Enlarged Prostate (Benign Prostatic Hyperplasia)
The prostate is a small gland in the male reproductive system located below the bladder and surrounding the urethra. It goes through two main periods of growth – first in early puberty, and then starting around age 25. This second phase often results, years later, in benign prostatic hyperplasia (BPH). As the prostate enlarges, the tissue surrounding the gland restricts its expansion, causing it to press against the urethra and impede urination. More than half of men in their sixties and as many as 90 percent in their seventies have symptoms of BPH.
The male hormones testosterone and dihydrotestosterone (DHT) appear to be involved in BPH but the causes of BPH need to be clarified.
Most symptoms of BPH stem from obstruction of the urethra and a gradual loss of bladder function. The most common symptoms involve changes or problems with urination, such as:
- Difficulty starting to urinate
- Interrupted or weak urine stream
- Urine dribbling or leakage
- More frequent urination, or feeling the need to urinate, especially at night It is important to note that while in most cases these symptoms suggest BPH, they also might indicate more serious conditions that require prompt treatment
You may first notice symptoms of BPH yourself, or your physician may determine your prostate is enlarged during a routine checkup. Several tests help the physician identify the problem and required treatments. Among the most common:
- Digital rectal exam: The physician inserts a lubricated, gloved finger into the rectum and feels your prostate through the rectal wall. This exam gives the physician a general idea of the size and condition of the gland.
- Uroflowmetry: The patient urinates into a special device that measures the urine flow and volume.
- Cystoscopy: In this procedure, a thin tube with a tiny camera is inserted into the urethra to view any abnormalities in the urethra or bladder.
Since BPH may cause urinary tract infections, your physician will likely prescribe antibiotics to clear up any infection first. Although the need for treatment is not usually urgent, physicians advise proceeding with treatment as soon as the problem becomes bothersome or presents a health risk:
- Medication: Several drugs treat BPH by relaxing the prostate and bladder muscles, improving urine flow. Other drugs inhibit production of the hormone DHT, which is involved in prostate enlargement.
- Transurethral resection of the prostate (TURP): A tiny instrument with an electrical loop, called a resectoscope, is inserted into the penis and cuts away obstructing tissue while sealing blood vessels.
- Holmium laser enucleation of the prostate (HoLEP): With the patient under general anesthesia, a laser precisely removes the portion of the prostate gland obstructing urine flow, without requiring incisions.
- Transurethral Vaporization of the prostate (TUVP): A tiny instrument with an electrode or laser fiber is passed through the urethra and vaporizes the obstructing tissue.
- Open surgery: When the prostate is very large a surgical incision will be required to remove obstructing prostate tissue.
Urolift System: The UroLift System features permanent implants that act like window-curtain tie-backs that hold the lobes of an enlarged prostate open. Pulling back the prostate relieves pressure on the urethra, which allows urine to flow normally again. Click for more information.
For more information on Enlarged Prostate (Benign Prostatic Hypertrophy), visit WebMD's Prostate Enlargement/BPH Health Center.