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Benign prostatic hyperplasia or BPH
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- The prostate gland surrounds the
urethra (tube through which urine flows outward) near the
bladder. The prostate gland makes a fluid that is a
component in ejaculate (along with semen). In a large
percentage of men, the prostate gland enlarges with age. The
enlarging prostate slowly "chokes" the urethra, decreasing
the urinary force and flow.
- The cause is unknown, but hormonal
effects seem to play a role, as men with damaged testicles
or castrated men often have a regression of
BPH.
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- Decreased urinary force
- Decreased urinary flow
- Intermittent urinary stream
- Urinary hesitancy
- Increased urinary frequency
- Nighttime urinary frequency
- Urinary
urgency
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- Rectal examination reveals Enlarged Prostate
- Abdomen may have a distended bladder (since bladder is
unable to void completely).
- Blood Urea nitrogen and Creatinine may be
elevated if there is significant urinary retention
- Urinalysis to make
sure no infection is present
- Prostate specific antigen to exclude Prostate Cancer
- Post void residual (patient
tries to urinate all of his urine, then a catheter is placed
to see what volume remains in the bladder)
- Urodynamic evaluation -- measures
urinary flow rate
- Cystourethroscopy (passing a scope into the urethra
and bladder) if the diagnosis is
uncertain
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- Medications
- Alpha-blocker medications -- e.g., Hytrin, Cardura, and Flomax
- Finasteride (Proscar) -- based on
current studies its usefulness is limited
- If considering alternative
therapies or preventive (low animal product diets)
supplements and herbs, such as Zinc picolinate, B6 vitamin,
flaxseed oil, linseed oil, alanine, glutamic acid, saw
palmetto berries, panax ginseng, vitamin E, or selenium,
discuss it first with your physician. Studies are on
the way on some of these therapies that may provide a viable
alternative to medications and surgery in some patients.
- Surgery:
- Transurethral prostate resection
(TURP) -- commonly called the "roto-rooter job." Excess
prostate tissue is surgically removed from inside the
urethra. Complications of surgery that may occur
include retrograde ejaculation (i.e., into bladder, but
still have orgasms), scarring of the bladder neck and
urethra, urinary incontinence.
- Microwave treatment -- prostate
is heated up and this results in its shrinkage.
- Transurethral needle ablation --
electrodes are placed in the prostate and radio frequency
energy, heat and destroy prostate tissue. Less
effective, but there are fewer side effects than in TURP.
- High frequency focused Ultrasound,
interstitial laser coagulation, water-induced
thermotherapy, and transurethral balloon dilation are some
of the noninvasive procedures that may be discussed with
your urologist.
- Comment: TURP is still the "gold
standard" of surgical treatment, and the most effective
treatment, though significant complications do occur in a
small percent of patients.
- Generally, Benign Prostatic Hyperplasia is treated when symptoms become
intolerable. Frequent night urination or interference with
daily activities warrants treatment. Most physicians
prescribe a trial of alpha-blocker medications. If this
fails, surgery is usually warranted. The only time surgery
is mandatory is if there is a significant obstruction of
the prostate and/or there is interference with kidney
function.
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