Prostate Enlargement (BPH)
What is Prostate Enlargement?
If you’re taking more trips to the bathroom every night, this can be the first sign of an enlarged prostate, also called benign prostatic hyperplasia (BPH). Other symptoms may include difficulty starting to urinate, leaking or dribbling. According to the American Urological Association, BPH is the most common problem for men over 50; by age 60 over one-half of men have BPH and by age 85 it’s 90%. As the prostate enlarges it blocks the flow of urine through the urethra and as the urethra narrows, the bladder contracts to more forcefully push the urine through the body. This causes the bladder to contract even when it contains small amounts of urine making you feel the need to urinate. Over time when the bladder does not completely empty, you may experience several problems, including:
- Urinary tract infections
- Bladder stones
- Blood in your urine
- The inability to urinate, which may result in a medical emergency
Prostate Enlargement Symptoms
The symptoms of an enlarged prostate can include:
- Difficulty starting to urinate and a weak or slow urinary stream
- Straining to urinate and dribbling after urination
- Feeling you never empty your bladder
- Having frequent urination
- Having to urinate again shortly after finishing
- Nocturia, night time urination
Prostate Enlargement Diagnosis
Your doctor may recommend the following tests for your prostate enlargement problems:
A urine sample is tested to detect substances that could cause specific conditions
Prostate-specific antigen test (PSA) to check for cancer
Which is when your bladder is filled with liquid via catheter to measure the pressure of your bladder during urination
Is an examination of your urethra and bladder with a lighted scope inserted in your urethra
Which tests the amount of urine left in your bladder after urination
Uses sound waves to create images of the prostate gland
Prostate Enlargement Treatments
Your Saint John’s Physician Partners urologist has a wide range of treatment options. Your options will depend on the size of your prostate, your symptoms and your age. Your doctor will help you understand these options so you can make an informed decision. There are also several herbal therapies that are marketed for enlarged prostates such as saw palmetto, beta-sitosterol and pygeum; however, these are not regulated by the Food and Drug Administration (FDA) and should only be taken after discussion with your urologist. Traditional treatment options include:
- Alpha-blockers are drugs that don’t reduce the size of the prostate, but are very effective at relieving symptoms.
- 5-Alpha reductase inhibitors are drugs that can partially shrink the prostate. These drugs take longer to work than alpha-blockers, and can generally improve urine flow after three months.
- The UroLift procedure is a minimally invasive approach to treating an enlarged prostate (BPH) that lifts or holds the enlarged prostate out of the way so it no longer blocks the urethra. There is no cutting, heating or removal of prostate tissue.
- Transurethral incision of bladder neck (TUIBN) is an outpatient surgical procedure that opens up the bladder neck for urine to flow more freely.
- Prostatic artery embolization (PAE) is a minimally invasive treatment that helps improve urinary tract symptoms caused by BPH.
If you have a very enlarged prostate, surgery may be your best bet to relieve symptoms. Your doctor will review both risks and benefits so you can make an informed decision. Surgical procedures that may be recommended by your doctor include:
- Transurethral resection of the prostate (TURP) is a common procedure where only the tissue growth that is affecting the urethra is removed to allow urine to flow easily. The procedure is less traumatic than open surgery and has a shorter recovery time. With TURP, men can expect to have retrograde ejaculation, which where you ejaculate backwards into the bladder.
- Transurethral incision of the prostate (TUIP) is a procedure that involves making cuts in the prostate to reduce pressure on the urethra, making urination easier. Retrograde ejaculation is less common with this procedure.
- Open prostate surgery (Prostatectomy) is a procedure that requires an incision in the abdomen in order to remove tissue in the prostate. The procedure is typically done when the prostate is greatly enlarged and when there is bladder damage. This is now usually done with robotic surgery.