Enlarged Prostate (BPH)
The prostate is a walnut-sized gland located below the bladder and surrounding the urethra. An enlarged prostate can squeeze the urethra and cause difficulty with urination. Urinary problems due to an enlarged prostate are extremely common and can be seen in men as young as 30 years old.
An enlarged prostate – also called benign prostatic hyperplasia (BPH) – is typically due to noncancerous growth of an internal area of the prostate. Your risk of an enlarged prostate increases with age. More than half of all men over the age of 50 and 90% over the age of 80 have an enlarged prostate.
Enlarged Prostate Symptoms
Symptoms of prostate troubles are divided into two categories:
Urine Obstruction: Difficulty starting the urine stream, a weak stream, and dribbling after finishing are common obstructive symptoms of an enlarged prostate.
Urine Storage: Frequent or urgent urination, waking at night to urinate, and difficulties holding urine (loss of urine before making it to the bathroom) are types of urinary incontinence that may indicate more advanced issues with the prostate.
The above symptoms may worsen over time and cause complications that include:
- Inability to urinate (urinary retention)
- Bladder or kidney damage
- Bladder stones
- Urinary tract infections (UTIs)
An enlarged prostate is usually diagnosed after a medical exam that includes a digital rectal examination and a prostate-specific antigen (PSA) blood test. Simple, in-office urinary flow tests may also be conducted, and in some cases more advanced testing may be required.
Treatment for Enlarged Prostate (BPH)
Initial treatment is geared toward behavioral modifications such as urinating on a fixed schedule and avoiding urinary irritants such as caffeine. You will also need to limit evening beverages and urinate when you first feel the urge. Increasing your physical activity level can also help.
Oftentimes, men with an enlarged prostate may also need medications. There are two general categories: medications that increase flow (alpha blockers such as Rapaflo, Flomax, Uroxatral, Cardura, and Hytrin) and medications that shrink the prostate (such as Proscar and Avodart).
Recent studies indicate that using combinations of medications that work by different pathways may be more effective than a single medication to treat BPH. More than 65% of men with BPH, however, will have worsening problems and may ultimately need surgical treatment.
Surgery is designed to open the prostate channel by surgically removing excess tissue in the area. Removal of some or all of the prostate is called a prostatectomy.
The gold standard surgical procedure to treat an enlarged prostate is a transurethral resection of the prostate (TURP), which removes excess prostate tissue using a small electrical loop. This surgery typically involves an overnight hospital stay.
Minimally invasive outpatient procedures that also effectively treat BPH include:
- Transurethral needle ablation (TUNA) uses low-energy radio frequency to destroy excess prostate tissue (such as with the Prolieve system, for example).
- Transurethral microwave therapy (TUMT) using microwave energy to destroy prostate tissue (such as with Urologix technology).
- The Greenlight KTP laser prostatectomyis a safe, effective option that uses a laser to melt away excess prostate tissue.
- The Rezūm™ Water Vapor Therapy is a newer procedure that uses thermal energy – steam – to shrink an enlarged prostate.