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
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
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:
to determine the presence of infection or bleeding
a blood test to help determine the need for cancer evaluation
to measure the rate and volume of flow
residual urine by catheter or sonogram to see if the bladder empties
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
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.
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
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.
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.
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
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
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
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
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
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.