• Bladder Outlet Obstruction
• Enlarged Prostate Gland (BPH)

ENLARGED PROSTATE GLAND

An enlarged prostate gland is a condition that affects all men as they get older. The prostate is a gland that sits underneath the bladder, surrounds the urethra, and produces seminal fluid (liquid that contains sperm). A larger prostate gland tends to press on the urethra (tube that carries urine away from the bladder) and slows down the urinary stream. This condition is also called benign prostatic hyperplasia (BPH). Though its symptoms may resemble cancer of the prostate, it is not a cancerous growth. The exact cause of BPH is unknown. Scientists believe that it may be related to higher levels of estrogen that are due to a decrease in testosterone stores that occurs with aging. Estrogen tends to stimulate cell growth. Others believe that the accumulation of DHT (by-product of testosterone) may also stimulate cell growth. Finally, some researchers believe that the cells are responding to a genetic message to “awaken” and begin growing again. Risk increases with age >40.

Symptoms may include:
Increased urinary frequency (get up 2-3 times or more at night)
Strong urge to urinate that develops quickly
Difficulty starting or stopping a urinary stream
Weak urinary stream
Retaining urine (feeling bloated)
Incontinence

What your doctor can do:
Diagnose the disease by asking about your symptoms, performing a physical exam that includes a digital rectal exam, and ordering several urinary tests. These may include a urinalysis to detect blood in urine; a urine culture to detect bacterial infections; urine flow rate (BPH rate<10ml per second); post-void residual urine (measures urine that remains in bladder after urination); and pressure flow studies in bladder (during urination).
Order x-rays of urinary system, voiding cystourethrogram (x-rays of ureters and bladder after injecting a dye), and an intravenous pyelogram (IVP) to evaluate urine flow for obstructions.
Order a cystoscopy (visualization of prostate and bladder with a thin, scope instrument that is inserted through the penis)
Order a blood test that evaluates the prostatic-specific antigen (PSA). Used to rule out cancer.
Treatment options depend on the severity of the condition and what you prefer as a patient:
“Watchful waiting" - annual digital rectal exam, urinalysis, and blood tests to evaluate kidney function and PSA levels.
Surgery - Remove the prostate through the urethra with the use of a special scope (TURP); Make an incision into the prostate through the urethra with a special scope to “free-up” the urethra (TUIP); and an open prostatectomy (incision into the abdomen or perineal area to remove prostate under general or spinal anesthesia).
Medications - Anti-hypertension medication such as Hytrin, Minipress or Cardura relaxes the prostate muscle and this allows urine to flow more freely. Proscar (finasteride) shrinks the prostate in some patients, thereby increasing urine flow. Antibiotics to treat bacterial infections that cause chronic prostatitis.

What you can do:
Take medications as directed by your doctor.
DO NOT retain urine. Urinate as soon as you have the urge.
Avoid long trips without access to a restroom.
Drink plenty of fluids as necessary, especially water.
Avoid fluids 2 hours prior to going to bed.
Eat a well-balanced diet that is low in fat and high in dietary fiber. Limit spicy foods (irritate the urethra).
See your doctor regularly and obtain a prostate cancer screening yearly if you are at risk or over 40. Remember that September is Prostate Awareness Month in the U.S. Some clinics, community centers and hospitals hold free screenings and provide educational materials.
Contact the American Cancer Society at 1-800-227-2345 for additional information.

What you can expect:
The majority of men are able to manage this condition without any specific treatment. However, 30% require some treatment to control symptoms.
With treatment, most men receive relief of symptoms.
Some common side effects of the medications include dizziness (anti-hypertension medications) and decreased sex drive or impotence (Proscar).
Some complications may include urinary retention, urinary tract infections, blood in the urine, chronic postatitis and hydronephrosis (inflammation and damage to the kidney due to fluid backup).
Though BPH is not cancerous, approximately 10-15% may develop prostate cancer.

Contact your doctor if you develop symptoms of an enlarged prostate gland.

Seek immediate medical assistance if you are unable to urinate; if you develop a fever or any side effects from the medications; or if your symptoms worsen despite receiving treatment!

Related THUCC Educational Pages (Medical Library Index)

• Bladder Infection (UTI, Cystitis)
• Bladder Outlet Obstruction (Blocked Urine, Can't Urinate)
• Enlarged Prostate (BPH, Benign Prostatic Hypertrophy)
• Impotence (Erectile Dysfunction)
• Kidney Infection
• Kidney Stone
• Low T (Low Testosterone, Hypotestosteronism)
• Prostate Infection (Prostatitis)
• UTI (Bladder Infection)