Benign Prostatic Hypertrophy

The prostate gland is part of the reproductive system of men. A normal prostate is about the size and shape of a walnut. The prostate gland makes a fluid that is mixed with sperm to make semen. This gland surrounds the urethra and is located in front of the rectum and just below the bladder. The bladder is where urine is stored. The urethra is the tube through which urine passes from the bladder to get out of the body.

The prostate grows as a man ages. An enlarged prostate not caused by cancer is called benign prostatic hypertrophy (BPH). This is a common health problem in men over age 50. This condition is a normal part of aging. An enlarged prostate presses on the urethra. This makes it harder to pass urine. In the early stages of enlargement, the bladder can get by with a narrowed urethra by forcing the urine through. If the problem gets worse, medical or surgical treatment may be required.

This condition should be followed by your caregiver. Longstanding back pressure on the kidneys can cause infection. Back pressure and infection can progress to bladder damage and kidney (renal) failure. If needed, your caregiver may refer you to a specialist in kidney and prostate disease (urologist).

CAUSES

The exact cause is not known.

SYMPTOMS

  • You are not able to completely empty your bladder.

  • Getting up often during the night to urinate.

  • Need to urinate frequently during the day.

  • Difficultly in starting urine flow.

  • Decrease in size and strength of the urine stream.

  • Dribbling after urination.

  • Pain on urination (more common with infection).

  • Inability to pass your water. This needs immediate treatment.

DIAGNOSIS

These tests will help your caregiver understand your problem:

  • Digital rectal exam (DRE). In a rectal exam, your caregiver checks your prostate by putting a gloved, lubricated finger into the rectum to feel the back of your prostate gland. This exam detects the size of the gland and abnormal lumps or growths.

  • Urinalysis (exam of the urine). This may include a culture if there is concern about infection.

  • Prostate Specific Antigen (PSA). This is a blood test used to screen for prostate cancer. It is not used alone for diagnosing prostate cancer.

  • Rectal ultrasound (sonogram). This test uses sound waves to electronically produce a "picture" of the prostate. It helps examine the prostate gland for cancer.

TREATMENT

Mild symptoms may not need treatment. Simple observation and yearly exams may be all that is required. Medications and surgery are options for more severe problems. Your caregiver can help you make an informed decision for what is best.

Two classes of medications are available for relief of prostate symptoms:

  • Medications that shrink the prostate. This helps relieve symptoms.

  • Uncommon side effects include problems with sexual function.

  • Medications to relax the muscle of the prostate. This also relieves the obstruction.

  • Side effects can include dizziness, fatigue, lightheadedness, and retrograde ejaculation (diminished volume of ejaculate).

Several types of surgical treatments are available for relief of prostate symptoms:

  • Transurethral resection of the prostate (TURP). In this treatment, an instrument is inserted through opening at the tip of the penis. It is used to cut away pieces of the inner core of the prostate. The pieces are removed through the same opening of the penis. This removes the obstruction and helps get rid of the symptoms.

  • Transurethral incision (TUIP). In this procedure, small cuts are made in the prostate. This lessens the prostates pressure on the urethra.

  • Transurethral microwave thermotherapy (TUMT). This procedure uses microwaves to create heat. The heat destroys and removes a small amount of prostate tissue.

  • Transurethral needle ablation (TUNA). This is a procedure that uses radio frequencies to do the same as TUMT.

  • Interstitial laser coagulation (ILC). This is a procedure that uses a laser to do the same as TUMT and TUNA.

  • Transurethral electrovaporization (TUVP). This is a procedure that uses electrodes to do the same as the procedures listed above.

Regardless of the method of treatment chosen, you and your caregiver will discuss the options. With this knowledge, you along with your caregiver can decide upon the best treatment for you.

SEEK MEDICAL CARE IF:

  • You develop chills, fever of 100.5° F (38.1° C), or night sweats.

  • There is unexplained back pain.

  • Symptoms are not helped by medications prescribed.

  • You develop medication side effects.

  • Your urine becomes very dark or has a bad smell.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You are suddenly unable to urinate. This is an emergency. You should be seen immediately.

  • There are large amounts of blood or clots in the urine.

  • Your urinary problems become unmanageable.

  • You develop lightheadedness, severe dizziness, or you feel faint.

  • You develop moderate to severe low back or flank pain.

  • You develop chills or fever.