Benign Prostatic Hyperplasia

As people age, an enlarged prostate, also known as benign prostatic hyperplasia (BPH), becomes more common. The prostate is a small gland located just below the bladder, and it plays a role in making semen. With age, the prostate often grows larger. This enlargement can lead to uncomfortable symptoms, such as difficulty urinating. A larger prostate can put pressure on the urinary tract, potentially causing issues with the bladder, urinary tract, or even the kidneys.

Fortunately, there are several treatment options for BPH. These options include medications, surgical procedures, and other interventions. Your doctor can help you decide which approach is best for you. The choice will depend on various factors, including:

Benign Prostatic Hyperplasia (BPH) is a common condition in men as they age. It happens when the prostate gland, located below the bladder, gets larger. This enlargement can cause problems with urination.

Common Symptoms of BPH:

• Frequent urination: Having to pee more often than usual, including during the night. This can be a constant and urgent need to urinate.
• Weak urine stream: The flow of urine might be weaker, or it may stop and start.
• Difficulty starting to urinate: It might take longer to start peeing.
• Dribbling: Urine might drip out after urination is finished.
• Incomplete emptying of the bladder: You might feel like you haven't fully emptied your bladder after urinating.

Less Common Symptoms:

• Urinary tract infection (UTI): A UTI can cause similar symptoms to BPH.
• Inability to urinate: If you can't urinate at all, this is a serious situation and needs immediate medical attention.
• Blood in the urine: Blood in your urine could signal a problem, and should be checked by a doctor.

Important Considerations:

• Symptom severity varies: The size of the prostate doesn't always predict how bad the symptoms will be. Some men with a slightly enlarged prostate may have significant problems, while others with a very large prostate might only have mild symptoms, or no symptoms at all.
• Other possible causes: Several other health issues can cause symptoms similar to BPH. These include:
  • Urinary tract infections (UTIs): Infections in the urinary system.
  • Inflamed prostate (prostatitis): Swelling and inflammation of the prostate.
  • Narrowing of the urethra: The tube that carries urine out of the body may become constricted.
  • Scarring in the bladder neck: This can happen from past surgery.
  • Kidney or bladder stones: Solid masses that form in the urinary tract.
  • Nerve problems affecting the bladder: Issues with the nerves controlling bladder function.
  • Prostate or bladder cancer: Though less common, cancer can cause similar symptoms.
• Medication side effects: Some medications can also mimic BPH symptoms, especially:
  • Opioids (strong pain relievers): These can affect bladder control.
  • Cold and allergy medicines: Some can cause urinary issues.
  • Older antidepressants (tricyclic antidepressants): These can also affect bladder function.

What to do:

It's crucial to talk to your doctor about any urination problems, even if they seem minor. A doctor can determine the underlying cause and recommend appropriate treatment. Untreated BPH or other conditions can lead to a dangerous blockage in the urinary tract. If you are unable to urinate at all, seek immediate medical attention.

See a doctor about any unusual body sensations, even if they seem minor. It's important to find out what's causing them. Sometimes, problems like these can lead to a serious blockage in your urinary system, which could be dangerous. If you can't urinate at all, seek immediate medical attention.

The prostate is a gland located below the bladder, surrounding part of the tube that carries urine out of the body, called the urethra. Think of the urethra as a pipe running through the center of the prostate. As the prostate grows larger, it can squeeze and narrow this tube, making it harder for urine to flow.

The prostate naturally grows throughout a person's life. Sometimes this growth becomes significant enough to cause problems. Exactly why the prostate grows larger isn't fully understood, but it might be linked to changes in the balance of hormones, particularly sex hormones, as we get older.

Factors that can increase your risk of an enlarged prostate include:

Age: An enlarged prostate, often called benign prostatic hyperplasia (BPH), is less common before age 40. After that, the likelihood of developing an enlarged prostate and experiencing symptoms like difficulty urinating gradually increases with age. This is a natural part of aging for many men.

Family history: If you have a parent, brother, or other close relative who has had prostate problems, you might be more prone to prostate issues yourself. This suggests a possible genetic link.

Health conditions: Certain medical conditions can increase your risk. For example, studies show that diabetes and heart disease might make you more likely to develop BPH. It's important to remember that these conditions aren't the sole cause, but they can be contributing factors.

Lifestyle choices: Carrying excess weight (obesity) is linked to a higher risk of BPH. On the other hand, regular physical activity and exercise can potentially help reduce your risk of developing an enlarged prostate. Maintaining a healthy weight and lifestyle is crucial for overall health and can have a positive impact on prostate health.

