BPH stands for benign prostatic hyperplasia (or benign prostatic hypertrophy). This condition is common in older men, and refers to an enlargement of the prostate gland. Symptoms will vary, but the most common involve changes or problems with urination. In the United States in 2000, there were 4.5 million visits to a physician for this condition. Treatment options include watchful waiting, drug therapy, and surgery.
It is common for the prostate gland to become enlarged as a man ages. Doctors call the condition benign prostatic hyperplasia (BPH) or benign prostatic hypertrophy.
As a man matures, the prostate goes through two main periods of growth. The first occurs early in puberty, when the prostate doubles in size. At around age 25, the gland begins to grow again. This second growth phase often results, years later, in BPH.
Though the prostate continues to grow during most of a man's life, the enlargement doesn't usually cause problems until late in life. BPH rarely causes symptoms before age 40, but more than half of men in their 60s and as many as 90 percent in their 70s and 80s have some symptoms of BPH.
As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the gland to press against the urethra like a clamp on a garden hose. The bladder wall becomes thicker and irritable. The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination. Eventually, the bladder weakens and loses the ability to empty itself, and urine remains in the bladder. The narrowing of the urethra and partial emptying of the bladder cause many of the problems associated with BPH.
The prostate gland is the male organ that produces most of the fluid in semen, the milky-colored fluid that nourishes and transports sperm out of the penis during ejaculation. It sits beneath your bladder. The tube that transports urine from the bladder out of your penis (urethra) passes through the center of the prostate. So, when the prostate enlarges, it begins to block (obstruct) urine flow.
Most men have continued prostate growth throughout life. In many men, this continued growth enlarges the prostate enough to cause urinary symptoms or to significantly block urine flow. Doctors aren't sure exactly what causes the prostate to enlarge. It may be due to changes in the balance of sex hormones or a drop in testosterone levels as men grow older. Others believe that one enlarged prostate cause is the "reawakening" of cells that deliver signals to other cells in the prostate.
For centuries, it has been known that an enlarged prostate occurs mainly in older men and that it doesn't develop in men whose testes were removed before puberty. For this reason, some researchers believe that factors related to aging and the testes may be factors in the development of this condition.
Many BPH (benign prostatic hyperplasia) symptoms stem from obstruction of the urethra and gradual loss of bladder function, which results in incomplete emptying of the bladder. Symptoms of this condition usually start after the age of 50. They can include:
Trouble starting a urine stream or making more than a dribble
Passing urine often, especially at night
Feeling that the bladder has not fully emptied
A strong or sudden urge to urinate
A weak or slow urine stream
Stopping and starting again several times while passing urine
Pushing or straining to begin passing urine.
At their worst, BPH symptoms can lead to:
A weak bladder
Backflow of urine causing bladder or kidney infections
Complete block in the flow of urine
Kidney failure.
Early symptoms of BPH take many years to turn into bothersome problems. These early symptoms are a cue to see your doctor. In 8 out of 10 cases, these symptoms suggest an enlarged prostate (benign prostatic hyperplasia, or BPH), but they can also signal other, more serious conditions that require prompt treatment. These conditions, including prostate cancer, can only be ruled out by a doctor's exam.
The size of the prostate does not always determine how severe the obstruction or symptoms will be. Some men with greatly enlarged prostate glands have little obstruction and few BPH symptoms while others, whose glands are less enlarged, have more blockage and greater problems.
Sometimes a man may not know he has any obstruction until he suddenly finds himself unable to urinate at all. This condition, called acute urinary retention, may be triggered by taking over-the-counter cold or allergy medicines. Such medicines contain a decongestant drug, known as a sympathomimetic. A potential side effect of this drug may be to prevent the bladder opening from relaxing and allowing urine to empty. When partial obstruction is present, urinary retention can also be brought on by alcohol, cold temperatures, or a long period of immobility.
It is important to tell your doctor about urinary problems such as these. In eight out of ten cases, these symptoms suggest BPH, but they can also signal other, more serious conditions that require prompt treatment. These conditions, including prostate cancer, can only be ruled out by a doctor's exam.
Severe BPH can cause serious problems over time. Urine retention and strain on the bladder can lead to:
Urinary tract infections
Bladder or kidney damage
Bladder stones
Incontinence.
If the bladder is permanently damaged, treatment for BPH may be ineffective. When the condition is found in its earlier stages, there is a lower risk of developing such complications.
The three main types of treatment for BPH include watchful waiting, drug therapy, and surgery and minimally invasive surgery. Some men with mild, non-bothersome symptoms often choose watchful waiting as their treatment approach. This includes getting annual checkups to monitor their condition. However, those with moderate or severe symptoms may opt for drug therapy or surgery. If you have an enlarged prostate, talk with your healthcare provider about which type of treatment is the best choice for you.
Men with mild, non-bothersome symptoms of BPH often choose watchful waiting as their treatment approach.
