Benign prostatic hyperplasia (BPH) – Diagnosis and treatment

Diagnosis

Your doctor will start by asking detailed questions about your symptoms and doing a physical exam. This initial exam is likely to include:

• Digital rectal exam. The doctor inserts a finger into the rectum to check your prostate for enlargement.
• Urine test. Analyzing a sample of your urine can help rule out an infection or other conditions that can cause similar symptoms.
• Blood test. The results can indicate kidney problems.
• Prostate-specific antigen (PSA) blood test. PSA is a substance produced in your prostate. PSA levels increase when you have an enlarged prostate. However, elevated PSA levels can also be due to recent procedures, infection, surgery or prostate cancer.

After that, your doctor might recommend additional tests to help confirm an enlarged prostate and to rule out other conditions. These tests include:

• Urinary flow test. You urinate into a receptacle attached to a machine that measures the strength and amount of your urine flow. Test results help determine over time if your condition is getting better or worse.
• Postvoid residual volume test. This test measures whether you can empty your bladder completely. The test can be done using ultrasound or by inserting a catheter into your bladder after you urinate to measure how much urine is left in your bladder.
• 24-hour voiding diary. Recording the frequency and amount of urine might be especially helpful if more than one-third of your daily urinary output occurs at night.

If your condition is more complex, your doctor may recommend:

• Transrectal ultrasound. An ultrasound probe is inserted into your rectum to measure and evaluate your prostate.
• Prostate biopsy. Transrectal ultrasound guides needles used to take tissue samples (biopsies) of the prostate. Examining the tissue can help your doctor diagnose or rule out prostate cancer.
• Urodynamic and pressure flow studies. A catheter is threaded through your urethra into your bladder. Water — or, less commonly, air — is slowly injected into your bladder. Your doctor can then measure bladder pressure and determine how well your bladder muscles are working. These studies are usually used only in men with suspected neurological problems and in men who have had a previous prostate procedure and still have symptoms.
• Cystoscopy. A lighted, flexible instrument (cystoscope) is inserted into your urethra, allowing your doctor to see inside your urethra and bladder. You will be given a local anesthetic before this test.

Tests and diagnosis at Mayo Clinic

Mayo Clinic specialists have experience diagnosing complex conditions involving enlarged prostate. You have access to the latest diagnostic testing, including urodynamic and pressure flow studies.

More Information

Show more related information

Treatment

A wide variety of treatments are available for enlarged prostate, including medication, minimally invasive therapies and surgery. The best treatment choice for you depends on several factors, including:

• The size of your prostate
• Your age
• Your overall health
• The amount of discomfort or bother you are experiencing

If your symptoms are tolerable, you might decide to postpone treatment and simply monitor your symptoms. For some men, symptoms can ease without treatment.

Medication

Medication is the most common treatment for mild to moderate symptoms of prostate enlargement. The options include:

• Alpha blockers. These medications relax bladder neck muscles and muscle fibers in the prostate, making urination easier. Alpha blockers — which include alfuzosin (Uroxatral), doxazosin (Cardura), tamsulosin (Flomax) and silodosin (Rapaflo) — usually work quickly in men with relatively small prostates. Side effects might include dizziness and a harmless condition in which semen goes back into the bladder instead of out the tip of the penis (retrograde ejaculation).
• 5-alpha reductase inhibitors. These medications shrink your prostate by preventing hormonal changes that cause prostate growth. These medications — which include finasteride (Proscar) and dutasteride (Avodart) — might take up to six months to be effective. Side effects include retrograde ejaculation.
• Combination drug therapy. Your doctor might recommend taking an alpha blocker and a 5-alpha reductase inhibitor at the same time if either medication alone isn’t effective.
• Tadalafil (Cialis). Studies suggest this medication, which is often used to treat erectile dysfunction, can also treat prostate enlargement.

Minimally invasive or surgical therapy

Minimally invasive or surgical therapy might be recommended if:

• Your symptoms are moderate to severe
• Medication hasn’t relieved your symptoms
• You have a urinary tract obstruction, bladder stones, blood in your urine or kidney problems
• You prefer definitive treatment

Minimally invasive or surgical therapy might not be an option if you have:

• An untreated urinary tract infection
• Urethral stricture disease
• A history of prostate radiation therapy or urinary tract surgery
• A neurological disorder, such as Parkinson’s disease or multiple sclerosis

Any type of prostate procedure can cause side effects. Depending on the procedure you choose, complications might include:

• Semen flowing backward into the bladder instead of out through the penis during ejaculation (retrograde ejaculation)
• Temporary difficulty with urination
• Urinary tract infection
• Bleeding
• Erectile dysfunction
• Very rarely, loss of bladder control (incontinence)

There are several types of minimally invasive or surgical therapies.

