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Prostate :: PSA & DRE Test :: Testicles
Common Benign Testicular Growths :: Testicular Cancer :: Hydrocele Repair

Enlarged Prostate or Benign Prostatic Hypertrophy

Transrectal Prostate Biopsy :: Prostate Cancer Surgery :: Brachytherapy
TURP :: Open Prostatectomy :: Enlarged Prostate

Benign Prostatic Hypertrophy or BPH is non-cancerous enlargement of the prostate gland. It is also referred to as Benign Prostatic Hyperplasia. It is not uncommon for the prostate gland to become enlarged as men age. When the prostate gland becomes enlarged, it can cause problems with urination.

It is common for the prostate gland to become enlarged as a man ages. Doctors call this condition benign prostatic hyperplasia (BPH), or benign prostatic hypertrophy. As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the gland to press against the urethra like a clamp on a garden hose. The bladder wall becomes thicker and irritable. The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination. Eventually, the bladder weakens and loses the ability to empty itself, so some of the urine remains in the bladder. The narrowing of the urethra and partial emptying of the bladder cause many of the problems associated with BPH.

Symptoms

BPH rarely causes symptoms before age 40, but more than half of men in their sixties and as many as 90 percent in their seventies and eighties have some symptoms of BPH. Many symptoms of BPH stem from obstruction of the urethra and gradual loss of bladder function, which results in incomplete emptying of the bladder. The symptoms of BPH vary, but the most common ones involve changes or problems with urination, such as: hesitant, interrupted, weak stream urgency and leaking or dribbling more frequent urination, especially at night.

Sometimes a man may not know he has any obstruction until he suddenly finds himself unable to urinate at all. This condition, called acute urinary retention, may be triggered by taking over-the-counter cold or allergy medicines. Such medicines contain a decongestant drug, known as a sympathomimetic. A potential side effect of this drug may prevent the bladder opening from relaxing and allowing urine to empty. When partial obstruction is present, urinary retention also can be brought on by alcohol, cold temperatures, or a long period of immobility.

Causes

The cause of BPH is not well understood. No definite information on risk factors exists. For centuries, it has been known that BPH occurs mainly in older men and that it doesn't develop in men whose testes were removed before puberty. For this reason, some researchers believe that factors related to aging and the testes may spur the development of BPH.

One theory focuses on DHT, a substance made from testosterone in the prostate that may help control prostate growth. The accumulation of DHT in older men may encourage the growth of cells leading to BPH.
Another theory suggests elevated estrogen levels that occur as men age may increase cellular growth activity leading to BPH.

Diagnosis

You may first notice symptoms of BPH yourself, or your doctor may find that your prostate is enlarged during a routine checkup. When BPH is suspected, you may be referred to an urologist, a doctor who specializes in problems of the urinary tract and the male reproductive system. Some tests your doctor may order can include the following:

Digital Rectal Examination (DRE): This examination is usually the first test done. The doctor inserts a gloved finger into the rectum and feels the part of the prostate next to the rectum. This examination gives the doctor a general idea of the size and condition of the gland.

Prostate-Specific Antigen (PSA) Blood Test: To rule out cancer as a cause of urinary symptoms, your doctor may recommend a PSA blood test. PSA, a protein produced by prostate cells, is frequently present at elevated levels in the blood of men who have prostate cancer. The U.S. Food and Drug Administration (FDA) has approved a PSA test for use in conjunction with a digital rectal examination to help detect prostate cancer in men who are age 50 or older and for monitoring men with prostate cancer after treatment.

However, much remains unknown about the interpretation of PSA levels, the test's ability to discriminate cancer from benign prostate conditions, and the best course of action following a finding of elevated PSA.

Rectal Ultrasound and Prostate Biopsy: If there is a suspicion of prostate cancer, your doctor may recommend a test with rectal ultrasound. In this procedure, a probe inserted in the rectum directs sound waves at the prostate. The echo patterns of the sound waves form an image of the prostate gland on a display screen. To determine whether an abnormal-looking area is indeed a tumor, the doctor can use the probe and the ultrasound images to guide a biopsy needle to the suspected tumor. The needle collects a few pieces of prostate tissue for examination with a microscope.

Urine Flow Study: Your doctor may ask you to urinate into a special device that measures how quickly the urine is flowing. A reduced flow often suggests BPH.

Cystoscopy: In this examination, the doctor inserts a small tube through the opening of the urethra in the penis. This procedure is done after a solution numbs the inside of the penis so all sensation is lost. The tube, called a cystoscope, contains a lens and a light system that help the doctor see the inside of the urethra and the bladder. This test allows the doctor to determine the size of the gland and identify the location and degree of the obstruction.

Treatment

Conservative treatment measures to treat BPH are always considered first before invasive measures such as surgery. Some conservative treatment measures include the following:

Medications: Medications are the most common treatment method for controlling symptoms of BPH. There are a number of medications approved for the treatment of BPH symptoms. Some prevent growth of the prostate while others actually shrink the prostate gland. Other drugs may be prescribed to improve urine flow and reduce bladder outlet obstruction. Your doctor will discuss the various drugs available to treat your particular situation.

Nonsurgical Treatment Measures are minimally invasive treatments to reduce the size of the prostate gland and enlarge the urethra to make voiding easier. These may include the following:

What is TURP?

TURP is the most common surgery to treat BPH and is considered the "gold-standard" for long-term results. During the procedure,prostate tissue is removed by using an electric current to generate heat. By removing the tissue, the size of the prostate is reduced.

TURP is well-studied and research has shown that subjects who undergo TURP show significant long-term improvement in both their Lower Urinary Tract Symptoms and Quality of Life.

How TURP Works:

How TURP Works
  • Step 1: A combined visualization and surgical instrument (resectoscope) is inserted through the tip of your penis and into your urethra.
  • Step 2: Using the resectoscope, your doctor trims away excess prostate tissue that's blocking urine flow.
  • Step 3: The resectoscope is removed, leaving a more open urethra.

What is UroLift?

The UroLift System is a new, minimally invasive device for treating BPH. Small implants are permanently placed to hold the enlarged prostate tissue out of the way so it no longer blocks the urethra. There is no cutting, heating or removal of prostate tissue.

Because UroLift is a new device, the procedure is not as well-studied as TURP. However, available data is encouraging. An ongoing study of the UroLift device in Australia in 64 men has shown significant improvement in both Lower Urinary Tract Symptoms and Quality of Life.

How UroLift Works:

How UroLift Works
  • Step 1: The UroLift delivery device with a visualization instrument is placed through the urethra to access the enlarged prostate.
  • Step 2: Small UroLift implants are permanently placed to lift or hold the enlarged prostate tissue out of the way and increase the opening of the urethra. Typically 4-6 implants are placed per patient, but it can vary from patient to patient.
  • Step 3: The UroLift delivery device is removed, leaving a more open urethra.

Laser treatment for BPH: is also called laser prostatectomy. The permanent effects of laser treatment on prostate tissue are vaporization and coagulation, which occur when laser energy heats prostatic tissue to 100°C. At this temperature, tissue death occurs, resulting in shrinkage of the prostate over time. This process can initially cause edema, which may increase prostate volume and make short-term catheterization necessary for voiding

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