Watchful waiting means getting annual checkups. The checkups can include digital rectal exams and other tests. BPH treatment is started only if the symptoms become too much of a problem. If you choose to live with enlarged prostate symptoms, these simple steps can help:
Limit drinking in the evening, especially drinks with alcohol or caffeine
Empty the bladder all the way when you urinate
Use the restroom often -- don't go for long periods without urinating.
Some medications can make BPH symptoms worse, so talk with your doctor or pharmacist about any medicines you are taking, such as:
Over-the-counter cold and cough medicines (especially antihistamines)
Tranquilizers
Antidepressants
Blood pressure medicine.
Medications are the most common treatment for moderate symptoms of prostate enlargement. Medications used to relieve symptoms of enlarged prostate include:
Alpha blockers. These medications relax bladder neck muscles and muscle fibers in the prostate itself and make it easier to urinate. These medications include terazosin, doxazosin (Cardura), tamsulosin (Flomax), alfuzosin (Uroxatral) and silodosin (Rapaflo). Alpha blockers work quickly. Within a day or two, you'll probably have increased urinary flow and need to urinate less often. These may cause a harmless condition called retrograde ejaculation — semen going back into the bladder rather than out the tip of the penis.
5 alpha reductase inhibitors. These medications shrink your prostate by preventing hormonal changes that cause prostate growth. They include finasteride (Proscar) and dutasteride (Avodart). They generally work best for very enlarged prostates. It may be several weeks or even months before you notice improvement. While you're taking them, these medications may cause marital side effects including impotence (erectile dysfunction), and retrograde ejaculation.
Combination drug therapy. Taking an alpha blocker and a 5 alpha reductase inhibitor at the same time is generally more effective than taking just one or the other by itself.
Tadalafil (Cialis). This medication, from a class of drugs called phosphodiesterase inhibitors, is often used to treat impotence (erectile dysfunction). It also can be used as a treatment for prostate enlargement. Tadalafil can't be used in combination with alpha blockers. It also can't be taken with medications called nitrates, such as nitroglycerin.
Your doctor may recommend surgery if medication isn't effective or if you have severe symptoms. There are several types of surgery for an enlarged prostate. They all reduce the size of the prostate gland and open the urethra by treating the enlarged prostate tissue that blocks the flow of urine. The decision about which type of surgery may be an option is based on a number of factors, including the size of your prostate, the severity of your symptoms, and what treatments are available in your area.
Any type of prostate surgery can cause side effects, such as semen flowing backward into the bladder instead of out through the penis during ejaculation (retrograde ejaculation), loss of bladder control (incontinence) and impotence (erectile dysfunction). Ask your doctor about the specific risks of each treatment you're considering.
Standard
surgeries
Standard surgeries
for an enlarged prostate include:
Transurethral resection of the prostate (TURP). TURP has been a common procedure for enlarged prostate for many years, and it is the surgery with which other treatments are compared. With TURP, a surgeon places a special lighted scope (resectoscope) into your urethra and uses small cutting tools to remove all but the outer part of the prostate (prostate resection). TURP generally relieves symptoms quickly, and most men have a stronger urine flow soon after the procedure. Following TURP, there is risk of bleeding and infection, and you may temporarily require a catheter to drain your bladder after the procedure. You'll be able to do only light activity until you're healed.
Transurethral incision of the prostate (TUIP or TIP). This surgery is an option if you have a moderately enlarged or small prostate gland, especially if you have health problems that make other surgeries too risky. Like TURP, TUIP involves special instruments that are inserted through the urethra. But instead of removing prostate tissue, the surgeon makes one or two small cuts in the prostate gland to open up a channel in the urethra — making it easier for urine to pass through.
Open prostatectomy. This type of surgery is generally done if you have a very large prostate, bladder damage or other complicating factors, such as bladder stones. It's called open because the surgeon makes an incision in your lower abdomen to reach the prostate. Open prostatectomy is the most effective treatment for men with severe prostate enlargement, but it has a high risk of side effects and complications. It generally requires a short stay in the hospital and is associated with a higher risk of needing a blood transfusion.
Minimally
invasive surgery
Minimally
invasive treatments are less likely to cause blood loss during
surgery and require a shorter, if any, hospital stay. These
treatments also typically require less pain medication. Depending on
the procedure — and how well it works for you — you may
need follow-up treatments.
Minimally invasive treatments include:
Laser surgery. Laser surgeries (also called laser therapies) use high-energy lasers to destroy or remove overgrown prostate tissue. Laser surgeries generally relieve symptoms right away and have a lower risk of side effects than does TURP. Some laser surgeries can be used in men who shouldn't have other prostate procedures because they take blood-thinning medications.
Laser surgery can be done with different types of lasers and in different ways.
