Enlarged Prostate (BPH)

Benign prostatic hyperplasia (BPH) is common in men.

• Enlarged prostate (benign prostatic hyperplasia, BPH) is a common, noncancerous enlargement of the prostate gland. Half of all men over 50 develop symptoms of benign prostatic hyperplasia, but only 10% need medical or surgical intervention.
• The prostate is a small organ about the size of a walnut. It lies below the bladder (where urine is stored) and surrounds the urethra (the tube that carries urine from the bladder). The prostate makes a fluid that helps to nourish sperm as part of the semen (ejaculatory fluid).
• Signs and symptoms of an enlarged prostate include blood in the urine, urinary retention, frequent urination, A slow flow or dribbling urine The need to urinate urgently, and Problems starting a urinary stream.
• An enlarged prostate is not malignant prostate cancer, which means that it is non-cancerous or benign.
• A man's prostate gland usually starts to enlarge after he reaches 40 years and evolves slowly. It only causes symptoms until over age 50.
• Researchers don't know exactly what causes benign prostatic hyperplasia.
  • One theory suggests that as men age, they begin to produce fewer hormones called testosterone (a male hormone) and small amounts of estrogen (a female hormone). As the male hormone testosterone levels in the blood decrease, it leaves a higher amount of estrogen in the blood. Thus, BPH in men occurs because of the higher proportion of estrogen within the prostate gland increases the activity of substances that promote prostate cell growth.
  • The other theory on what causes BPH is that as men age, the male hormone dihydrotestosterone (DHT) (which plays a role in the development and growth of the prostate gland), may encourage the cells of the prostate gland to continue to grow.
• The prostate gland serves a fertility function as it secretes the seminal fluid that helps to nourish and transport the sperm that comes from the testicles. The fluid is then stored in the seminal vesicles. The gland itself surrounds the urethra, which is the tube that carries urine from the bladder out through the tip of the penis.  As the prostate grows larger, it may press on the urethra. This narrowing of the urethra can cause some men with prostate enlargement to have trouble with urination.
• Prostate enlargement may be the most common health problem in men older than 60 years of age.
• Usually, treatment for BPH is reserved for men who have significant symptoms of an enlarged prostate. Medications and surgery treat BPH and its symptoms.

The prostate gland, which is normally about the size and shape of a walnut, wraps around the urethra between the pubic bone and the rectum, below the bladder. In the early stage of prostate enlargement, the bladder muscle becomes thicker and forces urine through the narrowed urethra by contracting more powerfully. As a result, the bladder muscle may become more sensitive, causing a need to urinate more often and more suddenly.

The prostate grows larger due to an increase in the number of cells (hyperplasia). However, the precise reason for this increase is unknown. A variety of factors may be involved, including androgens (male hormones), estrogens, growth factors, and other cell signaling pathways (cell-to-cell communication).

As the prostate grows larger and the urethra is squeezed more tightly, the bladder might not be able to fully compensate for the problem and completely empty. In some cases, blockage from prostate enlargement may result in stagnation and backing up of urine, which in turn may cause repeated urinary tract infections, bladder stones, and bladder diverticula (outpouchings or pockets inside the bladder), and gradually result in bladder or kidney damage. It may also cause a sudden inability to urinate (acute urinary retention) -- a painful medical emergency that requires urgent drainage.

Many men with an enlarged prostate have no symptoms or signs. If BPH symptoms are present, they commonly include

• weak urine flow;
• difficulty starting urination;
• dribbling of urine, especially after urinating;
• a sense of not fully emptying the bladder;
• leaking of urine;
• more frequent urination and a strong and sudden desire to urinate, especially at night; and
• blood in the urine.

What Does an Enlarged Prostate (BPH) Look Like?

