Benign Prostatic Hyperplasia

What is the prostate?
The prostate is a gland that sits between a man's bladder and penis. The tube (urethra) that carries urine from the bladder to the penis passes through the prostate.

The prostate makes fluid that helps sperm stay healthy. Almost all of the fluid a man ejaculates during sex is produced by the prostate.

The prostate is the size of a walnut in young men, but increases in size with age.

What is BPH?
The term hyperplasia means that the size of the prostate increases (enlarges). Benign means the growth is not cancerous. An enlarged prostate can compress the channel that carries urine (the urethra) and make urination (urinating) more difficult.

1. BPH is common after age 50.
2. The doctor diagnoses BPH by inserting a gloved finger into the rectum (the end of the digestive tract, where stool is stored) to feel the prostate (rectal examination).
3. Tests may be done to see if urine is flowing properly and to rule out prostate cancer.
4. Treatment is not always necessary for BPH.
5. If the symptoms are very bothersome, the person may need to take medication or have surgery.

What causes BPH?
Doctors aren't sure what causes BPH. It is probably due to hormonal changes associated with aging.

What are the symptoms of BPH?
BPH blocks the flow of urine, which is why men may experience these symptoms:

1. Difficulty starting urination.
2. Reduction and weakening of urinary flow.
3. Drip-like discharge at the end of urination.

As the urinary flow is obstructed, the bladder does not empty completely and the person may :

1. Feeling like urination hasn't finished.
2. Feeling the need to urinate more often, especially at night.
3. Feeling an urgent need to urinate.
4. Developing a bladder infection.

Sometimes the flow of urine is completely blocked and the person cannot urinate at all (a condition known as acute urinary retention). When this happens, the bladder quickly fills with urine and becomes extremely painful. The pain is such that the person wants and needs to see a doctor urgently.

What happens in case of enlargement of the prostate?

In benign prostatic hyperplasia, the prostate increases in size. Normally the size of a walnut, the prostate can grow to the size of a tennis ball. The enlargement of the prostate causes compression of the urethra, which carries urine out of the body. Therefore, the flow of urine may be slower or less.

How can doctors tell if BPH is present?

The doctor will ask the person about their symptoms and perform a rectal examination:

1. The doctor inserts a gloved finger into the rectum (the end of the digestive tract, where stool is stored).
2. This examination allows the doctor to feel the prostate.
3. In BPH, the prostate feels large and smooth to the touch.

In the event of significant difficulty in urination, the doctor may perform a urine flow test. During this test, the person urinates into a device that measures the volume of urine and how quickly it flows. After the urine flow test, the doctor performs an ultrasound to find out if the bladder has emptied. Ultrasound uses sound waves to measure the exact volume of urine in the bladder.

Prostate cancer is also a condition that enlarges the prostate. Doctors need to be able to determine if the symptoms are caused by BPH or prostate cancer. Sometimes the cancer produces a hard mass that the doctor can feel in the prostate, but this is not always the case. Because of this, the doctor usually does the following:

• A blood test called the PSA level

Based on this PSA level, physical exam, and other factors, the doctor may recommend:

• A prostate biopsy

A prostate biopsy involves removing samples of tissue from the prostate using a hollow needle. First, the doctor inserts an ultrasound probe into the person's rectum. The images produced by the ultrasound allow the doctor to orient his needle. The doctor first injects an anesthetic, then takes several samples.

How do doctors treat BPH?
BPH is usually not treated unless the symptoms are bothersome or cause infections. If this is the case, the doctor may prescribe medication for the person.

Some medications relax parts of the prostate and bladder, which improves urinary flow. Other drugs reduce the size of the prostate. If the drugs are ineffective, the person may need to have surgery.

During the surgery, called TURP (for transurethral resection of the prostate), the doctor:

1. Place a viewing probe through the penis to the prostate.
2. Use instruments or a laser to remove part of the prostate.

Most of the time, TURP relieves the person's symptoms. There is, however, a small risk of urine leakage (incontinence) or difficulty getting an erection after the procedure.

In the event of a sudden attack during which it is impossible to urinate (acute urinary retention), the person will need a catheter. A catheter is a flexible plastic tube that the doctor inserts through the penis to the bladder. The catheter lets the urine flow out. The person will usually need to keep the tube in place for several days.