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Enlarged Prostate

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Benign prostatic hyperplasia or BPH

  • The prostate gland surrounds the urethra (tube through which urine flows outward) near the bladder.  The prostate gland makes a fluid that is a component in ejaculate (along with semen).  In a large percentage of men, the prostate gland enlarges with age.  The enlarging prostate slowly "chokes" the urethra, decreasing the urinary force and flow.
  • The cause is unknown, but hormonal effects seem to play a role, as men with damaged testicles or castrated men often have a regression of BPH.

  • Decreased urinary force
  • Decreased urinary flow
  • Intermittent urinary stream
  • Urinary hesitancy
  • Increased urinary frequency
  • Nighttime urinary frequency
  • Urinary urgency

  • Examination
    1. Rectal examination reveals Enlarged Prostate
    2. Abdomen may have a distended bladder (since bladder is unable to void completely).
  • Laboratory tests:
    1. Blood Urea nitrogen and Creatinine may be elevated if there is significant urinary retention
    2. Urinalysis to make sure no infection is present
    3. Prostate specific antigen to exclude Prostate Cancer
  • Urinary tests:
    1. Post void residual (patient tries to urinate all of his urine, then a catheter is placed to see what volume remains in the bladder)
    2. Urodynamic evaluation -- measures urinary flow rate
    3. Cystourethroscopy (passing a scope into the urethra and bladder) if the diagnosis is uncertain

  • Medications
  • Alpha-blocker medications -- e.g., Hytrin, Cardura, and Flomax
  • Finasteride (Proscar) -- based on current studies its usefulness is limited
  • If considering alternative therapies or preventive (low animal product diets) supplements and herbs, such as Zinc picolinate, B6 vitamin, flaxseed oil, linseed oil, alanine, glutamic acid, saw palmetto berries, panax ginseng, vitamin E, or selenium, discuss it first with your physician.  Studies are on the way on some of these therapies that may provide a viable alternative to medications and surgery in some patients.
  • Surgery:
    1. Transurethral prostate resection (TURP) -- commonly called the "roto-rooter job." Excess prostate tissue is surgically removed from inside the urethra.  Complications of surgery that may occur include retrograde ejaculation (i.e., into bladder, but still have orgasms), scarring of the bladder neck and urethra, urinary incontinence.
    2. Microwave treatment -- prostate is heated up and this results in its shrinkage.
    3. Transurethral needle ablation -- electrodes are placed in the prostate and radio frequency energy, heat and destroy prostate tissue.  Less effective, but there are fewer side effects than in TURP.
    4. High frequency focused Ultrasound, interstitial laser coagulation, water-induced thermotherapy, and transurethral balloon dilation are some of the noninvasive procedures that may be discussed with your urologist.
    5. Comment: TURP is still the "gold standard" of surgical treatment, and the most effective treatment, though significant complications do occur in a small percent of patients.
    6. Generally, Benign Prostatic Hyperplasia is treated when symptoms become intolerable.  Frequent night urination or interference with daily activities warrants treatment.  Most physicians prescribe a trial of alpha-blocker medications.  If this fails, surgery is usually warranted.  The only time surgery is mandatory is if there is a significant obstruction of the prostate and/or there is interference with kidney function.




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