Male urinary system and prostate: The prostate makes some of the milky fluid (semen) that carries sperm. The gland is the size of a walnut and is found just below the bladder, which stores urine. The prostate wraps around a tube (the urethra) that carries urine from the bladder out through the tip of the penis. During a man's orgasm (sexual climax), muscles squeeze the prostate's fluid into the urethra. Sperm, which are made in the testicles, also go into the urethra during orgasm. The milky fluid carries the sperm through the penis during orgasm.

Normal prostate and enlarged prostate (prostate with benign prostatic hyperplasia [BPH]

Urinary symptoms related to enlarging prostate initially affect the quality of life, and if no complications exist, as mentioned above (urinary infections, bladder stones, bleeding), the decision to treat is optional and is left to the patient. This means that if you don't feel bothered enough to take a medicine or undergo a procedure for it, you'll need to follow up with your doctor to ensure the symptoms are stable, and the bladder empties well. This can be assessed by prostate symptom questionnaires and a measure of the strength of the urinary stream (flow test) and residual urine in the bladder. If complications develop, however, or if the bladder starts holding increasing amounts of residual urine after urination, treatment should be started.

If you experience bladder pain or burning with urination, blood in the urine associated with fever/chills or nausea/vomiting, or if the prostate enlargement condition worsens and symptoms such as blood in the urine or lower back pain are present, consult a doctor immediately. If you cannot reach your doctor when these symptoms are present, seek evaluation at a hospital's emergency department.

For acute symptoms such as acute urinary retention (you feel uncomfortably full but cannot urinate), you should immediately go to the closest emergency medical facility for bladder drainage, usually with a catheter, which is a tube inserted into the bladder.

Men over 50 years of age should have their prostate checked annually by their physician even if they have no symptoms.

A physical exam is required to see if other medical problems may be causing your BPH symptoms. The healthcare provider will order a digital rectal exam to examine the prostate gland. The healthcare provider may feel the prostate by inserting a gloved, lubricated finger into the rectum. The rectal exam allows your doctor to roughly estimate the size and consistency of the prostate. Most importantly, it allows the doctor to feel for lumps or hard areas that could indicate the presence of prostate cancer. Your doctor may check your urine (urinalysis) for blood or signs of infection. Your blood may be tested for kidney problems (a serum creatinine level), for PSA levels (prostate specific antigen test), a screening test for enlarged prostate, prostate cancer, prostatitis, and urinary tract infections (UTIs)

Some men are referred to a specialist (urologist) for further tests. Urologists specialize in diseases of the male and female urinary tracts and of the male genital tract. Before you are treated for BPH. It is important for the doctor to rule out other possible causes of an enlarged prostate, such as prostate cancer, which is benign or non-cancerous.

Several types of medications have been approved for the treatment of urinary symptoms secondary to prostate enlargement. Men with severe symptoms may require treatment with a combination of these medications. Your doctor will determine the optimal combination for your condition:

• Alpha-blockers, such as terazosin (Hytrin), prazosin (Minipress), or doxazosin (Cardura), relax the muscles in the prostate and thus may relieve symptoms. Newer alpha-blockers, such as tamsulosin (Flomax), alfuzosin (Uroxatral), and silodosin(Rapaflo), are more commonly prescribed because they may have fewer side effects.
• Finasteride (Proscar) or dutasteride (Avodart) can cause the prostate to shrink. As a result, the urinary symptoms may improve. These drugs are most helpful in men who have at least moderate enlargement of the prostate.
• Tadalafil (Cialis for daily use) has recently been approved for the treatment of BPH.
• Bladder calming medications that help with the symptoms related to bladder irritability from prostate blockage: oxybutynin (Ditropan-pills, Oxytrol skin patch, Gelnique-topical gel), solifenacin (Vesicare), darifenacin (Enablex), trospium (Sanctura), and mirabegron (Myrbetriq).

Once your doctor has given you a medical plan, you should stick to it and follow up as recommended. Sometimes men need follow-up with a urologist.

There are no natural or home remedies to treat BPH; however, you can prevent symptoms from worsening and complications. Call your doctor right away urination once you experience an urge, urinate as soon as you feel the urge, and empty the bladder completely.

