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John J Bauer, MD, FACS John J. Bauer, M.D., F.A.C.S.
www.flinturology.com

Urology Services, Inc.
G-1121 West Hill Rd.
Flint, Michigan 48507
Tel: 810.232.8888
Fax: 810.232.9190
Email: jbauer@flinturology.com
[map]




Prostate Enlargement (BPH)

General Information | Diagnosis | Treatment Options
Services : In-Office Procedures | Surgical services

After reading about this topic, please return to:
Center for Prostate Diseases


General Information

Benign Prostatic Hyperplasia (BPH) refers to the normal enlargement of the prostate gland that occurs in men, with aging. It is one of the most common conditions to affect middle aged and older men. The prostate is one of the glands of the male reproductive system. It is positioned underneath the bladder and encircles the urethra. The urethra is the tube that leads urine out of the bladder and through the penis. The prostate gland in adults remains a constant size until approximately age 40, when it begins to enlarge. The cause of the enlargement is unknown. However, it seems that the male hormone, testosterone, is in some way responsible. By the age of 80, it is estimated that approximately three quarters of all men will have BPH. Although, BPH does not produce trouble in all men, 1 out of 4 men usually require treatment.

enlarged prostate

The enlarged prostate causes trouble when it blocks the flow of urine out of the bladder. As the prostate enlarges, it compresses the urethra. The bladder then has to work harder to overcome this increased resistance to urine flow. If the blockage is severe enough, the bladder may be unable to empty, leading to a condition called urinary retention. The onset of symptoms of BPH can be very gradual. Symptoms can include difficulty starting the flow of urine, decreased force of urination, and dribbling at the end of urination. There may be incomplete emptying of the bladder, which produces a sense of still feeling full even after attempting to pass the urine. Incomplete bladder emptying also leads to "double voiding" in which a man passes the urine and then has to urinate again within a period of 10 to 20 minutes. As BPH progresses, other symptoms include the need to pass urine more frequently than normal and the development of a sense of urgency, which is the need to pass the urine as soon as the urge is felt. One of the most common symptoms of BPH is being awakened from sleep to urinate, called nocturia.

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Diagnosis

The diagnosis of BPH is made in a variety of ways. The most important is careful physical examination of the prostate by the physician. This is done by inserting a gloved finger into the rectum to palpate the surface of the prostate. A blood test to measure PSA, prostate specific antigen, is done to determine if prostate cancer may be present. Other tests may include a urinary flow study, (a test to measure the rate and force of urine flow), a bladder sonogram to check post void residual (the amount of urine left behind in the bladder after voiding) or cystoscopy. Cystoscopy is a study in which a physician can directly inspect the prostate and bladder with the use of a fiberoptic catheter.

We also administer a BPH symptom score questionnaire (printable version) or online BPH online calculator (to determine how much the patient is actually bothered by the symptoms. ( Adobe Acrobat Reader? required to open/print the printable version of this questionnaire. Free version available.)

Not all enlargement needs treatment. There are several indications for treatment of BPH. One of the foremost is urinary retention, which is the inability of the bladder to empty any urine. Another reason for intervention is when the enlarged prostate impairs drainage of urine out of the bladder and there is a large post-void residual. This residual urine can block the drainage of the kidneys and lead to inadequate kidney function. A bladder sonogram or scan is done to make sure the residual is not too high. Severe bleeding or recurrent urinary tract infections are also symptoms, which indicate the need for intervention. By far the most common indication for treatment is when difficulty with urination becomes so troublesome that the patient needs some relief.

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Treatment Options

There are varieties of ways to manage BPH. One of the most common is to "wait and watch". If the symptoms are not particularly troublesome and if there is no impending danger of damage to the urinary tract, no intervention may be necessary. Often the symptoms progress only very gradually over time. Regular follow up exams at 6-12 month intervals are recommended.

When intervention is necessary, it may be possible to manage BPH with medication. One type of pill is designed to reduce the size of the prostate. Proscar, a 5mg tablet taken once daily on an ongoing basis reduces the level of a derivative of testosterone that appears to contribute to prostate enlargement. Prostate size reduces somewhat in most men. However, in general, treatment with Proscar has not had much success in reducing urinary symptoms. It has been shown that only prostates that are larger than 40 grams in weight benefit from this therapy.

Another type of medication, called an alpha-blocker, is designed to release the "grip" of the prostate around the urethra. Hytrin and Cardura are the most commonly used alpha-blockers for treating BPH. They reduce the constriction around the urethra caused by the prostate. Many patients notice an immediate improvement in symptoms. Side effects can include low blood pressure, dizziness, tiredness and nasal congestion. (See our Drug Info page to look up details on these medications.)

When drug therapy does not work, invasive intervention is required. The current choices of intervention include transurethral microwave therapy (TUMT), laser coagulation of the prostate, transurethral needle ablation (TUNA), transurethral resection of the prostate (TURP) and open prostatectomy. Balloon dilation of the prostate has been attempted in the past but it does not work well. The insertion of a stent or coil into the prostate to keep the prostatic urethra open is currently under investigation, but is not routinely available. Transurethral microwave therapy uses microwave energy to coagulate the enlarged portion of the prostate. Over time, the coagulated portion shrinks and there is less constriction of the urethra. Laser coagulation and the TUNA procedure work by a similar principle. The obstructing portion of the prostate is coagulated with either laser energy or heat to reduce the enlarged part of the prostate and open up the urinary channel. TURP involves the actual removal of portions of the enlarged prostate through a fiberoptic catheter inserted through the penis. In open prostatectomy, a lower abdominal incision is made to remove the enlarged part of the prostate through surgery. This procedure is commonly used for prostates that are greater than 60-80 grams in size using transrectal ultrasound sizing. These invasive procedures are carried out only when the above management strategies of wait and watch or drug therapy are not working.

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Enlarged Prostate (BPH) Services

In-Office Procedures

The staff of Michigan Urology Associates, P.C. and the Center for Prostate Diseases performs many procedures in the office at a reduced fee compared to the same procedure in the Hospital. For descriptions about these office procedures please go to the specific links for the procedure that you are interested in as marked below. Our practice treats a variety of urological conditions included below are the most common procedures that we perform in the office that are involved in the diagnosis and treatment of enlarged prostate:

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Surgical Services

Michigan Urology Associates, P.C. also performs many of its urological services in the local Hospitals or surgical facilities. The outpatient and inpatient surgeries listed below are performed at these facilities.

The procedures listed below are direct links to "Your Surgery Details" which will have everything that you would want to know about your surgical procedure from after the diagnosis until fully recovered. Please use this section to learn about your upcoming surgery or to contemplate whether you really want a surgical procedure.

Open Surgery:
Open Prostatectomy

Endoscopic Surgery:
Transurethral Incision of the Prostate
Transurethral Resection of the Prostate
Transurethral Laser Ablation of the Prostate
Interstitial Laser Coagulation (ILC) of the Prostate

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After reading about this topic, please return to:
Center for Prostate Diseases
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John J. Bauer, M.D., F.A.C.S.
www.flinturology.com
Flint, Michigan [map]

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