Enlarged Prostate Podcast
Dr. Stormont, as men age, many seem to have problems with urination. What is happening and will it happen to everyone eventually?
For men in their 40’s and 50’s, problems with urination often become a fact of life. In most cases, this is due to BPH (benign prostatic hyperplasia) a noncancerous enlargement of the prostate that occurs in all men as they age. Some men get symptoms due to this enlargement what cause significant bother in their lives.
The prostate gland is part of a man’s reproductive system. Its function is to help a man father a child by producing semen. It’s about the size and shape of a walnut, and located just below the bladder and in front of the rectum. The urethra, which is a tube that carries urine from the bladder, passes through the middle of the prostate.
As men age a hormone called DHT promotes prostate enlargement. As a result of this growth, the hole that the urethra passes through becomes compressed, often blocking the flow of urine, thus leading to the typical first sign of BPH - a weaker or slower stream.
As the prostate continues to grow, other symptoms can become noticeable, such as getting up more at night, and the need to urinate more frequently in the day, a sense of urgent need to urinate, leakage after voiding, and needing to push or double void to empty.
In the final stages, some men suffer from an accumulation of urine in the bladder, which can lead to infections, bladder stones, kidney problems or acute retention - the sudden inability to urinate at all. These conditions may result in the need to insert a catheter, or tube, in the bladder to drain the urine. In some men the catheter remains in place until the blockage is treated, but in others, the bladder does not recover and a catheter is required permanently.
You said the first sign of BPH is usually a weak or slower stream of urine. Should a man see his doctor right away, or should he wait until he’s sure it’s not just a temporary glitch?
A man who experiences symptoms of BPH should see his doctor right away, since early diagnosis and treatment will help to restore his quality of life more quickly. This visit can also rule out other conditions that cause similar symptoms, such as prostate or bladder cancer. At the first visit I usually discuss the symptoms and what treatments are available, look over the tests (which include urinalysis and a blood test called PSA -- prostate specific antigen) and examine the prostate by a digital exam. The whole process takes just minutes.
Does BPH always require treatment?
Not necessarily. Whether to treat BPH really depends on how much it is bothering a man. There is a very good simple self-test questionnaire that lets a man and his doctor know how severe the symptoms are, and can help guide therapy.
Don’t we have that self-test available?
Yes - the self test is included as part of the BPH calculator on this web site.
Men with BPH should realize that effective treatments are available, and more successful the sooner they are started. In men with minor symptoms, many can obtain relief using lifestyle changes or sometimes herbal medications.
What kind of lifestyle changes?
Some include urinating whenever there is access to a bathroom and especially just before bed, instead of waiting for an urge. Also, making a conscious effort to urinate completely, and limiting fluids about 2-3 hrs before bedtime may help. Avoiding caffeine and alcohol and certain cold and allergy medications can also provide some relief.
And you mentioned herbs?
Herbs may help; the most common one is called saw palmetto. If taken as recommended, herbs should be safe, but realize there are no good studies showing how they work or proving they are better than a placebo.
What if neither lifestyle changes nor herbs work?
If symptoms are more bothersome and these methods don’t work, prescription medications may be tried. One medication class, known as an alpha blocker, relaxes the muscles in the area where urine empties from the bladder through the urethra. Other medications, known as alpha reductase inhibitors, actually shrink the prostate gland. Sometimes both medications may be necessary.
What about surgery? Is that ever an option?
There are surgical options for BPH. Conventional surgery, also known as TURP (Transurethral Resection of the Prostate) is effective, but I consider it a last resort today, since it involves special cutting tools scraping away the blocking prostate tissue. While it is very effective, it unfortunately causes significant pain and bleeding, can lead rarely to sexual problems or urine leakage, requires a catheter and hospitalization for a few days, and has a long recovery.
What about other types of surgery, like laser?
Currently there are also good Minimally Invasive BPH Therapies offered through Stillwater Medical Group. The gentlest treatment with the most rapid recovery is Prolieve cooled thermotherapy, a virtually painless procedure using microwave energy -- but no cutting -- to heat the prostate open in a 45 minute procedure done right in the office. Normal activities can usually be resumed the next day, and no catheter is generally needed.
Another popular treatment uses laser, which requires an anesthetic at the hospital with a couple-day recovery, using a catheter for a day or so. I discuss the pros and cons of the different treatments, since no one therapy is ideal for everyone, and help determine which is best for that particular patient.
But, once again, a patient may be able to avoid having to pursue more serious treatments by seeing his doctor as soon as he notices that something’s not working right. Early diagnosis and treatment is the best option.
