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BACK to frequently asked              BACK to prostate review

BPH
Benign Prostatic Hypertrophy, also known as BPH, is a virtually universal overgrowth of the prostate gland in men as they age. Various factors affecting BPH are age, genetic makeup, testosterone levels, and environment.  It can start in men's 20's but usually does not cause problems until middle age.

The prostate gland lies below the bladder and surrounds the urethra, or urine tube.  The prostate has little function in humans other than supporting the urethra and some of the sperm ducts.

What are the symptoms of BPH?   As the prostate enlarges it compresses the urethra causing obstruction to urine flow.  The urinary stream becomes smaller, there may be difficulty in initiating the stream, (hesitancy), dribbling, intermittent flow, frequency of urination, getting up at night to void, (nocturia), inability to empty, or even inability to void at all, (retention). BPH can also be the cause of urinary tract infections.

How is BPH Evaluated?  The Urologist will take a history, frequently asking the patient to fill out an AUA Symptom Score, do a physical examination including a digital rectal examination, (DRE), and then perform some of the following tests:

Urinalysis to determine the presence of infection or bleeding

PSA a blood test to help determine the need for cancer evaluation

Uroflow to measure the rate and volume of flow

Bladder residual urine by catheter or sonogram to see if the bladder empties completely.

Cystoscopy to look inside the bladder, urethra and prostate with a telescope.

How is BPH Treated?  Once the diagnosis of BPH has been made, and infection or prostatitis treated, there are several options for treatment.  If the symptoms are mild and there is no significant retention, the patient may be observed with reevaluation every 6 to 12 months. However, when the flow is very slow, the symptoms are great, and especially when retention reaches 100 cc, (3-4 oz.), treatment becomes necessary.  

        When a patient cannot void at all, acute urinary retention, a catheter is inserted for several days, treatment may be instituted, and the a trial of voiding given.   If the patient is able to void, and empty well no treatment or continuing medical treatment is appropriate.  When greater symptoms and/or  retention exist, medical or surgical therapy is indicated.  Some patients may have had blockage for so long that they have caused kidney damage, and may require a catheter for several weeks to allow the kidneys to regain whatever function remains before definitive surgical therapy. 

Medical Treatment of BPH  There are two forms of medical treatment for BPH: a series of drugs called alpha blockers relaxes the muscles within the prostate and bladder neck, allowing the flow of urine to improve; a second family of medication, 5-alpha reductase inhibitors, will cause some large prostates to shrink and thereby improve flow , although the action is slow and maximum response may take 6-12 months to achieve.  The herbal saw palmetto is a natural biologic 5-alpha reductase inhibitor.

There are four drugs in the alpha blocker family: terazocin/Hytrin™, doxasacine/Cardura™ , tamulosin/Flomax™ and alfuzacin/Uroxatrol™.  The first two are also antihypertensives, so they can be used to treat two conditions, they require dose titration, may take several weeks to reach maximum dose effectiveness and are available as generics.  Flomax and Uroxatrol are selective, working predominantly on the prostate and bladder neck muscles, and work in several days.  Side effects for all four may include dizziness, decreased erections and retrograde ejaculations, (dry orgasms). In some patients the prostate will continue to grow and some patients will require increasing doses of medication, addition of other drugs or surgical intervention over time. 

Finasteride/Proscar™ and dutasteride/Avodart™ are the 5-alpha reductase inhibitors available and will slowly shrink prostates.  They take about 3 to 6 weeks to begin to have an effect , and may take 3-6 months to reach maximum effect.   They will only have an effect on larger prostates, and are effective in about a third of patients.   The herbal suggestion are Click here and those suggestions improve the immune system, offer detoxification of the body and offers hormonal balancing.  Decreased sexual functioning  and increased hair growth, (Rogaine™ is finasteride), may affect a minority of patients on 5-alpha reductase inhibitors. 5-alpha reductase inhibitors artificially lowers PSA, the prostate cancer blood test. So if you are taking one of these you must let your doctors know, so that they can take it into account when doing your prostate cancer check!

Surgical Treatment of BPH  There are three forms of surgical treatment for BPH: TURP/PVP Laser, minimally invasive procedures and open surgery.  Over the past several years there has been a boom in treatment modalities for BPH.

TURP or transurethral resection of the prostate, (known euphemistically as "roto-rooter"), remains the gold standard for treatment of significant BPH. A specialized telescope, called a resectoscope, is inserted under anesthesia, into the urethra, and the overgrown prostate tissue is cut away from the inside using electric current.  The urethral lining is removed during this process, but will re-grow over several months. Results in terms of  rate of urine flow, and long term effectiveness is the best of all the procedures available.  It frequently requires a short hospital stay. Results are seen immediately, and complications can include bleeding, infection, incontinence, scarring and stricture and infrequently a decrease in potency.  Dry ejaculations are common.  It is uncommon to require a repeat TURP during ones lifetime. The new (2003) high power Laserscope, PVP Green Light laser is very similar to a TURP, but by using laser there is virtually no bleeding and patients frequently go home the same day, most without a catheter.  It is the only procedure approved for patients on anticoagulants or blood thinners. The procedure is usually not done in the doctor's office, but in the hospital outpatient department or surgicenter.   Laserscope,  Dr. Werner is a national instructor for the PVP laser.

