Enlarged Prostate

As a man ages, his prostate typically grows. This growth can restrict the tissue surrounding it, causing a number of issues, including a gradual loss of bladder function. We can help.

Overview

The prostate is a small gland that goes through two main periods of growth: in puberty and around age 25. This second phase often results, years later, in benign prostatic hyperplasia (BPH). The tissue surrounding the prostate eventually restricts its expansion, causing the gland to press against the urethra and impede urination. More than half of men in their 60s and as many as 90% in their 70s have symptoms of BPH.

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Cause

As you age, your prostate can enlarge, often beginning around the age of 40-50. Enlargement of the prostate is known as benign prostatic hyperplasia, or BPH. BPH is a benign (non-cancerous) condition that is very common in males. However, this enlargement tends to block the urethra and urine flow out of the body.

Symptoms

Symptoms of BPH can include:

  • Difficulty starting to urinate
  • Sudden, recurrent urge to urinate
  • Dripping or leaking after urination
  • Interrupted, slow or weak urine stream
  • Frequent urination, especially at night
  • Painful pushing or straining to urinate
  • Inability to empty the bladder completely

Determine your BPH symptoms by filling out this simple form. If your total score indicates Moderate or Severe symptoms, contact your urologist. IPSS Score Form

Diagnosis

Diagnosing BPH early is important because, if left untreated, it can lead to urinary tract infections (UTIs), bladder or kidney damage, kidney stones and incontinence. Distinguishing BPH from more serious diseases like prostate cancer is important.

To diagnose BPH we generally use a combination of the following:

  • Exam – Your urologist will do a physical exam, which will most likely include a digital rectal exam (DRE) to feel for size of the prostate and for lumps or nodules that may be a concern.
  • Blood test – A blood test called a PSA (prostate-specific antigen) test is often completed to help determine your risk for prostate cancer. A higher number can indicate an enlarged prostate, infection or cancer.
  • Urine test – A urinalysis and/or urine culture can tell us if you have blood or infection in your urine.
  • Bladder scan – A bladder scan is an ultrasound that is done in-office to check the amount of urine remaining in your bladder after you urinate.
  • Cystoscopy – A small scope, sometimes with a camera, is used to look inside the urethra, prostate and bladder. This will help determine if the prostate is enlarged and blocking the urethra, slowing urine from leaving the bladder. It may also find problems with the bladder such as stones or tumors.
  • Prostate needle biopsy – A needle is used to take a small sample of prostate tissue to check for cancer. This is only done if your PSA blood test is found to be abnormal or if your prostate exam during the DRE is abnormal. It is not typically done for just an enlarged prostate without any other concerns.
  • Transrectal ultrasound – A probe is inserted into the rectum to check the prostate for abnormal areas.

Together, these tests can help your urologist determine the cause of your issues and help create a customized treatment plan.

Treatment

  • Lifestyle modifications: As physicians, we believe the most conservative course of action is best to try first, unless circumstances warrant a more aggressive approach. There are some simple steps you can take without medication or procedures that may improve your urinary symptoms, including changing bathroom habits, monitoring medications and examining your diet.
  • Medication: Medicine is one of the most common ways to treat men with mild to moderate BPH. Some medicines ease BPH symptoms by calming the muscles in the bladder and prostate to improve urine flow. These are called alpha blockers, and they are the most common medication to treat BPH.
  • Surgical treatments:
    • UroLift® System: The physician places small, permanent implants into the prostate to lift and hold enlarged tissue out of the way. This relieves pressure on the urethra and allows urine to flow. In a way, the implants act like curtain ties, lifting the tissue out of the way. This minimally invasive procedure involves no cutting, heating or removal of prostate tissue. Your urologist will perform the procedure at our outpatient surgery center in Norwood.
    • GreenLight™ Laser Therapy: During this procedure, the tissue blocking your prostate is rapidly heated and vaporized. The urologist inserts a small scope into your urethra, allowing him/her to see the inner surfaces of the urethra, prostate and bladder. Your urologist will then vaporize the prostate tissue that is obstructing urine flow. Most patients experience rapid symptom relief and dramatic improvement in urine flow within 24 hours.
    • Transurethral resection of the prostate (TURP): TURP is a surgery where a combined visual and surgical instrument (resectoscope) is inserted through the tip of your penis and into your urethra, the tube that carries urine from your bladder. Using the resectoscope, your doctor trims away excess prostate tissue that’s blocking urine flow. TURP is generally considered an option for men with moderate to severe urinary problems that haven’t responded to medication.

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