|The prostate is a gland,
about the size of a walnut, only found in men. It is located just
below the bladder and surrounds the tube known as the urethra
through which urine flows from the bladder out through the penis.
The prostate is divided into three zones - central, transitional
and peripheral. One of the main functions of the prostate is to
produce an important liquefying component of semen, which allows
the sperm to move freely.
Benign prostatic hyperplasia (BPH) is a caused by overgrowth of
prostate cells in the central part of the prostate. This enlargement
constricts the urethra so the flow of urine is reduced and men
find it increasingly difficult to empty their bladder.
BPH is very common and affects about one third of men over 50,
and it is different from prostate cancer. However, their symptoms
overlap, so you should see your doctor if you start to experience
problems passing urine. A separate fact sheet on Prostate Cancer
contains more information.
|You should consult your
GP (General Practitioner) if you notice any of the following symptoms:
- hesitancy (difficulty in starting to pass urine)
- a weak stream
- the need to strain to pass urine
- the feeling that your bladder isn't empty after
- the need to pass urine urgently
- frequent trips to the toilet, including having
to get up several times in the night
- feeling a burning sensation or pain when passing
|Your doctor will ask you
questions about your symptoms, your general health and other relevant
information to help work out how bad and how bothersome your symptoms
are to you.
A digital rectal examination (DRE) will be performed to examine
the size and consistency of your prostate by inserting a finger
into your rectum. Although this can be uncomfortable, it is not
painful. Many men find the prospect of a DRE embarrassing, but
should bear in mind that it's a simple procedure, performed routinely
Your doctor will also feel the abdomen to find out if the bladder
is distended, which may mean that you are not emptying it fully
(chronic urinary retention, which is painless).
Other tests will be carried out to make sure that your urinary
problems are due to BPH and not other conditions. A urine test
will be done to check for infection or blood.
Blood tests, including a prostate specific antigen (PSA) test
may be carried out. This measures the amount of an enzyme produced
by the prostate and high levels can indicate the presence of prostate
cancer. Other blood tests include assessing your kidney function
and checking for blood sugar to rule out diabetes. Both of these
problems can have urinary symptoms.
Other less common tests may include: urine flow tests; ultrasound
to measure urine left in the bladder and to check for bladder
stones; urodynamic measurements using a small catheter inserted
into your bladder through your penis to measure the pressure within
your bladder; transrectal ultrasonography (TRUS) where an ultrasound
probe is passed into the rectum to give a view of the prostate.
A biopsy (samples of the prostate) may be collected using a needle
if cancer is suspected.
|The mainstays of treatment
for BPH are drugs or surgery. However, some men with mild symptoms
opt for 'watchful waiting', where no treatment is undertaken but
instead your condition will be monitored closely with routine
check-ups. If your condition deteriorates you can then opt for
|There are two main classes
of drugs that are prescribed for BPH:
- Five alpha reductase inhibitors (often written
5 alpha-reductase inhibitors)
Alpha-blockers work by relaxing the muscles at the neck
of the bladder and in the prostate. In this way they reduce the
pressure on the urethra and so help increase the flow of urine.
They do not cure BPH but help to alleviate some of the symptoms.
Around 60% of men find their symptoms improve significantly within
the first 2-3 weeks of treatment with an alpha-blocker. There
are several different five alpha blockers. Currently, these are
doxazosin (Cardura), terazosin (Hytrin), tamsulosin (Flomax),
alfuzosin (Xatral) and prazosin (Hypovase). They can also be used
to treat high blood pressure. The most common side-effects of
alpha-blockers are tiredness, dizziness and headache.
5 alpha-reducatase inhibitors work by inhibiting the production
of a hormone called DHT, which contributes to prostate enlargement.
Finasteride (Proscar) is the mostly commonly used drug of this
type for BPH. Unlike alpha blockers, 5 alpha-reductase inhibitors
are able to reverse BPH to some extent and so may delay your need
Potential side-effects of finasteride include a reduced sex drive
and difficulty in maintaining an erection. Several months of treatment
may be needed before improvement is noticed.
|A range of plant extracts
claim to alleviate BPH, although formal evidence that they are
effective is often scanty. However, there is some scientific evidence
that an extract of saw palmetto (called Serenoa repens) can be
beneficial and it is a popular treatment for BPH, especially in
Germany. If you decide you want to try a plant remedy, it's always
best to discuss this first with your doctor or pharmacist as interactions
with conventional medicines are possible.
|There are three main surgical
options for BPH:
- Transurethral resection of the prostate (TURP)
- Transurethral incision of the prostate (TUIP)
- Open prostatectomy
Transurethral resection of the prostate (TURP) is the most common
operation for BPH. The procedure usually takes place under a general
anaesthetic. A long thin instrument called a resectoscope is passed
into the urethra. With a light source and lens on the end, it
acts like a telescope, allowing the surgeon to view the prostate
either directly or on a video monitor. A precisely controlled
electric current, applied by a loop of wire at the end of the
resectoscope, is used to shave off sections of the enlarged prostate.
TURP is an effective procedure with over 90% of men reporting
an improvement after the operation. However, as with any surgical
procedure, there is a risk of side-effects and complications.
The most common side-effect (an unwanted effect that accompanies
a successful treatment) of this procedure is retrograde ejaculation
- where semen passes into the bladder during orgasm instead of
out of the penis. This is sometimes called a 'dry orgasm'. This
is usually not a problem although it may reduce fertility. Complications
of the operation can include some urinary incontinence or damage
to the urethra, resulting in a 'stricture' that can cause difficulty
in passing urine.
Transurethral incision of the prostate (TUIP) may be appropriate
for men who have a smaller enlarged prostate. It is a quicker
operation than a TURP and involves removal of less tissue. It
is performed under general or spinal anaesthetic. As with a TURP
an instrument is passed up through the penis, but instead of removing
a portion of the prostate, small cuts are made in the neck of
the bladder and the prostate. This reduces the obstruction of
the flow of urine.
Open prostatectomy is only recommended for those men whose prostate
is very large. It is a major operation and carried out under a
general anaesthetic. An incision is made in the lower abdomen
in order to remove the central part of the prostate.
|Laser therapy (using a laser
probe to cut away prostate tissue) and transurethral microwave
thermotherapy (using heat to remove some of the prostate tissue
via a probe) are becoming more common in the treatment of BPH.
|Although it is not known
why only some men develop BPH, it is clear that advancing age
is the prime risk factor. Testosterone is certainly involved in
the development of BPH in some way and it is likely that the female
hormone, oestrogen, plays a part. Studies suggest that men in
the Far East are protected against BPH by a diet high in soya
which contains oestrogen-like substances.
At present, there is little you can do to prevent BPH. You can
visit your doctor if you develop urinary problems to ensure that
any problems are dealt with promptly and appropriately and while
treatment is simpler.
|American Prostate Society
National Kidney and Urologic Diseases Information Clearinghouse
|Healthwise (Health Information Resource
Tel : (852) 2849 2400
Fax : (852) 2849 2900
Email : firstname.lastname@example.org
Homepage : http://www.healthwise.org.hk/
This leaflet is for information only. For a detailed
opinion or personal advice, please consult with your own