Comprehensive Urology

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The daVinci System

Delta Medix Patient General Information

BPH / Enlarged Prostate

BPH, or benign prostatic hypertrophy is a common, benign (not cancerous) condition in older men in which the prostate gland enlarges. The prostate is a walnut-sized gland that produces semen, the fluid that transports sperm. Located below the bladder and surrounding the urethra (the tube that carries urine out of the body). The growing prostate can squeeze the urethra and cause difficulty urinating.

Causes

BPH is believed to be related to the aging process and the presence of testosterone (a male hormone). More than half of men over age 50 and 90 percent of men over age 80 have BPH.

Symptoms

An enlarged prostate can cause a variety of urinary symptoms including:

  • A recurring sudden urge to urinate
  • Increasing frequency of urination, especially at night
  • Weak or interrupted urinary stream
  • Difficulty starting and stopping urination
  • Leaking of urine
  • Inability to completely empty the bladder
  • Blood in the urine (hematuria)

Caffeine, alcohol, spicy or acidic foods, certain cold medications, and constipation may make symptoms worse. Left untreated, symptoms may worsen over time and can cause complications that may include inability to urinate (urinary retention), bladder or kidney damage, bladder stones or urinary infections. Consult your doctor for an evaluation if you have any of these symptoms.

Diagnosis

Your doctor will perform a digital rectal exam (DRE) and he may order a PSA (prostate specific antigen) test. Elevated levels of PSA can indicate BPH, prostatitis (inflammation of the prostate), or prostate cancer. Additional tests may include a symptom score sheet, a urine flow study, ultrasound, CAT scan and cystoscopy.

Treatment

Treatment for BPH will depend on the severity of your symptoms and how much they interfere with your lifestyle. Men with minimal symptoms may only need to make lifestyle changes. Those with more pronounced symptoms or complications may require medications or a procedure. Your doctor can help you to determine which treatment is right for you.

Lifestyle changes

  • Avoid caffeine, acidic drinks such as colas, tomato and orange juice, alcohol, cold medications containing antihistamines or pseudoephedrine. Constipation can make it more difficult to urinate.
  • Limit evening beverages.
  • Urinate when you first feel the urge.
  • Increase your physical activity.
  • Medications may include:
    • Alpha blockers to relax the smooth muscle tissue in the bladder and prostate and increasing the flow of urine
    • Enzyme (5 alpha reductase) inhibitors to shrink the prostate by preventing the conversion of testosterone to dihydrotestosterone, a key ingredient in prostate enlargement
    • Anti-cholinergics to reduce urinary frequency and urgency

Surgical Intervention

  • Transurethral incision of the prostate using electrocautery or laser
  • Transurethral resection of the prostate (TURP) – the tissue causing the obstruction is removed through a cystoscope.
  • Prostatectomy – Surgical removal of the prostate. This procedure is reserved for patients with very large prostates.