An enlarged prostate, also known as benign prostatic hyperplasia (BPH), can cause several problems.

Problems with Urination: One common issue is difficulty urinating, sometimes called urinary retention. This means you can't completely empty your bladder. To help, a tube called a catheter might be inserted into your bladder to drain the urine. In some cases, surgery is necessary to relieve this problem.

Urinary Tract Infections (UTIs): When your bladder doesn't empty completely, bacteria can grow more easily, increasing the risk of urinary tract infections. Frequent UTIs can sometimes require surgery to remove part of the prostate.

Bladder Stones: Bladder stones are often a result of a bladder that doesn't empty properly. These stones can cause pain, irritation, blood in the urine, and blockages in the urinary system.

Bladder Damage: When the bladder doesn't empty completely, it can stretch and weaken over time. This weakens the bladder muscles, making it harder to fully empty the bladder and further contributing to the problems.

Kidney Damage: The pressure from a full bladder can harm the kidneys, or it can allow urinary tract infections to spread to the kidneys. This is a serious complication. Treatment for an enlarged prostate can help reduce the risk of these problems. Important Note: While an enlarged prostate is not linked to prostate cancer, it can cause significant health issues if not managed properly. Urinary retention and kidney damage can be very serious medical concerns.

Diagnosing an Enlarged Prostate: A Step-by-Step Guide

If you're experiencing symptoms that suggest an enlarged prostate, your doctor will likely start by asking you questions about your symptoms. They'll also perform a physical exam, which might include a digital rectal exam (DRE). During a DRE, your doctor will gently insert a finger into your rectum to feel the prostate gland for any enlargement.

Next, they'll likely order some tests to gather more information. These tests can help determine if the symptoms are due to an enlarged prostate or another condition.

Basic Tests:

• Urine Test: A sample of your urine is sent to a lab to check for infections or other problems that could mimic the symptoms of an enlarged prostate.
• Blood Test: A blood test can help identify potential kidney problems, which can sometimes be linked to prostate issues.
• Prostate-Specific Antigen (PSA) Blood Test: The prostate makes a protein called PSA. A higher than normal PSA level often indicates an enlarged prostate, but it can also be elevated due to other factors like recent medical procedures, infections, surgery, or even prostate cancer. Therefore, this test alone isn't definitive.

Further Tests (if needed):

• Urinary Flow Test: You urinate into a special container connected to a machine. This machine measures how strong your urine stream is and how much urine you produce. This can help track changes over time and see if your condition is improving or worsening.
• Post-Void Residual Volume Test: This test checks how completely your bladder empties after urination. It can be done using ultrasound (sound waves to create images) or a catheter (a thin tube) inserted into your bladder after you urinate to measure the remaining urine.
• 24-Hour Voiding Diary: Record how often and how much you urinate throughout the day and night, particularly if you're experiencing frequent nighttime urination (a common symptom of an enlarged prostate).

More Complex Tests (if necessary):

• Transrectal Ultrasound (TRUS): A device using sound waves is inserted into your rectum to create images of the prostate and measure its size.
• Prostate Biopsy: Using ultrasound guidance, a small tissue sample is taken from the prostate to be examined under a microscope. This helps your doctor determine if there's any prostate cancer.
• Urodynamic and Pressure Flow Studies: A thin tube (catheter) is inserted into your bladder. Water (or sometimes air) is slowly added to the bladder to measure the pressure and how well the bladder muscles work during urination.
• Cystoscopy: A thin, flexible tube with a light is inserted into your urethra (the tube that carries urine out of your body). This allows your doctor to see the inside of your urethra and bladder. A topical numbing medication may be used beforehand.

Mayo Clinic Expertise:

Mayo Clinic specialists have extensive experience diagnosing complex cases of an enlarged prostate. They have access to advanced diagnostic tools, including urodynamic and pressure flow studies. Their dedicated team provides comprehensive care for individuals facing BPH-related health concerns.

Important Note: This information is for general knowledge and should not be considered medical advice. Always consult with a healthcare professional for accurate diagnosis and treatment options for your specific situation.

Enlarged Prostate: Understanding Treatments and Options

An enlarged prostate, also known as benign prostatic hyperplasia (BPH), is a common condition in older men. It happens when the prostate gland, located below the bladder, becomes larger. This enlargement can lead to various urinary problems. Fortunately, several treatments are available.