Here are 10 different types of BPH surgery.

• Transurethral resection of the prostate (TURP). Transurethral resection of the prostate (TURP) is a common surgery used to treat the prostate and is considered the gold standard. In this procedure, the doctor scrapes away the innermost core of the prostate through a small instrument inserted through the urethra. The surgery reduces pressure on the urethra and generally gives relief from symptoms.
• Transurethral incision of the prostate (TUIP). Transurethral incision of the prostate (TUIP) may be an option for some men. In this operation, instead of removing prostate tissue, the doctor passes an instrument through the urethra to make one or two small cuts in the prostate. These cuts reduce the prostate's pressure on the urethra, making urination easier.
• Newer treatments. Newer treatments may be performed in your doctor's office with local anesthesia (you are awake for the surgery) alone or supplemented by sedation have been introduced and maybe work.
• Rezume therapy. Rezume therapy consists of injecting water steam into the prostate under a local anesthetic
• Urolift procedure. Urolift procedure, which consists of placing small suture implants to hold the prostate tissue apart from around the urethra; transurethral microwave thermotherapy (TUMT), transurethral radiofrequency needle ablation of the prostate (TUNA), and interstitial laser coagulation (ILC). The general principle of all these treatments is similar. In each case, the prostate tissue is heated to a level that will lead to the death of portions of the prostate tissue, thus shrinking away and removing some of the obstruction.
• The Rezum and Urolift procedures have the advantage of preserving ejaculatory function, which can be affected by almost all other prostate procedures. These can also be done in the office without the need for anesthesia.
• Photovaporization of the prostate (PVP) or laser ablation of the prostate. Photovaporization of the prostate (PVP) or laser ablation of the prostate, in which a laser is used to directly remove or vaporize prostate tissue in a similar fashion to what is accomplished with a TURP (see above) with much less bleeding. The advantage of this technique compared with TUMT, TUNA, or ILC is that it offers immediate removal of tissue with rapid improvement in symptoms. Conversely, these other three treatments lead to delayed tissue loss and are not associated with the immediate improvement of urinary symptoms in most cases.
• AquaBeam ablation procedure. AquaBeam ablation procedure is FDA approved in the U.S. (like the AquaBeam ablation procedure, which also preserves ejaculatory function). Ask your doctor about the potential risks and benefits of medication and surgery. An operation for an enlarged prostate does not eliminate the risk of developing prostate cancer.
• Holmium laser enucleation of the prostate (HoLEP). Holmium laser enucleation of the prostate (HoLEP) is a procedure that is offered in specialized centers and allows larger prostates to be enucleated (shelled out).
• Simple prostatectomy. Sometimes for very large prostates, a procedure called simple prostatectomy is indicated, which is traditionally done by open surgery. A minimally invasive procedure can be done in specialized centers where the enlarged part of the prostate (referred to as the adenoma) is removed laparoscopically or with a surgical robot through keyhole incisions instead of the open surgical incision.

Your condition may improve, remain the same, or become worse. Serious urinary problems from prostate enlargement affect one in 10 older men. If the bladder is permanently damaged from prostate enlargement, treatment may not be as effective.

There is no known way to prevent BPH. It is a common part of aging.

• Men can reduce the need to urinate frequently during the night by not drinking liquids after 6 p.m.
• Caffeinated beverages, alcohol, and spicy foods can be bladder irritants and make urinary symptoms worse.
• Drinking more fluid, up to eight glasses of water per day, may help prevent infection. However, for men already suffering from increased urinary frequency, this may only exacerbate the problem. In most cases, drinking a normal amount of fluid based on thirst is all that is necessary.
• There is evidence that cranberry juice may be helpful in the prevention of urinary tract infections in those who are prone to developing these.
• Finasteride or dutasteride (see above) are prescription medications that can slow down the process of prostatic enlargement and reduce the risk of urinary retention, complications, and the future need for surgery related to BPH.