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"What is benign prostatic hyperplasia? (BPH) The prostate is a male gland about the size of a chestnut, which surrounds the urethra (water pipe) just below the bladder. The prostate is thought to have a role in male fertility. The vas deferens tube (which carries sperms from the testicles) passes through the prostate and the sperms are mixed with seminal fluid to make semen. In many men, with increasing age, the prostate grows and as it does so it may compress the urethra. The growth in itself is harmless and the condition is called benign prostate hyperplasia (BPH).  It occurs most often in men over the age of 60. Up to 30 per cent of men in their 70s have BPH that causes them symptoms.  What kinds of problems can an enlarged prostate cause? The enlargement of the prostate gland compresses the urethra and so obstructs the urine flow.  Symptoms include the following.   Hesitancy: difficulty starting the urine flow, even when the bladder feels full. A weak or interrupted urinary stream. Incomplete emptying: a feeling the bladder is not completely empty after passing urine.  Frequency: a need to urinate often during the day and during the night. Increased need to urinate in the night is usually a very early symptom. Urgency: a need to urinate right away. Some men may experience involuntary discharge of urine (known as urge incontinence). Dribbling of urine after urination. This is known as terminal dribbling. Dysuria: a burning sensation or pain during urination.  Different men get different symptoms \u2013 the symptoms may also vary with each individual throughout the course of the disease.  It&amp;#039;s important to emphasise that the above symptoms do not necessarily prove that the prostate is enlarged.  Other diseases may cause similar symptoms. Men with problems urinating should always see their doctor. Can other problems arise? There are further complications with this disease.  Some men experience a sudden onset of inability to pass urine (known as acute retention). Studies have shown that acute retention affects between 1 and 2 per cent of men with BPH each year. This condition is very painful and demands immediate medical treatment. The usual treatment in the emergency situation is insertion of a urinary catheter to drain the bladder and relieve the obstruction. Other men find it gradually harder to empty the bladder. As the condition develops, more and more urine is left in the bladder after urination (known as chronic retention).  Other complications of BPH include: repeated attacks of cystitis (infection of the bladder) and the development of stones in the bladder.  How does the doctor diagnose the disease? A GP can often make the diagnosis on the following grounds.   Patients will be asked about their symptoms and may also be asked to fill out a symptom questionnaire to let the doctor know the nature of the symptoms and how troublesome they are. The symptom score lets the doctor quantify how severe the symptoms are. They may also be asked to record their drinking and urination over a period of three days. By carrying out a rectal examination, the doctor can feel through the rectum wall whether or not the prostate is enlarged. Usually, the patient&amp;#039;s urine will be examined, and may be sent for culture, when it will also be tested for sensitivity to antibiotics. Kidney function will also be examined by a blood test. It&amp;#039;s usual for the doctor to send a blood sample to check the prostate specific antigen (PSA) level. A raised level of PSA may indicate a risk of the presence of prostate cancer \u2013 this may require biopsies of the prostate to investigate further.  If there is a need for further tests, they will usually be carried out by a specialist.  He or she will be able to check for specific urinary functions like the flow rate of the urine and whether the bladder is emptied on urination.  X-rays, including ultrasound examinations, and blood tests, may be necessary.  Many hospitals and a number of general practices have specialised prostate clinics where a full prostate check is carried out. How is benign prostate hyperplasia treated? There are a variety of treatment strategies for this condition and the following factors should be considered:   treatment is normally only necessary if the symptoms are bothersome or complications are present. If there are minor symptoms only then a watchful waiting (ie &amp;#039;wait and see&amp;#039;) approach may be suitable each treatment has advantages and disadvantages. The patient and his doctor will have to decide which is most appropriate.  What kinds of medicines are used? There are two types of medication for this problem.  Alpha-blockers. These medicines help to relax muscle fibres within the prostate, thereby reducing the obstruction to the urine flow. They do not reduce the size of the prostate. Examples include terazosin (Hytrin), alfuzosin (Xatral) and tamsulosin (Flomax MR). Patients occasionally experience side-effects such as dizziness, headache, drowsiness and retrograde ejaculation. 