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Urinary Disorders

Prostate Enlargement (BPH)

Prostate enlargement, or benign prostatic hyerplasia (BPH) is extremely common to men as they age. More than half of men in their sixties and as many as 90 percent of men in their seventies and beyond exhibit some symptoms of BPH.

The prostate grows gradually throughout much of a man's life. Eventually, the growth can cause the prostate to begin to press against the urethra. When this happens, it interrupts the urine stream in much the same way that stepping on a garden hose would interrupt water flow. This can cause discomfort or pain, and can even lead to bladder damage if untreated.

Risk Factors

Age is the only risk factor, so there's no way of avoiding BPH. The prostate undergoes two major growth spurts: the onset of puberty and at around age 25. This second growth period continues throughout a man's life, but doesn't usually cause problems until later in life. 

Symptoms

Some men exhibit no symptoms of age-related prostate enlargement, or BPH, while others:

If untreated, BPH can lead to such serious complications as:

Diagnosis

Sometimes BPH is diagnosed because the patient reports the symptoms to his doctor. But at other times the condition is uncovered during a routine checkup.

All men over the age of 40 are urged to have an annual digital rectal exam, or DRE. Your doctor will use a rubber glove and inserted a lubricated finger into the rectum to feel for the shape and texture of the prostate. This examination can reveal the possibility of a full range of prostate-related conditions including BPH.

If your doctor suspects enlargement as a concern, you will be asked to undergo one or more of a range of tests to positively diagnose BPH and to rule out cancer. These tests include:

Prostate Specific Antigen (PSA) blood test: PSA, a protein produced in the prostate, is often found at elevated levels in the bloodstreams of men with cancerous prostates.

Rectal Ultrasound: This is another test that can be administered when cancer is suspected. A probe carefully placed in the rectum emits sound waves whose echo pattern forms an image of the prostate gland on a display monitor, allowing your doctor to detect a diseased organ.

Cystoscopy: Once the area is numbed, a small tube, or cystoscope, is inserted into the urethra through the penis. This instrument contains a light and camera lens so that the doctor can see the inside of the urethra and the bladder on a screen, and detect obstruction from an enlarged prostate.

Urine Flow Study: Your doctor might ask you to urinate into a device that measures the force of the urine stream. Reduced flow suggests prostate blockage.

Treatment Options

Mild prostate enlargement is sometimes left untreated. It might be only when the conditions brings on discomfort or even health risk that treatment is offered. Your doctor might instead wish to keep an eye on the situation with regular checkups.

When the condition does require treatment, it can take various forms:

Drug Treatments

Several drugs have been proven effective at shrinking or at least stopping the growth of the enlarged prostate. These include:

Finasteride: Available under the product name Proscar, inhibits products of the hormone involved in prostate enlargement. The drug can be effective in stopping the enlargement and, in some men, even in shrinking the prostate.

Dutasteride: Available under product name Avodart. Works much the same way as finasteride.

Alpha Blockers: This family of drugs includes terazosin (marketed as Hytrin), doxazosin (Cardura), tamsulosin (Flomax), and alfuzosin (Uroxatral). All of these drugs relax the smooth muscle of the prostate and bladder neck to reduce obstruction and improve urine flow.

Finasteride/Doxazosin: When used together, these two drugs are especially effective in many cases.

Minimally Invasive Therapy

Minimally invasive surgery can be performed in your urologist's office with little or no recovery time. If drug therapy proves ineffective, this is most likely your next option. Minimally invasive therapy includes:

Transurethral Microwave Procedures: This consists of two different treatment options, both of which use microwave technology to heat and destroy excess prostate tissue. Although it sounds painful, microwave technology can be administered on an outpatient basis in about an hour, and without anesthetic. While it doesn't cure BPH, microwave technology can reduce urination problems brought on by the enlargement.

Transurethral Needle Ablation (TUNA): This is another method of burning away excess tissue. Through the TUNA System, low-level radiofrequency energy is delivered to the targeted area while shielding protect the rest of the nearby urinary tract.

Surgery

In rare instanced where neither drugs nor minimally invasive surgery are effective, the next recourse is surgery. Only the obstructing, enlarged tissue will be removed, and the prostate should retain its full function. Your doctor will consider three forms of surgery:

Transurethral Surgery: This method involves no external incisions. Through a process known as transurethral resection of the prostate (TURP), an instrument is entered into the body through the urethra after anesthesia is administered, and used to cut and flush away excess tissue. This instrument, a resectoscope, contains a light, valves to direct the flow of water to remove the tissue, and an electrical loop that cuts tissue and cauterizes blood vessels. Once the surgeon cuts the obstructive tissue, the water flushes it into the patient's bladder. From there, it's expelled from the body in the next urine stream. The operation takes about 90 minutes, and recovery time is brief, although the patient will require an overnight stay in a hospital.

Open Surgery: If the prostate is particularly enlarged, or the bladder is damaged and must be repaired, or there are other complicating factors, conventional surgery might be the best option.

Laser Surgery: This method involves a laser inserted through the urethra into the prostate through a cystoscope. Several laser bursts, each 30-60 seconds in duration, vaporize the obstructive tissue. There's little blood loss and recovery time is briefer than for conventional surgery.

After Surgery

Regardless of the surgical method your physician recommends, there will be a recovery time. Your physician will ask that you do the following for a period of time following your surgery:

For the first few days after surgery, you might experience:

These conditions should improve once your bladder regains full functioning, however but if the blood in the urine is rich red in color or there's clotting, call your doctor.

You should regain full sexual function, though perhaps not immediately. In fact, it could take as long as one year to perform as before. If you had the ability to attain an erection before surgery, this should return. However, sterility could occur in that the surgical procedure might cut through the muscle that normally channels semen into the penis. As a result of the loss of this muscle, the semen is rerouted into the bladder and is later expelled in the urine stream.

Prostatic Stents

As a final treatment option when all else fails, prostatic stents are spring-like devices that are inserted into the urethra to the blockage area. When the device springs open, it pushes back the obstructive prostate tissue, once again allowing full urine flow.

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Last Reviewed: Mar 02, 2007

Martin I Resnick, MD Martin I Resnick, MD
Formerly, Professor of Urology
School of Medicine
Case Western Reserve University