Enlarged prostate

Enlarged prostate is a non-cancerous condition that narrows the urethra (a tube running from the bladder through the prostate gland) and makes eliminatingurine more difficult. It affects many men over 50 years old and can be effectively treated by surgery and drugs. The common term for enlarged prostate isBPH, which stands for benign (non-cancerous) prostatic hyperplasia or hypertrophy. BPH is part of the aging process. Symptoms generally appear between ages 55-75. About 10% of all men eventually will require treatment for BPH. BPHis less common in blacks and Asians. The cause of BPH is unknown, but age-related hormonal changes may be a factor. An enlarging prostate gradually obstructs the flow of urine and in time, prevents the bladder from emptying completely at each urination. The urine that collects in the bladder can become infected and lead to stone formation or kidney damage. A man will have to urinate more often, perhaps two or three times at night. The need to urinate can become very urgent and, in time, urine may dribble out to stain clothing. Othersymptoms of BPH are a weak and sometimes split stream, and general aching orpain in the perineum (the area between the scrotum and anus). Some men haveconsiderable enlargement of the prostate before symptoms develop.

When a man's symptoms point to BPH, the physician will do a digital rectal examination, inserting a finger into the anus to feel whether--and how much--the prostate is enlarged. A smooth prostate surface suggests BPH, whereas a lump in the gland might mean prostate cancer. The next step is a blood test fora substance called prostate-specific antigen or PSA. Between 30-50% of men with BPH have an elevated PSA level. This does not mean cancer, but other tests are needed to make sure that the prostate enlargement is benign. An ultrasound exam of the prostate can show whether it is enlarged and mayshow that cancer is present. If there's a suspicion of cancer, most urologists will recommend a prostatic tissue biopsy. This is usually done using a lance-like instrument that is inserted into the rectum to obtain prostatic tissue for laboratory examination. To measure how severe the obstruction is, a catheter can be placed through the urethra and into the bladder, the man can urinate into a uroflowmeter, or a special viewing instrument called a cystoscopecan be passed into the bladder. It is routine to check a urine sample for anincrease in white blood cells, which may mean there is infection of the bladder or kidneys. The same sample could show what type of bacterium is causingthe infection, and which antibiotics will work best. The kidneys can be checked through imaging by ultrasound or injecting a dye (the intravenous urogram,or pyelogram); or a blood test for creatinine. Drugs to treat BHP include alpha-adrenergic blockers, such as phenoxybenzamine and doxazosin, which improve obstructive symptoms but do not keep the prostate from enlarging; and others such as finasteride which shrink the prostate and may delay the need for surgery. It may take three months or longer for symptoms to improve. Antibiotics are given for infections. Some medications, including antihistamines and some decongestants, can make the symptoms of BPH worse and cause urinary retention and should be avoided. When drugs don't control symptoms but the physician doesn't believe that surgery is needed, transurethral needle ablation can be tried. In the office and using local anesthesia, a needle is inserted intothe prostate and radiofrequency energy destroys the tissue that is obstructing urine flow. Microwave hyperthermia, done at an outpatient surgery center, uses a device called the Prostatron to deliver microwave energy to the prostate through a catheter. The standard operation for BPH is transurethral resection (TUR) of the prostate. Under general or spinal anesthesia, a cystoscope ispassed through the urethra and prostate tissue surrounding the urethra is removed using either a cutting instrument or a heated wire loop. The small pieces of prostate tissue are washed out through the scope. No incision is needed. Alternatives to TUR include: laser ablation of the prostate done in an operating room; transurethral incision of the prostate which is less invasive than standard TUR and may work well in men whose prostate is not grossly enlarged; transurethral vaporization of the obstructing prostatic tissue; and if theprostate is greatly enlarged an open prostatectomy to remove the entire gland. An extract of the saw palmetto (Serenoa repens or S. serrulata) stops or decreases the hyperplasia of the prostate. In a man without symptoms whose prostate is enlarged, it is hard to predict when symptoms will develop and how fast they will progress. For this reason, some specialists (urologists) advise "watchful waiting." When BPH is treated by TUR, urinary symptoms will be relieved and quality of life improved for the great majority of men. There is no known way of preventing BPH.

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