Minimally invasive procedures include a family of procedures that destroy islands of tissue within the prostate using different forms of energy: laser, microwave, radio-frequency waves, or ultrasound.  The procedures go under the various names of Indigo Laser, TUNA, TUMT, Prostatron, etc.  An energy source is inserted through a cystoscope into the prostate, and when the energy is turned on, it coagulates an olive shaped volume of tissue.  This may be done to multiple areas in the prostate.  The coagulated tissue is slowly absorbed by the body, opening up the urinary channel.   The procedures are usually done as outpatient procedures.  A catheter must remain in for several days to a month or two, as the prostate swells up after the procedure, and the tissue is absorbed slowly.  Maximum effectiveness is seen in 3 to 6 months.  The improvement in flow rates is less than with TURP or PVP Laser.  The durability of the results has not yet been fully determined but repeat procedures after several years are not uncommon.  Bleeding, infection and scarring can occur.  Dry or retrograde ejaculation or decreased potency is not common, but does occur. A newer minimally invasive procedure, Thermodilation or Prolieve™ combines TUMT with balloon dilation of the prostate, an older technology that afforded a rapid but short lived improvement in voiding.  This procedure is usually done in the urologist's office under sedation, takes about an hour.  Most patients are able to void right after the procedure, though a few require a short term catheter.  The long term results areequivalentto the other minimally invasive procedures. As the ballon dilation slowly fails over several month, the TUMT is improving flow, so there does not appear to be a change during the healing process. At the present time this is our preferred minimally invasive technique.                                                                                                       

Cryotherapy or freezing is another minimally invasive procedure for obstructive BPH.  Similar to the heat induced treatments, an iceball is formed within the prostate, and the destroyed tissues slowly sloughs.  A catheter is frequently needed, and rates of impotence are high.

Open surgery for BPH is relatively rare but is sometimes needed for very large prostate glands.  The procedure requires a hospital stay.  Results are usually good an seen shortly after surgery.  Complications include, bleeding, infection, scarring, retrograde ejaculation, incontinence and occasionally, impotence among others.  However for most patients requiring an open prostatectomy, there is no good alternative.  

BPH, Benign prostatic Hyperplasia referred to as BPH, is a condition that affects the prostate gland in men. The prostate is a gland found between the bladder (where urine is stored) and the urethra (the tube urine passes through). As men age, the prostate gland slowly grows bigger (or enlarges). As the prostate gets bigger, it may press on the urethra and cause the flow of urine to be slower and less forceful. "Benign" means the enlargement isn't caused by cancer or infection. "Hyperplasia" means enlargement.

Most symptoms of BPH start gradually. One symptom is the need to get up more often at night to urinate. Another symptom is the need to empty the bladder often during the day. Other symptoms include difficulty in starting the urine flow and dribbling after urination ends. The size and strength of the urine stream may decrease.

These symptoms can be caused by other things besides BPH. They may be signs of more serious diseases, such as a bladder infection or bladder cancer. Tell your doctor if you have any of these symptoms, so he or she can decide which tests to use to find the possible cause.

THIS IS TRADITIONALLY WHAT THE DOCTOR WANTS TO DO:

After your doctor takes a complete history of your symptoms, a rectal exam is the next step. In a rectal exam, your doctor checks your prostate by putting a gloved, lubricated finger into your rectum to fee the back of your prostate gland. This exam allows your doctor to feel the size of the prostate gland.

To make sure that your prostate problem is benign, your doctor may need to look at a sample of your urine for signs of infection. Your doctor may also do a blood test. An ultrasound exam or a biopsy of the prostate may help your doctor make the diagnosis.

NOW THIS IS STRAIGHT FROM WEBMED, PROVING WHAT I SAY IS TRUE, THAT SURGERY IS COMMON PLACE IN THE MEDICAL INDUSTRY. Why would you want to chose medical over natural after reading this page?

Once your doctor is sure that your symptoms are caused by benign growth of the prostate gland, treatment can be recommended. However, your doctor may suggest that you wait to see if your symptoms get better. Sometimes mild symptoms get better on their own. If your symptoms get worse, your doctor may suggest another treatment option.

Surgery is considered the most effective treatment and is used in men with strong symptoms that persist after other treatments are tried. This is also the best way to diagnose and cure early cancer of the prostate. Surgery is usually done through the urethra, leaving no scars. Surgery does have risks, such as bleeding, infection or impotence. These risks are generally small. CAN YOU BELIEVE THEY CAN SAY THAT ABOUT YOUR LIFE AS A VIRILE MAN COMING TO AN END, AND THE RISKS ARE --------SMALL

Do you want drugs, here is what they offer you;

Drug treatments are available. Finasteride (brand name: Proscar) and dutasteride (brand name: Avodart) blocks a natural hormone that makes the prostate enlarge, but it does not help all patients. The side effects of finasteride are rare and mild, but they usually have to do with sexual function. They go away when the medicine is stopped. The prostate may enlarge again when the medicine is stopped, so your doctor may suggest another treatment.

Another kind of medicine, called alpha-blockers, also can help the symptoms of BPH but do nothing for the cause. Alpha-blockers have been used for a long time to treat high blood pressure, but they can also help the symptoms of BPH, even in men with normal blood pressure. Some of these drugs are terazosin (brand name: Hytrin), doxazosin (brand name: Cardura), tamsulosin (brand name: Flomax) and alfuzosin (brand name: Uroxatral). These medicines may not work in all men. The side effects of alpha-blockers include dizziness, fatigue and lightheadedness. The side effects go away if you stop taking the medicine.