Prostate Enlargement

Enlargement of the Prostate Gland (BPH)
All men over the age of 40 will experience enlargement of the prostate. Some men will have no problems associated with this naturally occurring growth of the prostate gland. However because of its position, encircling the tube through which the urine flows, it can cause difficulty urinating.

As a man ages he may notice a weakening of his urinary stream. There may be some trouble starting to urinate. He may have to strain to start the flow.

Sometimes the enlarged prostate may cause frequency or interrupt normal sleep habits with the need to urinate every few hours. It may cause dribbling or dripping at the end of urination or a feeling of not completely emptying his urinary bladder. In its late stages an enlarged prostate can completely block the urine flow, and sometimes cause the kidney failure.

What is the prostate?

The prostate is a muscular, walnut-shaped gland, which is responsible for manufacturing part of the fluid that makes up semen, the solution that transports sperm. Sitting right below the bladder, the prostate surrounds urethra, the tube that transports urine out of the body.

What is BPH?
As a man ages, his prostate enlarges. As the prostate enlarges, it encroaches upon the urethra, causing partial and sometimes nearly complete obstruction of urine flow. This condition is known as BPH.

BPH, or benign prostatic hyperplasia, is a benign (non-cancerous) enlargement of the prostate. While BPH is usually not life-threatening, it can be uncomfortable and affect your quality of life. Typical symptoms of BPH include the following:

• Weak urine flow
• Sudden urge to urinate
• Difficulty/pain in starting urination
• Multiple trips to the bathroom at night
• Feeling of not emptying the bladder
• Stopping and starting of urine flow

IF you are suffering from the symptoms of BPH, you are not alone. In this country, approximately half of all men over the age of 50 have BPH By age 80, this number has jumped to 80% of all men.

In order to determine how much your particular urinary problems are bothering you, you will be asked to complete The AUA Symptom Score questionnaire regarding your symptoms. The AUA Symptom Score contains questions developed and validated by The American Urological Association. Your total score on this questionnaire will indicate how severe your condition is.

If you are diagnosed with BPH, your urologist will perform a complete physical exam, and likely measure your residual urine (the volume of urine remaining in your bladder after you urinate). Other tests may be performed to view your prostate, such as cystoscopy and prostate ultrasound. These tests will allow the urologist to better understand your particular condition.

For many years the only treatment for these problems was surgical, most times a TURP. This involved scraping out the obstructing prostatic tissue through an instrument inserted into the penis. Complications of this surgical procedure, such as bleeding, infection, loss of ejaculation, impotence, and loss of urinary control spurred the development of newer treatments for BPH.

What are my treatment options?
Several options are available to you. Surgery is a proven and effective approach, but requires hospitalization and can involve many significant side effects. Drug therapy is chosen by some men, but requires a life long commitment and sometimes presents undesirable side effects. Another approach is no active treatment at all, called "watchful waiting". If your symptoms are bearable, you can, with guidance of your urologist, simply "wait and see". While this approach presents no side effects, it also does nothing to treat your symptoms and it is highly unlikely that your symptoms will improve.

Medication

Proscar- shrinks the prostate gland by blocking a body chemical that causes the prostate to enlarge. This drug can be taken by nearly all men with few side effects. A weaker version of this medication, Propecia has been developed to help treat male-pattern baldness. The major difficulty with Proscar is that it may take six to twelve months to shrink the prostate, and improve urination. This is also a lifelong drug therapy. The urinary difficulty usually returns if the medication is stopped.

Alpha-Blockers - can alleviate many of the bothersome problems associated with prostatic enlargement. Originally developed to treat high blood pressure, many men found that they were urinating with an easier stream, emptying their bladder better, and waking up less at night to urinate. Hytrin and Cardura are the best known drugs in this class. However, side effects such as fatigue, dizziness, and dangerously-low blood pressure spurred the development of a more selective alpha-blocker known as Flomax. This is much better tolerated by most men with fewer side effects. It works directly in the prostate and blocks the nerves, thereby allowing it to open morefully and empty the bladder better. Hytrin, Cardura, and Flomax act more quickly than Proscar. They are therefore used as first-line therapy for symptomatic BPH. When they work to improve urination, their effect will only last as long as they are taken on a daily basis.

Herbs - Many men who resist taking drugs on a long term basis might consider natural herbal remedies to alleviate urinary difficulties. Saw palmetto and Africanum pygeum are the two best known herbs associated with prostate health. Other natural substances, minerals, such as zinc and selenium, and vitamins, such as Vitamin C and E, are also believed to promote prostate health.

Minimally invasive treatments

For those who do not wish to take drugs, or for those in whom the drugs cause side effects or simply do not work, surgery was once the only alternative. Now a days, however, minimally invasive procedures have been developed to reduce the size of the prostate gland without the use of conventional, more invasive surgical treatments.

TUNA...INDIGO LASER...TUMT

TUNA- also known as needle-ablation of the prostate, involves the use of low level radiofrequencies delivered through the use of needles placed within the prostate gland.

INDIGO LASER- also placed into the prostate gland directly, heats the prostate to 85°C thereby destroying the prostate glandular tissue. Both procedures are performed in an outpatient setting involving the use of local anesthesia, and usually, intravenous sedation. Both require the use of a telescope placed into the penis to deliver the probes.

TUMT - or trans urethral microwave thermotherapy, heats the prostate gland to temperatures up to 50°C, causing cell death and eventual shrinking of the prostate gland. In contrast to TUNA or Indigo Laser, there is no penetration of the prostate gland by needle or laser probe. The lower temperatures also allow for true, in-office treatment with no need for intravenous sedation or anesthesia.

Minimally invasive procedures preserve erection, ejaculation, and urinary control. The enlarged prostate tissue shrinks over the course of time allowing the urethra, or urinary tube, to open more fully during urination, improving the flow. A catheter left for 3-4 days allows for swelling to subside. The improved flow and reduction in urinary symptoms are comparable to the proven more conventional surgical procedures of the past. In nearly 10 years of clinical use, the results seems long-lasting with much fewer side effects.

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