What is the prostate gland?
The prostate is a small organ about the size of a walnut. It lies below the bladder (where urine is stored) and surrounds the urethra (the tube that carries urine from the bladder). The prostate makes a fluid that helps to nourish sperm as part of the semen (ejaculatory fluid).
Prostate problems are common in men 50 and older. Most can be treated successfully without harming sexual function. A urologist is a specialist in diseases of the urinary system, including diagnosing and treating problems of the prostate gland.
How does the doctor detect prostate enlargement?
A doctor usually can detect an enlarged prostate by rectal exam. The doctor also may examine the urethra, prostate, and bladder using a cytoscope, an instrument that is inserted through the penis.
What is benign prostatic hyperplasia?
Benign prostatic hyperplasia is nonmalignant (noncancerous) enlargement of the prostate gland, a common occurrence in older men. It is also known as benign prostatic hyperplasia and abbreviated as BPH.
When does benign prostatic hyperplasia start?
BPH generally begins in a man's 30s, evolves slowly, and most commonly only causes symptoms after 50.
What happens in BPH? What are symptoms of BPH?
In BPH, the prostate gland grows in size. It may compress the urethra which courses through the center of the prostate. This can impede the flow of urine from the bladder through the urethra to the outside. It can cause urine to back up in the bladder (retention) leading to the need to urinate frequently during the day and night. Other common symptoms include a slow flow of urine, the need to urinate urgently and difficulty starting the urinary stream. More serious problems include urinary tract infections and complete blockage of the urethra, which may be a medical emergency and can lead injury to the kidneys.
Male Torso Picture - Benign Prostatic Hyperplasia (BPH)
How common is BPH? Are there any risk factors?
BPH is extremely common. Half of all men over 50 develop symptoms of BPH, but only 10% need medical or surgical intervention.
Is BPH a type of cancer?
No! BPH is completely benign. It is not a precursor (a forerunner) to prostate cancer.
1. Watchful Waiting
If your symptoms are mild, your doctor may recommend simply monitoring the situation before taking action.
2. Oral Therapy
Oral therapy has potential for symptom relief. It has the advantage of no surgery. Disadvantages include ongoing medication therapy, risks of side effects, high out of pocket cost, and sometimes over time effectiveness diminishes. Certain men also do not like to take medications.
2.1. Alpha Blocker Drugs
This is the most common way to treat BPH. Medicines like Flomax, Cardura, Hytrin and Uroxatral have proven to be effective in the treatment of most cases. Alpha Blockers relieve the obstruction by trying to stop the process by which the construction occurs. They basically relax the smooth muscle cells in the prostate to relieve urinary obstruction. Like most medicines side effects can occur. They are mild in most cases and include dizziness on standing, feeling fatigued, loss of ability to ejaculate with orgasm.
2.2. Alpha Reductase Inhibitors
Avodart and Proscar are drugs that work by bringing about hormonal changes that actually shrink the prostate. These however must only be used by men who exhibit clear signs of prostate enlargement, not just LUTS. Side effects include excess hair growth, decrease volume of ejaculation and decreased sexual desire.
3. Minimally Invasive Procedures
These generally tend to be far more effective that the oral medicines but can carry greater risks. They include:
* Thermotherapy
* Urethral Stent
* Transurethral Microwave Therapy (TUMT)
3.1. Thermotherapy
In Thermotherapy, heat is applied to the prostate to destroy the prostate tissue. Heat can be applied using several different sources, including microwave energy as with Thermatrx Dose Optimize Thermotherapy (DOT). The heat causes changes in the prostate tissue and results in improvement of symptoms. There is no cutting or incision. Oral drugs are given to help you relax and the procedure is well tolerated. Most patients have only minor discomfort. You may have a urine drainage catheter 2-5 days after treatment. The Thermatrx system continues to measure the prostate temperature to ensure you are given the optimal “dose of heat”. The procedure is done in the doctor’s office and takes about 90 minutes. No hospital stay is required. No sexual side affects have been reported. Your doctor will perform tests to see if it is the right treatment option for you. Medicare and most private insurance plans cover Thermatrx.
Advantages of Thermatrx include long lasting symptom relief, and it is an alternative to cost, side effects and inconvenience of other therapies. In clinical trials, patients did not report incontinence or retrograde ejaculation as a result of the treatment. It had minor short term side effects only which usually went away on their own and id does not effect one’s ability to take ED medications. It is FDA approved as safe and effective.
3.2. Urethral Stent:
Urethral stent is a mesh tube that holds the urethra open at the point of obstruction. It immediately improves the flow of urine. The stent is placed through the procedure in an out-patient procedure. It has been clinically proven to maintain these results over the long term. No catheter is required after most procedures. It is fully incorporated within the body. This procedure is easy and safe and can be done under local anesthesia but is usually reserved for cases of recurrent stricture of the bladder opening.
3.3 . Transurethral Microwave Therapy (TUMT):
In Transurethral Microwave Therapy, an instrument called an antenna, that send out microwave energy is inserted though the urethra to a location inside the prostate. The temperature becomes high enough inside the prostate to kill the extra tissue. As this part of the prostate heals, it shrinks, reducing the blockage of urine flow. This is an out patient procedure done under general or spinal anesthesia. The main complication of TUMP is the inability to urinate for more than a week but can be treated by inserting a catheter.
4. Surgical Treatment
4.1. Surgical removal of the prostate (Prostatectomy)
If your BPH symptoms are severe and all other treatment options have not been successful, surgery (prostatectomy) may be recommended. These surgeries remove large amounts of prostate tissue. They have to be performed in the hospital, require general anesthesia and carry risks of side effects. (ED and Incontinence being some of them).
4.2. Transuretheral resection of the prostate (TURP)
This is one of the most common surgeries performed. With TURP, the inner portion of the prostate is cut out through the urethra using a cystoscope. It is effective in most cases and can provide long-term relief. It requires a hospital stay. Side effects can include bleeding, loss of ejaculation and in rare instances, incontinence and erectile dysfunction.
4.3. Laser Surgery
This is essentially very similar to the TURP. Where as in the TURP the electric current is used to cut the prostate, here a laser beam is used instead. Laser surgery is a relatively newer treatment and its advantage is that bleeding is markedly reduced and patients can be discharged much sooner. With over 200,000 procedures performed worldwide, the GreenLight procedure is creating a new standard of care.
http://www.urologicalcare.com/urinary-dysfunction/bph-treatment/
http://www.medicinenet.com/benign_prostatic_hyperplasia/article.htm