Ablative procedures (including vaporization) remove prostate tissue pressing on the urethra by burning it away, easing urine flow. Ablative procedures may cause irritating urinary symptoms after surgery and may need to be repeated at some point.
Enucleative procedures are similar to open prostatectomy, but with fewer risks. These procedures generally remove all the prostate tissue blocking urine flow and prevent regrowth of tissue. One benefit of enucleative procedures over ablative procedures is that removed prostate tissue can be examined for prostate cancer and other conditions.
Types of laser surgery include:
Holmium laser ablation of the prostate (HoLAP)
Visual laser ablation of the prostate (VLAP)
Holmium laser enucleation of the prostate (HoLEP)
Photoselective vaporization of the prostate (PVP)
Options for laser therapy depend on prostate size, the location of the overgrown areas, your doctor's recommendation and your preferences. Choices available also depend on where you seek treatment. Not all facilities have lasers to perform prostate surgery or doctors who have the specialized skills and training to do the procedures.
Transurethral microwave thermotherapy (TUMT). With this procedure, your doctor inserts a special electrode through your urethra into your prostate area. Microwave energy from the electrode generates heat and destroys the inner portion of the enlarged prostate gland causing it to shrink and ease urine flow. This surgery has a lower risk of complications than does TURP, but is generally only used on small prostates in special circumstances, because re-treatment may be necessary.
Transurethral needle ablation (TUNA). With this outpatient procedure, a lighted scope (cystoscope) is passed into your urethra. Your doctor uses the scope to place needles into your prostate gland. When the needles are in place, radio waves pass through them, heating and destroying excess prostate tissue that's blocking urine flow. TUNA basically scars the prostate tissue, which causes it to shrink and open up, easing urine flow. This type of surgery may be a good choice if you bleed easily or you have certain other health problems. Like TUMT, TUNA may only partially relieve your symptoms and it may take some time before you notice results. The risk of erectile dysfunction with the procedure is very low.
Prostatic stents. A prostatic stent is a tiny metal or plastic device that's inserted into your urethra to keep it open. Tissue grows over the metallic stent to hold it in place. The plastic stent needs to be changed every four to six weeks but keeps you from having to undergo any surgical procedure. In most cases, doctors don't consider stents a viable long-term treatment because they can cause side effects including painful urination or frequent urinary tract infections. The metal stents can be difficult to remove and are used only in special circumstances, such as for someone who can't have surgery. Sometimes, plastic stents may be used temporarily before surgery to make sure you'll be able to urinate after your surgery.
Making some lifestyle changes can often help control the symptoms of an enlarged prostate and prevent your condition from worsening. Try these measures:
Limit beverages in the evening. Don't drink anything for an hour or two before bedtime to help you avoid wake-up trips to the bathroom at night.
Limit your caffeine and alcohol intake. These can increase urine production, irritate your bladder and worsen your symptoms.
If you take water pills (diuretics), talk to your doctor. Maybe a lower dose, taking them only in the morning, or a milder diuretic or change in the time you take your medication will help ease urinary symptoms. Don't stop taking diuretics without first talking to your doctor.
Limit decongestants or antihistamines. These drugs tighten the band of muscles around your urethra that control urine flow, which makes it harder to urinate.
Go when you feel the urge. Try to urinate when you first feel the urge. Waiting too long to urinate may overstretch the bladder muscle and cause damage.
Schedule bathroom visits. Try to urinate at regular times to "retrain" the bladder. This can be done every four to six hours during the day and can be especially useful if you have severe frequency and urgency.
Stay active. Inactivity causes you to retain urine. Even a small amount of exercise can help reduce urinary problems caused by an enlarged prostate.
Urinate — and then urinate again a few moments later. This is known as double voiding.
Keep warm. Colder temperatures can cause urine retention and increase your urgency to urinate.
Studies on alternative therapy for an enlarged prostate have had mixed results. Sometimes these treatments appear to help, while other times, they don't. Saw palmetto extract, which is made from the ripe berries of the saw palmetto shrub, were believed to help reduce the symptoms of an enlarged prostate. But, research has found that the herbal treatment is no more effective than a placebo.
Because there's no strong evidence that any herbal treatment can relieve urinary symptoms caused by an enlarged prostate, the American Urological Association doesn't recommend any herbal treatments. In addition, certain herbal products may increase your risk of bleeding or interfere with other medications you're taking.
Some of the herbal treatments that have been suggested as helpful for reducing enlarged prostate symptoms include:
Saw palmetto extract, made from the ripe berries of the saw palmetto shrub
Beta-sitosterol extracts, made from several plants, such as certain grasses and trees
Pygeum, an oil made from the bark of an African prune tree
Ryegrass extract, made from ryegrass pollen
Stinging nettle extract, made from the root of the stinging nettle plant
If you take any herbal remedies, be sure to tell your doctor. These may help treat some of your symptoms but are generally less effective than are prescription medications.