Benign prostatic hyperplasia (BPH) or enlargement of the prostate is one of the most common health complaints in men over 50, affecting half the men between ages 51 and 60 and up to 90 percent of men older than 80.
The prostate is a male reproductive gland about the size of a walnut, that produces fluid for semen and surrounds the urethra at the neck of the bladder. The urethra is the tube that carries urine from the bladder to the outside of the body. In men, the urethra also carries semen out through the penis.
A growth in the prostate can either be benign (nonthreatening) or malignant (cancerous). Benign growths do not increase your chance of getting cancer but many of the early signs are the same.
When the prostate enlarges, it can block the urethra, causing symptoms such as:
* Frequent need to urinate both day and night (frequency/nocturia)
* Weak or slow urinary stream (weak urine flow)
* A sense that you cannot completely empty your bladder (incomplete emptying)
* Difficulty or delay in starting urination (hesitation)
* Urgent need to urinate (urgency)
* A urinary stream that stops and starts (intermittency)
Less-common signs and symptoms include:
* Urinary tract infection
* Inability to urinate
* Blood in the urine
If you experience urinary problems, even if they don’t bother you much, it is best to discuss them with a board-certified urologist so that more serious conditions can be ruled out or treated.
Similar symptoms to those caused by an enlarged prostate include:
* Urinary tract infections
* Inflammation of the prostate (prostatitis)
* Narrowing of the urethra (urethral stricture)
* Scarring in the bladder neck because of previous surgery
* Bladder or kidney stones
* Problems with nerves that control the bladder
* Cancer of the prostate or bladder
The size of your prostate doesn’t necessarily determine the severity of your symptoms. Some men with only slightly enlarged prostates can have significant symptoms, while other men with very enlarged prostates can have only minor urinary symptoms.
While BPH is a benign condition, unrelated to prostate cancer, it can greatly affect a man’s quality of life. If left untreated, BPH can lead to permanent bladder damage. However, in some men, symptoms can stabilize and even improve over time.
The science on what causes prostate enlargement is not clear, but hormonal changes as men grow older are believed to be a factor.
Risk factors include:
* Aging. BPH is rare in men under 40 years old and becomes more prevalent as men age.
* Family history. Men with blood relatives who have had prostate problems are more likely to experience prostate problems
* Diabetes and heart disease. Studies show that diabetes, as well as heart disease and use of beta blockers, might increase the risk of BPH.
* Lifestyle. Obesity increases the risk of BPH, while exercise can lower your risk. According to Harvard Health, researchers found that men who were more physically active were less likely to suffer from BPH. Even low- to moderate-intensity physical activity, such as walking regularly at a moderate pace, yielded benefits.
Medication is the most common treatment for mild to moderate symptoms of prostate enlargement. The options include:
* Alpha blockers, which relax bladder neck muscles and muscle fibers in the prostate, making urination easier. Side effects can include retrograde ejaculation where the semen goes back into the bladder instead of out through the tip of the penis.
* 5-alpha reductase inhibitors, which shrink your prostate by preventing hormonal changes that cause prostate growth. Side effects include retrograde ejaculation.
* Combination drug therapy. Your doctor might recommend taking an alpha blocker and a 5-alpha reductase inhibitor at the same time if either medication alone isn’t effective.
* Tadalafil (Cialis). Often used to treat erectile dysfunction, this drug has shown to be an effective treatment for enlarged prostate.
There are several types of minimally invasive or surgical therapies that can be used to treat BPH. In determining which treatment to recommend, your urologist will consider the size of your enlarged prostate, severity of symptoms, your desire to retain or maintain sexual function, your age, presence of other health problems, and your lifestyle. Before you make any decision, however, be sure to review all of your alternatives, talk with loved ones who may be impacted by your decision, and select a surgeon who is knowledgeable, receptive to your questions, and experienced in your chosen procedure.
Transurethral resection of the prostate (TURP)
This procedure typically requires general or spinal anesthesia. During a TURP, a lighted scope is inserted through the tip of your penis and into the urethra to remove the enlarged portion of the prostate.
TURP generally relieves symptoms quickly, and most men have a stronger urine flow soon after the procedure. After TURP, you might temporarily need a catheter to drain your bladder. Long-term side effects may include ejaculatory dysfunction, erectile dysfunction, and incontinence (leaking urine).
Transurethral incision of the prostate (TUIP)
This procedure also requires general or spinal anesthesia. It can be an option for patients with a small or moderately enlarged prostate gland, especially if they have health issues that increase risks of alternative procedures. During TUIP, a lighted scope is inserted into the urethra, and the surgeon makes one or two small cuts in the prostate gland to allow urine to pass through the urethra. This is generally a safe procedure, but as with all surgery, complications can arise.
Laser therapy uses a laser to destroy and remove prostate tissue. Laser therapy generally relieves symptoms right away and has a low risk of side effects.
The UroLift® System
The UroLift® System uses a revolutionary approach to treating BPH that lifts and holds the enlarged prostate tissue so it no longer blocks the urethra. It is the only BPH treatment performed by a urologist that does not require heating, cutting, or removal of the prostate tissue. The procedure is typically performed using local anesthesia in a physician’s office or ambulatory surgery center. Most patients return home immediately and experience a speedy recovery.
This minimally invasive treatment that can get men off BPH medications and avoid major surgery.
To find out more or make an appointment with one of our board certified urologists, please call 641.494.5280
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