Enlarged Prostate
Alternate Names : Benign Prostatic Hypertrophy (Hyperplasia), BPH, Prostate - Enlarged
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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 from BPH than younger men. But, many men with an enlarged prostate have only minor symptoms. Taking self-care measures is generally enough to 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
If your symptoms are mild, try the following methods for relief:
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Urinate when you first get the urge. Also, go to the bathroom when time and location permit, even if you don't feel a need to urinate.
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Avoid alcohol and caffeine, especially after dinner.
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Don't drink excessive amounts of fluid (especially at night). Instead, spread your fluids out throughout the day and avoid drinking fluids within two hours of your bedtime.
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Try NOT to take over-the-counter cold and sinus medications that contain decongestants or antihistamines. These medications can increase BPH symptoms.
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Keep warm and exercise regularly. Cold weather and lack of physical activity may worsen symptoms.
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Reduce stress. Nervousness and tension can lead to more frequent urination.
Some men have had success taking extracts of saw palmetto berries, an herb that has been used to ease prostate symptoms. Look for fat-soluble saw palmetto extract that has been standardized to contain 85% to 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.
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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.
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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:
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.
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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.
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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.
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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 studies are underway to evaluate the effectiveness of other treatments, such as hyperthermia, laser therapy, and prostatic stents.
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