Transurethral resection of the prostate (TURP)

A lighted scope is inserted into your urethra, and the surgeon removes all but the outer part of the prostate. TURP generally relieves symptoms quickly, and most men have a stronger urine flow soon after the procedure. After TURP you might temporarily need a catheter to drain your bladder.

Transurethral incision of the prostate (TUIP)

A lighted scope is inserted into your urethra, and the surgeon makes one or two small cuts in the prostate gland — making it easier for urine to pass through the urethra. This surgery might be an option if you have a small or moderately enlarged prostate gland, especially if you have health problems that make other surgeries too risky.

Transurethral microwave thermotherapy (TUMT)

Your doctor inserts a special electrode through your urethra into your prostate area. Microwave energy from the electrode destroys the inner portion of the enlarged prostate gland, shrinking it and easing urine flow. TUMT might only partially relieve your symptoms, and it might take some time before you notice results. This surgery is generally used only on small prostates in special circumstances because re-treatment might be necessary.

Transurethral needle ablation (TUNA)

In this procedure, a scope is passed into your urethra, allowing your doctor to place needles into your prostate gland. Radio waves pass through the needles, heating and destroying excess prostate tissue that’s blocking urine flow. TUNA may be an option in select cases, but the procedure is rarely used any longer.

Laser therapy

A high-energy laser destroys or removes overgrown prostate tissue. Laser therapy generally relieves symptoms right away and has a lower risk of side effects than does nonlaser surgery. Laser therapy might be used in men who shouldn’t have other prostate procedures because they take blood-thinning medications.

The options for laser therapy include:

• Ablative procedures. These procedures vaporize obstructive prostate tissue to increase urine flow. Examples include photoselective vaporization of the prostate (PVP) and holmium laser ablation of the prostate (HoLAP). Ablative procedures can cause irritating urinary symptoms after surgery, so in rare situations another resection procedure might be needed at some point.
• Enucleative procedures. Enucleative procedures, such as holmium laser enucleation of the prostate (HoLEP), generally remove all the prostate tissue blocking urine flow and prevent regrowth of tissue. The removed tissue can be examined for prostate cancer and other conditions. These procedures are similar to open prostatectomy.

Prostatic urethral lift (PUL)

Special tags are used to compress the sides of the prostate to increase the flow of urine. The procedure might be recommended if you have lower urinary tract symptoms. PUL also might be offered to some men concerned about treatment impact on erectile dysfunction and ejaculatory problems, since the effect on ejaculation and sexual function is much lower with PUL that it is with TURP.

Embolization

In this experimental procedure, the blood supply to or from the prostate is selectively blocked, causing the prostate to decrease in size. Long-term data on the effectiveness of this procedure aren’t available.

Open or robot-assisted prostatectomy

The surgeon makes an incision in your lower abdomen to reach the prostate and remove tissue. Open prostatectomy is generally done if you have a very large prostate, bladder damage or other complicating factors. The surgery usually requires a short hospital stay and is associated with a higher risk of needing a blood transfusion.

Follow-up care

Your follow-up care will depend on the specific technique used to treat your enlarged prostate.

Your doctor might recommend limiting heavy lifting and excessive exercise for seven days if you have laser ablation, transurethral needle ablation or transurethral microwave therapy. If you have open or robot-assisted prostatectomy, you might need to restrict activity for six weeks.

Mayo Clinic Minute: Steam treatment for enlarged prostate

Show transcript for video Mayo Clinic Minute: Steam treatment for enlarged prostate

It’s a common problem for older men: benign prostatic hyperplasia, or BPH.

“BPH is a fancy way of saying the prostate is getting larger, and we don’t want it to. “

Dr. Toby Kohler, a Mayo Clinic urologist, says the enlarged prostate forces the urethra to narrow, causing a variety of urination problems. And as men age, the symptoms occur more frequently.

Treatment for BPH has long been medications and procedures, such as lasers or an electric loop, which burn the prostate from the inside out.

But, now, a relatively new convective water therapy treatment uses steam to make the prostate smaller.

“For nine seconds, a steam ball is produced and that kills all that prostate tissue that we don’t want or that has grown out of control.”

Dr. Kohler says the procedure, performed right in the doctor’s office, has a very low risk for complications or sexual side effects.

“It does not carry heat outside the prostate, and it does not carry heat to areas we don’t want it.”

He says this next generation of BPH treatment may soon replace the need for costly medications.

For the Mayo Clinic News Network, I’m Jason Howland.

Treatment at Mayo Clinic

Mayo Clinic specialists have training in a wide range of state-of-the-art technology to treat enlarged prostates. You have access to the latest noninvasive laser treatments, including HoLEP and PVP lasers. Your Mayo Clinic specialist will explain the range of treatments available and help you choose the best approach based on your symptoms.

