BPH (Enlarged Prostate)

The prostate is a small, muscular gland in the male reproductive system. Surrounding a portion of the bladder and urethra, the prostate produces most of the fluid in semen that allows sperm mobility during ejaculation. The muscular action of the prostate helps propel the fluid and semen through your penis during sexual climax.

Benign prostatic hypertrophy, or benign prostatic hyperplasia (BPH) occurs when the cells of the prostate gland begin to multiply. These additional cells swell your prostate gland, which squeezes the urethra and limits the flow of urine.

Obstruction may be so severe that no urine can leave the bladder at all. This is called bladder outlet obstruction (BOO) and it is a complication of BPH. It can be dangerous because urine trapped in the bladder will cause urinary tract infections and damage your kidneys.

BPH is not the same as prostate cancer. It is a benign condition that does not increase the risk of cancer. BPH is a common condition in men over the age of 50.

BPH is considered a normal condition of male aging, and it is estimated that 90 percent of men over the age of 80 have BPH. Although the exact cause is unknown, changes in male sex hormones as you age may be a factor. Any family history of prostate problems or any abnormalities with your testicles may raise your risks for BPH. Men who had their testicles removed at a young age do not develop BPH.

Fewer than 50 percent of men with BPH have severe enough symptoms to make them seek a doctor’s care. Symptoms include:

• incomplete bladder emptying
• nocturia (the need to urinate two or more times per night)
• dribbling at the end of the urinary stream
• incontinence
• the need to strain when urinating
• weak urinary stream
• sudden urge to urinate
• slowed or delayed urinary stream
• painful urination
• bloody urine
• pus in the urine

Evaluation for BPH begins with a physical exam and review of your medical history. The physical exam includes a rectal examination that allows the doctor to estimate the size and shape of your prostate. Other tests can include:

• a urinalysis or urine culture will check your urine for blood and bacteria
• prostate biopsy (small amount of prostate tissue is removed and examined for abnormalities)
• urodynamic tests (your bladder is filled with liquid via a catheter to measure bladder pressure during urination)
• prostate-specific antigen (PSA, a blood test for to check for cancer of the prostate)
• post void residual (to see how much urine is left in the bladder after urination)
• cystoscopy (examines your urethra and bladder through a tiny lighted instrument inserted into the urethra)
• rectal ultrasound and prostate biopsy (to confirm diagnosis of BPH and rule out malignancy)
• intravenous pyelogram or urogram (dye is injected into your system which reveals your entire urinary system on an X-ray or computed tomography (CT) scan)

Treatment of BPH can begin with self-care. If symptoms don’t subside through self-care, medication or surgery may be recommended. Your age and general health will also influence the prescribed treatment. Self-care includes the following:

• Urinate as soon as you feel the urge.
• Make a habit of going to the bathroom to urinate, even when you don’t feel the urge.
• Avoid taking over then counter decongestants or anti-histamine medications. They can make it harder for the bladder to empty.
• Avoid alcohol and caffeine, especially in the hours after dinner.
• Reduce stress. Nervousness can increase the frequency of urination.
• Exercise regularly. Lack of exercise can aggravate symptoms.
• Learn and practice Kegel exercises to strengthen pelvic muscles.
• Keep warm. Being cold can make symptoms worse.

Other treatment options include:

Medications

Alpha-1-blockers, these medications relax the muscles of the bladder neck and prostate. Medications to reduce the levels of testosterone such as dutasteride and finasteride are commonly prescribed. Antibiotics are also prescribed when inflammation of the prostate accompanies BPH.

Alpha-1-Blockers

Alpha-blockers relax the neck of the bladder and make it easier for urine to flow. Examples of alpha-1-blockers are doxazosin, prazosin, alfulzocin, terazosin, and tamsulosin.

Hormonal Reduction

Dutasteride and finasteride are two medications that lower the levels of hormones produced by the prostate gland. With some cases, when hormonal levels decrease, the size of the prostate decreases and urine flow improves. On the downside, however, these medications may also cause impotence and decreased sex drive.

Antibiotics

Antibiotics can be used if your prostate becomes chronically inflamed, a condition known as prostatitis. Treating prostatitis with antibiotics can also improve your symptoms of BPH. Antibiotics are also helpful with urinary tract infections (UTIs). These infections can occur whenever urine flow from the bladder is decreased.

Minimally Invasive Procedures

There are minimally invasive procedures available that may be used in an outpatient setting.

These involve inserting an instrument into your urethra and into the prostate gland. Here is a list of these non-surgical alternatives:

• transurethral needle ablation (TUNA) (radio waves are used to scar and shrink prostate tissue)
• transurethral microwave therapy (TUMT) (microwave energy is used to eliminate prostate tissue)
• water induced thermotherapy (WIT) (heated water is used to destroy excess prostate tissue)
• high-intensity focused ultrasound (HIFU) (sonic energy is used to eliminate excess prostate tissue)

Surgery for BPH

Surgery in a hospital setting might be recommended if you have any of the following symptoms:

• kidney failure
• bladder stones
• recurrent UTIs
• incontinence
• inability to empty the bladder
• recurrent blood in the urine

Surgery can relieve symptoms of BPH, but BPH can return even after surgical intervention. Here’s a list of surgeries relevant to an enlarged prostate.

• Tranurethral resection of the prostate (TURP) is the most commonly used surgical treatment for BPH. A small instrument is inserted through your urethra into the prostate. The prostate is then removed piece by piece. This procedure usually requires a hospital stay.
• Simple prostatectomy: An incision is made in your abdomen or perineum (the area behind the scrotum). The inner part of your prostate is removed, leaving the outer part behind. This procedure uses general or spinal anesthesia. Hospitalization may last for five to 10 days.
• Transurethral incision of the prostate (TUIP): This procedure starts off similar to TURP, but the prostate is not removed. Instead, a small incision is made in your prostate that will enlarge your bladder outlet and the urethra. The incision allows urine to flow more freely. You may or may not require a hospital stay with this procedure.

Men who have long-standing history of BPH may develop the following complications:

• urinary tract infections
• urinary stones
• kidney damage
• bleeding in the urinary tract
• sudden onset of an inability to urinate

Many men ignore their symptoms of BPH. However, early treatment can help you avoid potentially dangerous complications. Call your doctor if you are urinating less than usual and your bladder is not emptying completely. Let your doctor know if you are experiencing chills, fever, pain in you back, side or abdomen, and if you see blood or pus in your urine.

Also, talk with your doctor about any of your medications that might be affecting your urinary system, such as antidepressants, diuretics, antihistamines or sedatives. Your doctor can make any necessary medication adjustments. Do not attempt to adjust your medications or doses yourself. Let your doctor know if you have taken self-care measures for your symptoms (for at least two months) without any noticeable improvement.