsen. In fact, symptoms tend to
resolve on their own in up to one-third of mild cases of BPH.
BPH Treatment: Lifestyle Changes
Some
lifestyle changes may be able to help with symptom relief.
Lifestyle Changes to Relieve BPH Symptoms
·
Avoid alcohol and caffeine
·
Avoid drinking fluids at bedtime, and drinking smaller amounts
throughout the day
·
Avoid taking decongestant and antihistamine medications
·
Get regular exercise
·
Make a habit of going to the bathroom when you have the urge
·
Practice double voiding (empty the bladder, wait a moment, then
try again)
·
Practice stress management and relaxation techniques
BPH Treatment: Drugs for Urine Flow
Alpha
blockers, drugs often prescribed to treat high blood pressure, can help relax
the muscles in the bladder and prostate, allowing urine to flow more freely.
Alpha blockers that are FDA-approved to treat BPH include silodosin, alfuzosin,
tamsulosin, doxazosin, and terazosin. A common side effect of these medications
is decreased or lack of ejaculation.
BPH Treatment: Drugs to Slow Prostate Growth
5-alpha
reductase inhibitors are drugs that can stop growth of the prostate or even
shrink its size. They work by lowering the production of the hormone DHT.
Examples of these medications are dutasteride and finasteride. The downside of
these drugs is that they can lower sex drive and can cause erectile
dysfunction. It can also take up to a year to see benefits with these drugs.
BPH Treatment: Medicine Combinations
Saw
palmetto is a supplement that showed benefit in some studies in managing BPH
symptoms. In other studies, this effect was not seen. Because there is no clear
benefit and a risk that supplements may interfere with the action of other
drugs, the American Urological Association does not recommend saw palmetto or
other herbal supplements for BPH.
Patients
are urged to discuss the use of any complementary, herbal and/or home remedies
for COPD with their doctors before use.
BPH Treatment: Complementary Medicine
Saw
palmetto is a supplement that showed benefit in some studies in managing BPH
symptoms. In other studies, this effect was not seen. Because there is no clear
benefit and a risk that supplements may interfere with the action of other
drugs, the American Urological Association does not recommend saw palmetto or
other herbal supplements for BPH.
BPH Treatment: Less Invasive Procedures
When
medicines are not effective for symptom relief, procedures to remove excess
prostate tissue can be considered. Two procedures can usually be done in a
urologist’s office: transurethral needle ablation (TUNA), also known as
radiofrequency ablation, and transurethral microwave therapy (TUMT). These
procedures are less invasive than surgery and can be done in less than one hour.
BPH Treatment: Surgery
Common BPH Surgeries
1.
Transurethral Resection of the Prostate (TURP)
TURP is a surgical procedure for relief of BPH. In this procedure an instrument is inserted through the penis and into the urethra to remove some of the prostate tissue.
TURP is a surgical procedure for relief of BPH. In this procedure an instrument is inserted through the penis and into the urethra to remove some of the prostate tissue.
2.
Transurethral Laser Surgery
Transurethral laser surgery is more commonly performed now than TURP. There are three different laser procedures.
Transurethral laser surgery is more commonly performed now than TURP. There are three different laser procedures.
3.
Photoselective Vaporization of the Prostate (PVP)
In this procedure, a laser is used to melt away (vaporize) excess prostate tissue to open the urinary channel.
In this procedure, a laser is used to melt away (vaporize) excess prostate tissue to open the urinary channel.
4.
Holmium Laser Ablation of the Prostate (HoLAP)
This is a similar procedure to PVP, except that a different type of laser is used to melt away (vaporize) the excess prostate tissue.
This is a similar procedure to PVP, except that a different type of laser is used to melt away (vaporize) the excess prostate tissue.
5.
Holmium Laser Enucleation of the Prostate (HoLEP)
In HoLEP surgery, the laser is used to cut and remove the excess tissue that is blocking the urethra. Another instrument, called a morcellator, is then used to chop the prostate tissue into small pieces that are easily removed.
In HoLEP surgery, the laser is used to cut and remove the excess tissue that is blocking the urethra. Another instrument, called a morcellator, is then used to chop the prostate tissue into small pieces that are easily removed.
Will BPH Affect My Sex Life?
The
prostate is an important part of the male sexual anatomy. Prostates produce
semen, and stimulation of the prostate can bring about orgasm.
Some
evidence suggests that older men with BPH may have more sexual problems than
other men their age, and some drugs used to treat BPH can cause problems with
erection and ejaculation. You should talk to your doctor if you develop these
problems, since a change in medications may relieve them.
Living with BPH
Many
men never know they have BPH, and others are never bothered by its symptoms.
But for those who do have troubling symptoms, there are many treatment options
available. See your doctor as soon as you notice any symptoms.
Reviewed by Charles Patrick Davis, MD,
PhD on Tuesday, July 19, 2016
Enlarged Prostate (BPH)
Symptoms, Diagnosis, Treatment
This tool does not
provide medical advice
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