5-alpha-reductase inhibitors, such as finasteride (Proscar), inhibit the growth of the prostate and decrease the size of the gland. These medicines can take many months to become maximally effective since they rely on physically shrinking the enlarged prostate.  Research studies have shown that both types of medical treatment are effective at improving urinary symptoms in men with BPH. There are also different kinds of over-the-counter herbal medicine on the market.  However, these preparations are not generally recommended because their effect has not been completely documented.  Those which do have some supporting evidence are saw palmetto and beta-sitosterol plant extracts and rye grass pollen extract.  What kind of surgery is available? An operation on the prostate will involve the removal of parts of the enlarged tissue.  The most common operation is an endoscopic surgical procedure known as transurethral resection of the prostate (TURP).  Under either a general or spinal anaesthetic, a telescope is inserted into the urethra via the penis and advanced to the prostate.  A special cutting loop is then used to remove small chippings of prostate until a wider channel is made through the prostate through which the urine can pass unimpeded. If the prostate is only slightly enlarged, it may be enough to make a little cut in the prostate, without removing tissue, to reduce the constriction of the urethra. This is called transurethral incision (TUI) or bladder neck incision (BNI). If the prostate is considerably enlarged, it may be necessary to make an incision in the lower abdomen and to carry out an open operation to remove the prostate. But this procedure is rarely carried out nowadays. Surgery carries more risk than medical treatment and there are possible complications including retrograde ejaculation.  In retrograde ejaculation, the sperm enters the bladder during ejaculation instead of being expelled through the penis. Later it is flushed out with urine. This is not harmful but will affect a man&amp;#039;s fertility, so it&amp;#039;s important to let your doctor know if you have not finished having children.  Studies estimate that 74 per cent of men will experience retrograde ejaculation after transurethral resection of the prostate (TURP). Surgery has also been linked with side-effects of erectile dysfunction (in 14 per cent of men after TURP) and urinary incontinence (5 per cent).  But studies are inconclusive as to whether the same rates of these problems would have occurred anyway in men not undergoing surgery.  The benefits of surgery are long lasting, but because only part of the prostate is removed, some men may eventually need another operation. Are there other more gentle surgical treatments? Newer treatments for benign prostate hyperplasia already exist and are continually being developed.  These techniques are minimally invasive.  Some need only local anaesthesia and the risk of complications is smaller.  A couple of general points about these new techniques.  It&amp;#039;s still not fully known whether the results are as effective as endoscopic surgery. Doctors are continually learning which patients are most suitable for each treatment. The techniques concerned are still being developed and tested.  Microwave thermotherapy In this treatment, the prostate tissue is heated to around 45\u00BAC by means of microwaves.  This reduces the size of the prostate by causing cells in the centre of the prostate to die.  This treatment is carried out through the urethra. Electrovaporisation In this procedure, part of the prostate tissue is removed by evaporation by means of electrical current.  The treatment is performed with an endoscope. Laser resection Another endoscopic treatment, in which part of the prostate tissue is removed with laser energy. Many centres are now reporting excellent results with the holmium Laser (HoLep). Is treatment with a catheter a possibility? Some patients with urine retention, who cannot endure an operation, may have to have a permanent catheter.  This can be placed through the urethra or through the lower abdomen into the bladder. But with a permanent catheter, the patient is at greater risk of cystitis (infection of the bladder). An alternative, is for the patient to learn to empty the bladder himself with a catheter.  This way the catheter is removed after each use and the danger of infection is reduced. Other people also read: Prostate cancer: what are the symptoms? Impotence (erectile dysfunction): find out why ED occurs. Cystitis: how do you get cystitis?  References NHS Centre for Reviews and Dissemination. Benign Prostatic Hyperplasia. Effective Healthcare Bulletin, December 1995. McConnell JD, Barry MJ, Bruskewitz RC, et al. Benign Prostatic Hyperplasia: diagnosis and treatment. Clinical Practice Guideline, Number 8. US Agency for Health Care Policy and Research, Pub. No. 94-0582: US Department of Health and Human Services, February 1994. Barry MJ, Roehrborn CG. Benign prostatic hyperplasia. In Clinical Evidence, Issue 5. BMJ June 2001.   Based on a text by Dr Bettina Norby, Dr Ejnar Kuur  Last updated 22.03.2015 "^^<http://www.w3.org/2001/XMLSchema#string>
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