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A non-cancerous condition that affects many men past 50 years of age, enlarged prostate makes urinating more difficult by narrowing the urethra, a tube running from the bladder through the prostate gland. It can be effectively treated by surgery and, today, by certain drugs.
The common term for enlarged prostate is BPH, which stands for benign (non-cancerous) prostatic hyperplasia or hypertrophy. Hyperplasia means that the prostate cells are dividing too rapidly, increasing the total number of cells, and, therefore, the size of the organ itself. Hypertrophy simply means "enlargement." BPH is part of the aging process. The actual changes in the prostate may start as early as the 30s but take place very gradually, so that significant enlargement and symptoms usually do not appear until after age 50. Past this age the chances of the prostate enlarging and causing urinary symptoms become progressively greater. More than 40% of men in their 70s have an enlarged prostate. Symptoms generally appear between ages 55–75. About 10% of all men eventually will require treatment for BPH.
BPH has been viewed as a rare condition in African, Chinese and other Asian peoples for reasons that are not clear.
The cause of BPH is a mystery, but age-related changes in the levels of hormones circulating in the blood may be a factor. Whatever the cause, an enlarging prostate gradually narrows the urethra and obstructs the flow of urine. Even though the muscle in the bladder wall becomes stronger in an attempt to push urine through the smaller urethra, in time, the bladder fails to empty completely at each urination. The urine that collects in the bladder can become infected and lead to stone formation. The kidneys themselves may be damaged by infection or by urine constantly "backing up."
When the enlarging prostate gland narrows the urethra, a man will have increasing trouble starting the urine stream. Because some urine remains behind in the bladder, he will have to urinate more often, perhaps two or three times at night (nocturia). The need to urinate can become very urgent and, in time, urine may dribble out to stain a man's clothing. Other symptoms of BPH are a weak and sometimes a split stream and general aching or pain in the perineum (the area between the scrotum and anus). Some men may have considerable enlargement of the prostate before even mild symptoms develop.
If a man must strain hard to force out the urine, small veins in the bladder wall and urethra may rupture,
causing blood to appear in the urine. If the urinary stream becomes totally blocked, the urine collecting in the bladder may cause severe discomfort, a condition called acute urinary retention. Urine that stagnates in the bladder can easily become infected. A burning feeling during urination and fever are clues that infection may have developed. Finally, if urine backs up long enough it may increase pressure in the kidneys, though this rarely causes permanent kidney damage.
Author Info: David A. Cramer MD, The Gale Group Inc., Gale, Detroit, Gale Encyclopedia of Medicine, 2002
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