Enlarged prostate

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  • Overview
  • Symptoms
  • Treatment
  • Prevention
  • Alternative Names:

    BPH; Benign prostatic hypertrophy (hyperplasia); Prostate – enlarged

    Treatment:

    The choice of a treatment is based on the severity of your symptoms, the extent to which they affect your daily life, and the presence of any other medical conditions. Treatment options include “watchful waiting,” lifestyle changes, medication, or surgery.

    If you are over 60, you are more likely to have symptoms. But many men with an enlarged prostate have only minor symptoms. Self-care steps are often enough to make you feel better.

    If you have BPH, you should have a yearly exam to monitor the progression of your symptoms and determine if any changes in treatment are necessary.

    SELF-CARE

    For mild symptoms:

    • Urinate when you first get the urge. Also, go to the bathroom when you have the chance, even if you don’t feel a need to urinate.
    • Avoid alcohol and caffeine, especially after dinner.
    • Don’t drink a lot of fluid all at once. Spread out fluids throughout the day. Avoid drinking fluids within 2 hours of bedtime.
    • Try NOT to take over-the-counter cold and sinus medications that contain decongestants or antihistamines. These medications can increase BPH symptoms.
    • Keep warm and exercise regularly. Cold weather and lack of physical activity may worsen symptoms.
    • Learn and perform
      Kegel exercises
      (pelvic strengthening exercises).
    • Reduce stress. Nervousness and tension can lead to more frequent urination.

    Saw palmetto may ease prostate symptoms. Look for fat-soluble saw palmetto extract with 85-95% fatty acids and sterols.

    Sit in an aisle seat at the theatre or on an airplane. This won’t reduce your symptoms, but it may relieve your anxiety about having to urinate often or suddenly.

    If these measures are not enough to ease your symptoms, talk to your doctor, who may consider medications or surgery.

    MEDICATIONS

    • Finasteride lowers levels of hormones produced by the prostate, reduces the size of the prostate gland, increases urine flow rate, and decreases symptoms of BPH. It may take 3 to 6 months before you notice a significant improvement in your symptoms. Potential side effects related to use of finasteride include decreased sex drive and
      impotence
      .
    • Alpha 1-Blockers (like doxazosin, prazosin, tamsulosin, and terazosin) are a class of medications also used to treat
      high blood pressure
      . These medications relax the muscles of the bladder neck, allowing easier urination. Two thirds of the people treated with alpha 1-blocker medications report an improvement in symptoms.
    • Antibiotics may be prescribed to treat
      chronic prostatitis
      (inflammation of the prostate), which may accompany BPH. Some men note relief of their BPH symptoms after a course of antibiotics.

    SURGERY

    Prostate surgery may be recommended if you have:

    • Incontinence
    • Recurrent
      blood in the urine
    • Urinary retention
    • Recurrent
      urinary tract infections

    The choice of a specific surgical procedure is usually based on the severity of your symptoms and the size and shape of your prostate gland.


    • TURP:

      Transurethral resection of the prostate (TURP) is the most common surgical treatment for BPH. The TURP is performed by inserting a scope through the penis and removing the prostate piece by piece.

    • TUIP:

      Transurethral incision of the prostate (TUIP) is similar to TURP, but is usually performed in men who have a relatively small prostate. This procedure is usually performed as an outpatient without need for a hospital stay. Like the TURP, a scope is inserted through the penis until the prostate is reached. Then, rather than removal of the prostate, a small incision is made in the prostatic tissue to enlarge the opening of the urethra and bladder outlet.

    • Open Prostatectomy:

      An open prostatectomy is usually performed using general or spinal anesthesia. An incision is made through the abdomen or perineal area (i.e., through the pelvic floor, including the region from the scrotum to the anus). Then, the prostate is removed. This is a lengthy procedure, and it usually requires a hospital stay of 5 to 10 days.

    The majority of men who have prostate surgery have improvement in urine flow rates and symptoms. Possible complications include impotence, urinary incontinence, retrograde ejaculation (semen flowing back into the bladder rather than out the penis), infertility, and
    urethral stricture
    (narrowing). Rates of these complications vary, depending on the surgical procedure that you and your doctor decide is best.

    Various other procedures are available, such as those that destroy prostate tissue with heat generated by microwaves or lasers. Photoselective Vaporization of the Prostate (PVP), one of the newer laser technologies, is typically done as an outpatient procedure. The patient goes home on the same day. However, there is no long-term data for this procedure. Another form of treatment is prostatic
    stents
    .

    For more information, see
    prostate surgery
    .

    Support Groups:

    Several national groups provide information on BPH. See
    BPH support groups
    .

    Expectations (prognosis):

    Studies show that of the men who receive no treatment for BPH, as many as 31 to 55% actually show an improvement, and only 1 to 5% ever develop complications.

    Complications:

    Men who have had long-standing BPH with a gradual increase in symptoms may develop:

    • Sudden inability to urinate
    • Urinary tract infections
    • Urinary stones
    • Damage to the kidneys
    • Blood in the urine

    Even after surgical treatment, a recurrence of BPH may develop over time.

    Calling your health care provider:

    Call your doctor right away if you have:

    • Less urine than usual.
    • Fever or chills.
    • Back, side, or abdominal pain.
    • Blood or pus in your urine.

    Also call your doctor if:

    • Your bladder does not feel completely empty after you urinate.
    • You take medications that may cause urinary problems, like diuretics, antihistamines, antidepressants, or sedatives. DO NOT stop or adjust your medications on your own without talking to your doctor.
    • You have taken self-care measures for 2 months without relief.

    References:

    National Kidney and Urologic Diseases Information Clearinghouse. Prostate Enlargement: Benign Prostatic Hyperplasia. Available at:
    http://kidney.niddk.nih.gov/kudiseases/pubs/prostateenlargement/
    . Accessed May 18, 2005.

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