Treatment Options

Treatment choices depend on several factors, including:

• Prostate size: A larger prostate generally requires more involved treatments.
• Age: Older men may experience different side effects or have different health considerations.
• Overall health: Existing health conditions can influence treatment recommendations.
• Severity of symptoms: If symptoms are mild and don't significantly impact daily life, delaying treatment might be an option. Some people's symptoms improve without treatment.

Medications

Medication is often the first line of treatment for mild to moderate BPH symptoms.

• Alpha-blockers: These medications relax the muscles in the bladder neck and prostate, making urination easier. Common alpha-blockers include alfuzosin, doxazosin, tamsulosin, silodosin, and terazosin. They often work quickly, especially in men with smaller prostates. Possible side effects include dizziness and, less commonly, retrograde ejaculation (semen returning to the bladder instead of exiting the penis).

• 5-alpha reductase inhibitors: These medications help shrink the prostate by preventing hormonal changes that contribute to its growth. Examples include finasteride and dutasteride. These medications may take several months to show their full effect and can cause sexual side effects.

• Combination therapy: If one type of medication isn't enough, a doctor might recommend combining an alpha-blocker and a 5-alpha reductase inhibitor.

• Tadalafil (Cialis): While primarily used for erectile dysfunction, studies show it can also help with BPH symptoms in some cases.

Surgical and Other Procedures

Surgery or other procedures might be necessary if:

• Medications don't provide sufficient relief.
• A person prefers not to take medication.
• There are urinary problems that require immediate attention, such as complete inability to urinate.
• Kidney problems are present.
• Bladder stones, blood in the urine, or urinary tract infections (UTIs) are recurring.

Surgery may not be an option if:

• An untreated urinary tract infection exists.
• Urethral stricture (narrowing of the urethra) is present.
• Previous prostate radiation therapy or urinary tract surgery has been performed.
• Neurological disorders (like Parkinson's disease or multiple sclerosis) are present.

Possible side effects of any prostate procedure can include:

• Retrograde ejaculation
• Urinary leakage
• Urinary tract infection
• Bleeding
• Erectile dysfunction

Types of Procedures

Several procedures are available for treating enlarged prostates. Each has its own benefits, risks, and potential side effects. These include:

• Transurethral resection of the prostate (TURP): A thin scope is inserted through the urethra to remove part of the prostate. This procedure often provides quick symptom relief. A catheter may be needed for a short period after the procedure.

• Transurethral incision of the prostate (TUIP): Using a scope, small cuts are made in the prostate to improve urine flow. This option is often suitable for men with smaller or slightly enlarged prostates or those with health conditions that make other surgeries riskier.

• Transurethral microwave thermotherapy (TUMT): Microwave energy is used to shrink the prostate. This method may not relieve all symptoms and may take time to show results. It is often used only on smaller prostates.

• Laser therapy: High-energy lasers are used to destroy or remove excess prostate tissue. Laser therapy may be a good option for individuals who are taking blood-thinning medications and who are not ideal candidates for other procedures. Different types of laser therapies include:

  • Ablative procedures: These destroy prostate tissue blocking urine flow. Examples include photoselective vaporization of the prostate (PVP) and holmium laser ablation of the prostate.
  • Enucleative procedures: These procedures remove the prostate tissue blocking urine flow. The removed tissue can be examined for cancer. An example is holmium laser enucleation of the prostate (HoLEP).

• Prostate lift: Special devices are used to compress the sides of the prostate, improving urine flow. This approach is often suitable for men whose middle prostate isn't causing blockage.

• Water vapor thermal therapy (WVTT): A device turns water into steam to remove excess prostate tissue. This method generally has a lower risk of sexual side effects than other procedures.

• Robotic waterjet treatment: A robotic device uses water jets to remove prostate tissue. This method can have some of the same side effects as TURP.

• Open or robot-assisted prostatectomy: One or more incisions are made to remove prostate tissue. This option is often chosen for men with very large prostates.

• Prostate artery embolization (PAE): The blood supply to the prostate is blocked, causing it to shrink. This procedure has potential short-term and long-term benefits for certain individuals, but it should only be performed by a trained interventional radiologist.

Important Considerations

Follow-up care after any procedure will vary depending on the specific treatment. Your doctor will provide instructions on activities to avoid and for how long. It's essential to discuss all treatment options, potential benefits, risks, and side effects with your healthcare provider to determine the best course of action for your specific situation.