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Prostate Enlargement

Understanding Prostate Enlargement

Illustration of normal prostate gland vs. englarged prostate gland

Benign prostatic hyperplasia (BPH)

The prostate is a walnut-shaped gland that is part of the male reproductive system. The prostate goes through two main growth periods as a man ages. The first occurs early in puberty, when the prostate doubles in size. The second phase of growth begins around age 25 and continues during most of a man's life. Benign prostatic hyperplasia (BPH) often occurs with the second growth phase.

As the prostate enlarges, the gland presses against and pinches the urethra. The bladder wall becomes thicker. Eventually, the bladder may weaken and lose the ability to empty completely, leaving some urine in the bladder. The narrowing of the urethra and urinary retention—the inability to empty the bladder completely—cause problems associated with BPH—a condition in men in which the prostate gland is enlarged and not cancerous.

A common condition

The cause of BPH is not well understood; however, it occurs mainly in older men. BPH is the most common prostate problem for men over age 50.

In 2010, as many as 14 million men in the United States had lower urinary tract symptoms suggestive of BPH.

Symptoms

Symptoms of BPH most often come from a blocked urethra or a bladder that is overworked from trying to pass urine through the blockage. Symptoms that suggest BPH may include:

  • Urinating eight or more times a day
  • Inability to delay urination
  • Trouble starting a urine stream
  • A weak or an interrupted urine stream
  • Dribbling at the end of urination
  • Frequent urination during periods of sleep
  • Urinary retention
  • Incontinence—the accidental loss of urine
  • Pain after ejaculation or during urination
  • Urine with an unusual color or smell

Diagnosis

A health care provider diagnoses BPH based on a personal and family medical history, a physical exam, and medical tests, including:

  • Rectal exam. A rectal exam is a physical exam of the prostate. The exam helps the health care provider see if the prostate is enlarged or tender, or has abnormalities that require more testing.
  • Medical Tests. A health care provider may refer men to a urologist—a doctor who specializes in urinary problems and the male reproductive system—though the health care provider most often diagnoses BPH on the basis of symptoms and a digital rectal exam.
  • Urinalysis. Urinalysis involves testing a urine sample.
  • PSA Blood Test. Prostate cells create a protein called PSA. Men who have prostate cancer may have a higher amount of PSA in their blood. However, a high PSA level does not necessarily indicate prostate cancer. In fact, benign prostatic hyperplasia, prostate infections, inflammation, aging, and normal fluctuations often cause high PSA levels. Much remains unknown about how to interpret a PSA blood test.

Treatment

Lifestyle Changes

A health care provider may recommend lifestyle changes for men whose symptoms are mild. Lifestyle changes can include:

  • Reducing intake of liquids, particularly before going out in public or before sleeping
  • Avoiding or reducing caffeinated beverages and alcohol
  • Avoiding or monitoring medications such as decongestants, antihistamines, antidepressants, and diuretics
  • Training the bladder to hold more urine for longer periods

Medications

A health care provider or urologist may prescribe medications that stop the growth of or shrink the prostate or reduce symptoms associated with benign prostatic hyperplasia:

  • Alpha blockers. These medications relax the smooth muscles of the prostate and bladder neck to improve urine flow and reduce bladder blockage.
  • Combination medications. Several studies, such as the Medical Therapy of Prostatic Symptoms (MTOPS) study, have shown that combining two classes of medications, instead of just one, can more effectively improve symptoms, urinary flow, and quality of life.

Surgery

For long-term treatment of BPH, a urologist may recommend removing enlarged prostate tissue or making cuts in the prostate to widen the urethra—the tube that carries urine and semen from the bladder or the ejaculatory ducts.

Surgery for enlarged prostate includes:

  • Transurethral resection of the prostate (TURP)
  • Transurethral incision of the prostate (TUIP)
  • Laser surgery
  • Open prostatectomy

Find Out More

A urologist performs these surgeries using the transurethral method, except for open prostatectomy. Men who have these surgical procedures require local, regional, or general anesthesia and may need to stay in the hospital.

TURP is the most common surgery for BPH. A urologist inserts a resectoscope with a wire loop through the urethra to reach the prostate and cuts pieces of enlarged prostate tissue. Special fluid carries the tissue pieces into the bladder, and the urologist flushes them out at the end of the procedure.

TUIP is a surgical procedure to widen the urethra. The urologist inserts a cystoscope and an instrument that uses an electric current or a laser beam through the urethra to reach the prostate. The urologist widens the urethra by making a few small cuts in the prostate and in the bladder neck.

With laser surgery, a urologist uses a high-energy laser to destroy prostate tissue.

In an open prostatectomy, a urologist cuts through the skin to reach the prostate. The urologist can remove all or part of the prostate through the incision.

Read More "Prostate Enlargement" Articles

Treating the Problem Prostate / Understanding Prostate Enlargement / Dr. Ziya Kirkali: Managing BPH

Winter 2017 Issue: Volume 11 Number 4 Page 11-12