3- Prostate gland enlargement
Prostate gland enlargement is a common condition as men get older. Also called benign prostatic hyperplasia (BPH) and prostatic hypertrophy, prostate gland enlargement can cause bothersome urinary symptoms. Untreated prostate gland enlargement can block the flow of urine out of the bladder and can cause bladder, urinary tract or kidney problems.
There are several effective treatments for prostate gland enlargement. In deciding the best option for you, you and your doctor will consider your particular symptoms, the size of your prostate, other health problems you may have and your preferences. Your choices may also depend on what treatments are available in your area. Treatments for prostate gland enlargement include medications, lifestyle changes and surgery.
Symptoms of Prostate gland enlargement
Prostate gland enlargement varies in severity among men and tends to gradually worsen over time. Prostate gland enlargement symptoms include:• Weak urine stream.
• Difficulty starting urination.
• Stopping and starting while urinating.
• Dribbling at the end of urination.
• Frequent or urgent need to urinate.
• Increased frequency of urination at night (nocturia).
• Straining while urinating.
• Not being able to completely empty the bladder.
• Urinary tract infection.
• Formation of stones in the bladder.
• Reduced kidney function.
The size of your prostate doesn't necessarily mean your symptoms will be worse. Some men with only slightly enlarged prostates have significant symptoms. On the other hand, some men with very enlarged prostates have only minor urinary symptoms.
Only about half the men with prostate gland enlargement have symptoms that become noticeable or bothersome enough for them to seek medical treatment. In some men, symptoms eventually stabilize and may even improve over time.
When to see a doctor
If you're having urinary problems, see your doctor to check whether your symptoms are caused by an enlarged prostate and find out what tests or treatment you may need. If you're unable to pass urine at all, seek immediate medical attention.If you don't find urinary symptoms too bothersome and they don't pose a health threat, you may not need treatment. But you should still have your symptoms checked out by a doctor to make sure they aren't caused by another problem such as prostate cancer.
Causes
The prostate gland is the male organ that produces most of the fluid in semen, the milky-colored fluid that nourishes and transports sperm out of the penis during ejaculation (orgasm). It sits beneath your bladder. The tube that transports urine from the bladder out of your penis (urethra) passes through the center of the prostate. So, when the prostate enlarges, it begins to block (obstruct) urine flow.Most men have continued prostate growth throughout life. In many men, this continued growth enlarges the prostate enough to cause urinary symptoms or to significantly block urine flow. Doctors aren't sure exactly what causes the prostate to enlarge. It may be due to changes in the balance of sex hormones as men grow older.
Risk factors
The main risk factors for prostate gland enlargement include:• Aging. Prostate gland enlargement rarely causes signs and symptoms in men younger than 40. By 55, about 1 in 4 men have some signs and symptoms. By 75, about half of men report some symptoms.
• Family history. Having a blood relative such as a father or brother with prostate problems means you're more likely to have problems as well.
Complications
Prostate gland enlargement becomes a serious problem when it severely interferes with your ability to empty your bladder. If this is the case, you'll probably need surgery. Complications of enlarged prostate include:• Acute urinary retention. Acute urinary retention is a sudden, painful inability to urinate. This may occur after you've taken an over-the-counter decongestant medication for allergies or a cold. When you are unable to urinate at all, your doctor may thread a tube (catheter) through your urethra into your bladder. Or, your doctor may put in a suprapubic tube — a catheter that drains your bladder through the lower abdomen. The type of catheter you need will depend on your particular circumstances. Some men with an enlarged prostate require surgery or other procedures to relieve urinary retention.
• Urinary tract infections (UTIs). Some men with an enlarged prostate end up having surgery to remove part of the prostate to prevent frequent urinary tract infections.
• Bladder stones. These are mineral deposits that can cause infection, bladder irritation, blood in the urine and obstruction of urine flow and are generally caused by the inability to completely empty the bladder.
• Bladder damage. This occurs when the bladder hasn't emptied completely over a long period of time. The muscular wall of the bladder stretches and weakens and no longer contracts properly. Often, symptoms of bladder damage improve after prostate surgery or other treatment, but not always.
• Kidney damage. This is caused by high pressure in the bladder due to urinary retention. This high pressure can directly damage the kidneys or allow bladder infections to reach the kidneys. When an enlarged prostate causes obstruction of the kidneys, a condition called hydronephrosis — a swelling of the urine-collecting structures in one or both kidneys — may result.
Most men with an enlarged prostate don't develop these complications. However, acute urinary retention and kidney damage in particular can be serious health threats when they do occur.
Tests and diagnosis
An initial evaluation for enlarged prostate will likely include:• Detailed questions about your symptoms. Your doctor will want to know about other health problems you may have, what medications you're taking and whether there's a history of prostate problems in your family. Your doctor may have you complete a questionnaire such as the American Urological Association (AUA) Symptom Index for BPH.
• Digital rectal exam. This exam can allow your doctor to check your prostate by inserting a finger into your rectum. With this simple test, your doctor can determine whether your prostate is enlarged and check for signs of prostate cancer.
