BPH - Benign Prostatic Hyperplasia

General Information
Enlargement of the prostate gland is an expected phenomenon of aging in men. This is called benign prostatic hypertrophy and is present in 80% of men by age 80. The prostate gland surrounds the urethra, the passageway for urine that leads from the bladder to the outside of the body. As this gland enlarges, it presses on the urethra and bladder and interferes with the flow of urine from the bladder, hampering proper bladder function. Gradually the muscle in the wall of the bladder thickens to overcome this resistance to the emptying of urine. Nevertheless, the bladder begins to empty with some difficulty, and the following symptoms may be noted:

• The urinary stream becomes difficult to start, which is called hesitancy.
• The urinary stream is also difficult to stop cleanly, and there may be dribbling.
• The thickened bladder wall causes a decrease in the volume that the bladder can hold; thus there is an increase in frequency of urination.
• When increased frequency occurs at night, it is called nocturia.
• Urgency, the frequent passage of small volumes of urine, also is a problem.

A simple examination of the gland during a rectal examination can tell your doctor approximately how much the gland has enlarged. As the prostate gland grows, these symptoms progress. Treatment is ultimately required in about 20% of men.

Important Points in Treatment
Much of the ‘‘treatment’’ for benign prostatic hypertrophy is watchful waiting. Not every man with prostatic hypertrophy requires medical or surgical treatment.

One treatment for benign prostatic hypertrophy is surgery. Usually this is done through the urethra, the opening in the penis, and it does not leave an external scar. Your physician can review the benefits and risks of this form of therapy with you.

Alternatively, there are two medical therapies that can benefit some patients. One drug, finasteride (Proscar), acts by decreasing the level of a male hormone in the prostate gland. This slows the growth of the prostate gland, and, in many cases, the gland shrinks. Symptoms improve if the gland shrinks adequately. Not all patients note an improvement in symptoms. Improvement may take 6 months or more. This drug has few side effects. A few patients experience decreased sex drive.

Terazosin (Hytrin) (and other drugs of this sort) is of use in some men with benign prostatic hypertrophy. This drug is used for the treatment of high blood pressure. It relaxes the muscles in the blood vessels, allowing the blood pressure to fall. It can also relax the muscles where the bladder empties, reducing the obstruction caused by the enlargement of the prostate gland. It is more rapidly effective than finasteride. This medication does have side effects, particularly faintness on standing.

Although both finasteride and terazosin are effective, they are suitable for use in only some patients.

Notify Our Office If

• You note a change in your ability to urinate.
• You see blood in your urine.
• You experience a loss of sex drive while taking finasteride or terazosin.
• You have weakness or dizziness, particularly on rising from a sitting or lying position, while taking terazosin.
• You have nasal stuffiness while taking terazosin.

Incontinence and BPH

General Information
As men get older, the prostate gland gets larger, a condition known as benign prostatic hyperplasia. Many men do not become incontinent even though they have an enlarged prostate. In some men, however, an enlarged prostate may cause problems because it can put pressure on the bladder, resulting in the frequent release of small quantities of urine. You may feel the need to urinate at night. You may also find it difficult to get your stream of urine started, and then you may find that your bladder is emptying very slowly. Sometimes the interference of the enlarged prostate with the bladder area causes minor incontinence, referred to as dribbling.

Malignant tumors also may develop in the prostate. Unfortunately, these tumors do not always produce symptoms.

Important Points in Treatment
Surgical removal of part of the enlarged prostate is the usual treatment for benign prostatic hyperplasia. An alternative, nonsurgical treatment with drugs alone may be used at times when symptoms are mild.

After surgery, there may be a period of incontinence, but this should end sometime during the subsequent 6 months. An extremely small percentage of patients (1%) may continue to have mild dribbling when in an upright position. Continence garments and incontinence pads should offer a comfortable solution while you attempt to improve this condition by means of pelvic muscle exercises. Particularly helpful are those called Kegel’s exercises.

The goal of these exercises is to make you aware of and be in control of the muscles that are involved in urination. The best way to become aware of these muscles is to stop your urinary stream and then restart it voluntarily. Become familiar with the process of tightening, stopping urination, and relaxing then starting urination, with these muscles. Once you are familiar with these muscles, try tightening and relaxing them at other times (when not urinating). Do these exercises three times daily, starting with five sets (repetitions) of tightening and then relaxing the muscles at each session, or a total of 15 sets per day. Then progress slowly up to 25 sets (repetitions) each session or a total of 75 sets per day.

Occasionally, surgery to correct benign prostatic hyperplasia affects potency but because the disease occurs at a time in life when sexual activity is decreasing anyway, it is not clear whether surgery is actually the cause of the decreased potency. Most patients experience little, if any, actual change in potency. This surgery occasionally causes retrograde ejaculation (emptying of ejaculate into the bladder rather than directly through the penis). Sterility does result but impotence does not.

Even though removal of prostate tumors requires more extensive surgery, the postoperative effects are similar to those that occur after surgery for benign prostatic hyperplasia. The effects become more severe, however, if there is more extensive surgery for removal of the tumor.

Notify Our Office If ...

• You have urinary incontinence.
• You must urinate or are awakened frequently from sleep to urinate.