What is benign prostatic hyperplasia?
Benign prostatic hyperplasia (BPH) is a prostate gland that is
bigger than normal. The prostate is part of a man's reproductive
system. It is, on average, a little bigger than a walnut. It is
located between the base of the bladder and the beginning of the
penis. It surrounds the upper part of the urethra. (The urethra
carries urine from the bladder out through the penis.) When the
prostate gets bigger, it may put pressure on the urethra and cause
problems with urination.
BPH is a common health problem for men over age 60. Other names
for this condition are benign prostatic hypertrophy and enlarged
prostate.
How does it occur?
Usually by the age of 40 a man's prostate gland starts to enlarge.
This can make the passageway through the urethra smaller. The
bladder muscle forces urine through the narrowed urethra by
squeezing more strongly. This can make the bladder muscle thicker
and more sensitive. The change in the muscle can cause urination
problems, such as a need to urinate more often. As the prostate
grows even bigger, the urethra may be squeezed more tightly. This
may make it hard for the bladder to empty completely.
What makes the prostate get bigger is not known.
What are the symptoms?
Many men with enlarged prostates have no symptoms. If you have
symptoms, they may include:
- a weak stream of urine
- stopping and starting of the stream of urine
- leaking of urine
- dribbling of urine, especially after urinating
- a feeling that the bladder is not empty
- trouble starting to urinate
- urinating more often, especially at night
- a strong and sudden desire to urinate
- blood in the urine.
Rarely, BPH may cause urinary tract infections. If you have an
infection, you may have burning or pain during urination.
BPH may also cause a sudden inability to urinate. This is called
acute urinary retention and is a medical emergency.
How is it diagnosed?
Your healthcare provider will ask about your medical history and
symptoms. Your provider will examine you to check for other
medical problems that might cause your symptoms.
You will have a rectal exam. Your provider can feel the prostate
by putting a gloved, lubricated finger into the rectum. The exam
allows your provider to estimate the size and condition of the
prostate.
You may have urine tests to check for blood or signs of infection.
You may have blood tests to check for kidney problems or
prostate-specific antigen (PSA).
Your provider may refer you to a urologist for more tests.
Urologists specialize in diseases of the urinary tract and the
male genital tract. Before you are treated for BPH, it is
important to rule out other diagnoses, such as cancer. Other tests
you might have are:
- Rectal ultrasound and prostate biopsy: A probe put into the
rectum sends sound waves at the prostate to create a picture
of the prostate gland. Your provider may use a needle, guided
by the ultrasound images, to collect a few pieces of prostate
tissue for lab tests.
- Urine flow study: This test measures how fast urine flows when
you urinate.
- Cystoscopy: For this test your provider uses a slim, flexible,
lighted tube inserted through the urethra to look at the
bladder and prostate. (You are given a solution to numb the
inside of the penis so that you will have little discomfort
during the test.)
How is it treated?
If you have BPH but no symptoms, or your symptoms are mild, you
may not need any treatment. Your provider may advise you to have
regular exams to be sure that you are not developing more serious
problems. This is called watchful waiting. Your symptoms may get
better without treatment.
If your symptoms become bothersome or are a health risk, your
provider may recommend treatment. BPH may be treated with
medicines or various procedures.
These medicines may be used for treatment of BPH:
- Finasteride (Proscar) and dutasteride (Avodart) can stop the
prostate from getting larger. These drugs may even cause the
prostate to get smaller. As a result, your symptoms may get
better. These drugs do not work for everyone.
- Alpha blockers, such as terazosin (Hytrin), doxazosin
(Cardura), tamsulosin (Flomax), and alfuzosin (Uroxatral),
relax the muscles in the prostate. These medicines can often
lessen symptoms.
Drug treatment does not always work. Different procedures may be
done to relieve BPH symptoms.
- Transurethral microwave thermotherapy (TUMT) uses microwaves
to heat and destroy excess prostate tissue. The procedure
takes about 1 hour and can be done without general anesthesia.
TUMT does not appear to cause erectile dysfunction (impotence,
or ED) or loss of bladder control (incontinence). Microwave
therapy does not cure BPH, but it lessens symptoms, such as
having to urinate too often. It does not always correct the
problem of incomplete emptying of the bladder.
- Transurethral needle ablation delivers low-level radio waves
through needles to burn away part of the enlarged prostate.
This procedure improves urine flow and relieves symptoms. It
does not appear to cause incontinence or ED.
- Surgical removal of the enlarged part of the prostate is often
the best long-term solution for BPH.
- Removal of the prostate reduces pressure on the urethra
and generally gives relief from symptoms. The common
surgical procedure for BPH is transurethral resection of
the prostate (TURP). For this procedure the surgeon
removes just the part of the prostate that is pressing on
the urethra. The surgeon uses a small scope and wire loop
inserted through the penis to do this. One possible side
effect of TURP is retrograde, or backward, ejaculation.
This means that semen flows backward into the bladder
during orgasm instead of out the urethra.
- In some cases a procedure called transurethral incision of
the prostate (TUIP) may be done instead of TURP. Instead
of removing prostate tissue, the surgeon passes a cutting
tool through the penis. The tool is used to make a few
small cuts (incisions) in the prostate and in the part of
the urethra that joins the bladder. The cuts reduce the
prostate's pressure on the urethra, making it easier to
urinate.
- Another surgical procedure uses a laser to destroy
prostate tissue that is causing blockage. The doctor
passes the laser through the urethra into the prostate
using a cystoscope. The laser delivers several bursts of
energy lasting 30 to 60 seconds. The laser energy destroys
prostate tissue and causes shrinkage. An advantage of
laser surgery is that it causes less blood loss than other
surgical procedures. Recovery from the procedure is also
faster. But laser surgery may not work if you have a very
large prostate. Also, how long the effect of this
treatment will last is not known.
- Sometimes open surgery is needed. This means that prostate
tissue is removed through a cut (incision) made in your
lower abdomen. Open surgery is often done when the gland
is quite large, when the bladder has been damaged and
needs to be repaired, or when there are other problems.
You will be given an anesthetic for all surgical procedures so
that you do have pain during the surgery.
Ask your provider about the potential risks and benefits of
medicine, surgery, and other possible treatments.
How long will the effects last?
Serious urinary problems from BPH affect 1 in 10 older men. Your
symptoms may get better, stay the same, or get worse. BPH may hurt
the bladder or kidneys over time. If the bladder is damaged by
BPH, treatment for BPH may not be as effective.
BPH is not cancer and it does not seem to increase the chances of
getting prostate cancer. You can, however, have both BPH and
prostate cancer at the same time.
How can I help take care of myself?
If you have symptoms of BPH, it is important to get checked by
your healthcare provider because prostate cancer causes similar
symptoms.
Follow the treatment prescribed by your healthcare provider.
What can I do to help prevent BPH?
There is no known way to prevent BPH. It is a common part of
aging.
This content is reviewed periodically and is subject to
change as new health information becomes available. The
information is intended to inform and educate and is not a
replacement for medical evaluation, advice, diagnosis or
treatment by a healthcare professional.
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