What is Prostate Hypertrophy?

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

Prostate gland enlargement varies in severity among men and tends to gradually worsen over time. Prostate gland enlargement symptoms include:

1) Weak urine stream
2) Difficulty starting urination
3) Stopping and starting while urinating
4) Dribbling at the end of urination
5) Frequent or urgent need to urinate
6) Increased frequency of urination at night (nocturia)
7) Straining while urinating
8) Not being able to completely empty the bladder
9) Blood in the urine (hematuria)
10) Urinary tract infection
11) Formation of stones in the bladder
12) Impaired kidney function

Having a more enlarged prostate does not 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.

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 (the urethra) passes through the center of the prostate. Basically, your urethra passes through the prostate as if it were passing through a doughnut hole. When the prostate enlarges, the hole shrinks and 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 are not sure exactly what causes the prostate to enlarge. It may be due to changes in the balance of sex hormones as men grow older.

Western Medicine Treatment

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:

1) 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 (Hytrin), doxazosin (Cardura), tamsulosin (Flomax), alfuzosin (Uroxatral) and silodosin (Rapaflo). Alpha blockers work quickly. Within a day or two, you will 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.

2) 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 are taking them, these medications may cause sexual side effects including impotence (erectile dysfunction), decreased sexual desire or retrograde ejaculation.

3) 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.

4) Surgery. Your doctor may recommend surgery if medication isn't effective or if you have severe symptoms. There are several types of surgery for an enlarged prostate. They all reduce the size of the prostate gland and open the urethra by treating the enlarged prostate tissue that blocks the flow of urine. The decision about which type of surgery may be an option is based on a number of factors, including the size of your prostate, the severity of your symptoms, and what treatments are available in your area.

Any type of prostate surgery can cause side effects, such as semen flowing backward into the bladder instead of out through the penis during ejaculation (retrograde ejaculation), loss of bladder control (incontinence) and impotence (erectile dysfunction). Some types of surgery are more likely to cause certain symptoms than are other types.

5) Standard surgeries. Standard surgeries for or an enlarged prostate include:

A) Transurethral resection of the prostate (TURP) TURP has been a common procedure for enlarged prostate for many years, and is the surgery with which other treatments are compared. With TURP, a surgeon places a special lighted scope (resectoscope) into your urethra and uses small cutting tools to remove all but the outer part of the prostate (prostate resection). TURP generally relieves symptoms quickly; most men have a stronger urine flow within a few days. Following TURP, there is risk of bleeding, infection, and you may require a catheter to drain your bladder for three to five days after the procedure. You will be able to do only light activity until you are healed. This procedure is generally used to treat smaller prostates. However, newer and less invasive treatments (minimally invasive therapies) are becoming more common. Minimally invasive surgeries generally have a lower risk of side effects or complications, and require less recovery time than does TURP or other types of invasive surgery. Nonetheless, TURP is still the best treatment choice for some men.
B) Transurethral incision of the prostate (TUIP or TIP) This surgery is an option if you have a moderately enlarged or small prostate gland, especially if you have health problems that make other surgeries too risky. Like TURP, TUIP involves special instruments that are inserted through the urethra. But instead of removing prostate tissue, the surgeon makes one or two small cuts in the prostate gland to open up a channel in the urethra — making it easier for urine to pass through.

6) Open prostatectomy. This type of surgery is generally done if you have a very large prostate, bladder damage or other complicating factors, such as bladder stones. It is called open because the surgeon makes an incision in your lower abdomen to reach the prostate. Open prostatectomy is the most effective treatment for men with severe prostate enlargement, but it has a high risk of side effects and complications. It generally requires a short stay in the hospital and is associated with a higher risk of needing a blood transfusion.

7) Minimally invasive surgery. Minimally invasive treatments are less likely to cause blood loss during surgery and generally don't require a hospital stay. These treatments also typically require less pain medication. Depending on the procedure, and how well it works for you, you may need follow-up treatments.

Minimally invasive treatments include:

A) Laser surgery. Laser surgeries (also called laser therapies) use high-energy lasers to destroy or remove overgrown prostate tissue. Laser surgeries generally relieve symptoms right away and have a lower risk of side effects than does TURP. Some laser surgeries can be used in men who shouldn't have other prostate procedures because they take blood-thinning medications. Laser surgery can be done with different types of lasers and in different ways.

B) Ablative procedures (including vaporization) remove prostate tissue pressing on the urethra by burning it away, easing urine flow. Ablative procedures may cause irritating urinary symptoms after surgery and may need to be repeated at some point.

C) Enucleative procedures are similar to open prostatectomy, but with fewer risks. These procedures generally remove all the prostate tissue blocking urine flow, and prevent regrowth of tissue. One benefit of enucleative procedures is that removed prostate tissue can be examined for prostate cancer and other conditions.

Types of laser surgery include:

1) Holmium laser ablation of the prostate (HoLAP)
2) Visual laser ablation of the prostate (VLAP)
3) Holmium laser enucleation of the prostate (HoLEP)
4) Photosensitive vaporization of the prostate (PVP)

Options for laser therapy depend on prostate size, the location of the overgrown areas, your doctor's recommendation and your preferences. Choices available also depend on where you seek treatment. Not all facilities have lasers to perform prostate surgery or doctors who have the specialized skills and training to do the procedures.

Transurethral microwave therapy (TUMT). With this procedure, your doctor inserts a special electrode through your urethra into your prostate area. Microwave energy from the electrode generates heat and destroys the inner portion of the enlarged prostate gland causing it to shrink and ease urine flow. This surgery has a lower risk of complications than does TURP, but is generally only used on small prostates in special circumstances. Irritating side effects may persist for weeks, and it may only partially relieve your symptoms and may take some time for you to see the benefit.

Transurethral needle ablation (TUNA). With this outpatient procedure, a lighted scope (cystoscope) is passed into your urethra. Your doctor uses the scope to place needles into your prostate gland. When the needles are in place, radio waves pass through them, heating and destroying excess prostate tissue that's blocking urine flow. TUNA basically scars the prostate tissue, which causes it to shrink and open up, easing urine flow. This type of surgery may be a good choice if you bleed easily or you have certain other health problems. Like TUMT, TUNA may only partially relieve your symptoms and it may take some time before you notice results.

Prostatic stents. A prostatic stent is a tiny metal or plastic device that's inserted into your urethra to keep it open. Tissue grows over the metallic stent to hold it in place. The plastic stent requires it to be changed every four to six weeks but keeps you from having to undergo any surgical procedure. In most cases, doctors don't consider stents a viable long-term treatment because they can cause side effects including painful urination or frequent urinary tract infections. The metal stents can be difficult to remove and are used only in special circumstances. Usually, stents are used only for men who are unable to take medications or who are unable to have surgery.

Adopted From Mayo Clinic