• Neurological exam. This is a brief evaluation of your mental functioning and nervous system. It can help identify causes of urinary problems other than enlarged prostate. What this exam involves will depend on your specific condition.
• Urine test (urinalysis). Analyzing a sample of your urine in the laboratory can help rule out an infection or other conditions that can cause similar symptoms.
Your doctor may use additional tests to rule out other problems and help confirm enlarged prostate is causing your urinary symptoms. These can include:
• Prostate-specific antigen (PSA) blood test. It's normal for your prostate gland to produce PSA, which helps liquefy semen. When you have an enlarged prostate, PSA levels increase. However, PSA levels can also be elevated due to prostate cancer, recent tests, surgery or infection (prostatitis).
• Urinary flow test. This test measures the strength and amount of your urine flow. You urinate into a receptacle attached to a special machine. The results of this test over time help determine if your condition is getting better or worse.
• Postvoid residual volume test. This test measures whether you can empty your bladder completely. This is often done by using an ultrasound test to measure urine left in your bladder. Or, it may be done by inserting a tube (catheter) into your bladder after you urinate.
• Transrectal ultrasound. An ultrasound test provides measurements of your prostate and also reveals the particular anatomy of your prostate. With this procedure, an ultrasound probe about the size and shape of a large cigar is inserted into your rectum. Ultrasound waves bouncing off your prostate create an image of your prostate gland.
• Prostate biopsy. With this procedure, a transrectal ultrasound guides needles used to take tissue samples of the prostate. Examining tissues from a biopsy under a microscope can be help diagnose or rule out prostate cancer.
• Urodynamic studies and pressure flow studies. With these procedures, a catheter is threaded through your urethra into your bladder. Water (or less commonly air) is slowly injected into your bladder. This allows your doctor to measure bladder pressures and to determine how well your bladder muscles are working.
• Cystoscopy. Also called urethrocystoscopy, this procedure allows your doctor to see inside your urethra and bladder. After you receive a local anesthetic, a lighted flexible telescope (cystoscope) is inserted into your urethra to look for signs of problems.
• Intravenous pyelogram or CT urogram. These tests can help detect urinary tract stones, tumors or blockages above the bladder. First, dye is injected into a vein, and X-rays or CT scans are taken of your kidneys, bladder and the tubes that connect your kidneys to your bladder (ureters). The dye helps outline the drainage systems of the kidneys.
Other possible causes of urinary symptoms
Your doctor will use these tests to make sure there isn't something else causing your problem, or if an enlarged prostate has caused or worsened another problem. Problems that can cause urinary symptoms similar to those caused by enlarged prostate include:• Bladder stones.
• Bladder and urinary tract infections.
• Diabetes.
• Neurological problems.
• Inflammation of the prostate (prostatitis).
• Prostate cancer.
• Stroke.
• Muscle and nerve (neuromuscular) disorders.
• Scarring or narrowing of the urethra.
Prostate cancer is entirely different than prostate gland enlargement, even though they can cause some similar symptoms and may be detected by some of the same tests. Having an enlarged prostate doesn't reduce or increase the risk of prostate cancer. Even if you're being treated for an enlarged prostate gland, you still need to continue regular prostate exams to screen for cancer. Surgery for prostate gland enlargement may identify cancer in its early stages.
Treatments and drugs
A wide variety of treatments are available for enlarged prostate. They include medications, surgery and minimally invasive surgery. The best treatment choice for you depends on several factors, including how much your symptoms bother you, the size of your prostate, other health conditions you may have, your age and your preference. If your symptoms aren't too bad, you may decide not to have treatment and wait to see whether your symptoms become more bothersome over time.Medications
Medications are the most common treatment for moderate symptoms of prostate enlargement. Medications used to relieve symptoms of enlarged prostate include:• Alpha blockers. These medications relax bladder neck muscles and muscle fibers in the prostate itself and make it easier to urinate. These medications include terazosin, doxazosin (Cardura), tamsulosin (Flomax), alfuzosin (Uroxatral) and silodosin (Rapaflo). Alpha blockers work quickly. Within a day or two, you'll probably have increased urinary flow and need to urinate less often. These may cause a harmless condition called retrograde ejaculation — semen going back into the bladder rather than out the tip of the penis.
• 5 alpha reductase inhibitors. These medications shrink your prostate by preventing hormonal changes that cause prostate growth. They include finasteride (Proscar) and dutasteride (Avodart). They generally work best for very enlarged prostates. It may be several weeks or even months before you notice improvement. While you're taking them, these medications may cause sexual side effects including impotence (erectile dysfunction), decreased sexual desire or retrograde ejaculation.
• Combination drug therapy. Taking an alpha blocker and a 5 alpha reductase inhibitor at the same time is generally more effective than taking just one or the other by itself.
• Tadalafil (Cialis). This medication, from a class of drugs called phosphodiesterase inhibitors, is often used to treat impotence (erectile dysfunction). It also can be used as a treatment for prostate enlargement. Tadalafil can't be used in combination with alpha blockers. It also can't be taken with medications called nitrates, such as nitroglycerin.