Our caring team of Mayo Clinic experts can help you with your health concerns. Visit Mayo Clinic Men’s Health to
get started.

Get the process started

More Information

Show more related information

Lifestyle and home remedies

To help control the symptoms of an enlarged prostate, try to:

• Limit beverages in the evening. Don’t drink anything for an hour or two before bedtime to avoid middle-of-the-night trips to the toilet.
• Limit caffeine and alcohol. They can increase urine production, irritate the bladder and worsen symptoms.
• Limit decongestants or antihistamines. These drugs tighten the band of muscles around the urethra that control urine flow, making it harder to urinate.
• Go when you first feel the urge. Waiting too long might overstretch the bladder muscle and cause damage.
• Schedule bathroom visits. Try to urinate at regular times — such as every four to six hours during the day — to “retrain” the bladder. This can be especially useful if you have severe frequency and urgency.
• Follow a healthy diet. Obesity is associated with enlarged prostate.
• Stay active. Inactivity contributes to urine retention. Even a small amount of exercise can help reduce urinary problems caused by an enlarged prostate.
• Urinate — and then urinate again a few moments later. This practice is known as double voiding.
• Keep warm. Colder temperatures can cause urine retention and increase the urgency to urinate.

Alternative medicine

The Food and Drug Administration hasn’t approved any herbal medications for treatment of an enlarged prostate.

Studies on herbal therapies as a treatment for enlarged prostate have had mixed results. One study found that saw palmetto extract was as effective as finasteride in relieving symptoms of BPH, although prostate volumes weren’t reduced. But a subsequent placebo-controlled trial found no evidence that saw palmetto is better than a placebo.

Other herbal treatments — including beta-sitosterol extracts, pygeum and rye grass — have been suggested as helpful for reducing enlarged prostate symptoms. But the safety and long-term efficacy of these treatments hasn’t been proved.

If you take any herbal remedies, tell your doctor. Certain herbal products might increase the risk of bleeding or interfere with other medications you’re taking.

Preparing for your appointment

You might be referred directly to a doctor who specializes in urinary issues (urologist).

What you can do

• Make a list of your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Keep track of how often and when you urinate, whether you feel you’re completely emptying your bladder, and how much liquid you drink.
• Make a list of your key medical information, including other conditions you might have.
• Make a list of all medications, vitamins or supplements that you’re currently taking.
• Write down questions to ask your doctor.

Questions to ask your doctor

• Is an enlarged prostate or something else likely causing my symptoms?
• What kinds of tests do I need?
• What are my treatment options?
• How can I manage other health conditions along with an enlarged prostate?
• Are there any restrictions on sexual activity?

Don’t hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them might give you more time to address any concerns. You might be asked:

• When did you first begin experiencing urinary symptoms? Have they been continuous or occasional? Have they gradually worsened over time, or did they come on suddenly?
• How often do you urinate during the day, and how often do you need to get up at night to urinate?
• Have you ever leaked urine? Do you have a frequent or urgent need to urinate?
• Is it difficult for you to begin urinating? Do you start and stop when urinating, or feel like you have to strain to urinate? Does it ever feel like you haven’t completely emptied your bladder?
• Is there any burning when you urinate, pain in your bladder area or blood in your urine? Have you had urinary tract infections?
• Do you have a family history of enlarged prostate, prostate cancer or kidney stones?
• Have you ever had any trouble getting and maintaining an erection (erectile dysfunction), or other sexual problems?
• Have you ever had surgery or another procedure that involved insertion of an instrument through the tip of your penis into your urethra?
• Are you taking any blood thinners, such as aspirin, warfarin (Coumadin, Jantoven) or clopidogrel (Plavix)?
• How much caffeine do you consume? What is your fluid intake?

Our caring team of Mayo Clinic experts can help you with your health concerns. Visit Mayo Clinic Men’s Health to
get started.

Get the process started

Bladder outlet obstruction: Causes in men?

My doctor says I might have bladder outlet obstruction. What does that mean?

Bladder outlet obstruction in men is a blockage that slows or stops urine flow out of the bladder. Bladder outlet obstruction can cause urine to back up in your system, leading to difficulty urinating and other uncomfortable urinary symptoms.

Possible causes of bladder outlet obstruction might include:

• Enlarged prostate, also known as benign prostatic hyperplasia (BPH) — this is the most common cause of bladder outlet obstruction in men
• Scarring of the urinary channel (urethra) or bladder neck, as a result of injury or surgery
• Use of certain medications, including antihistamines, decongestants or drugs to treat overactive bladder
• Prostate cancer

Prompt diagnosis and treatment of bladder outlet obstruction is important to prevent serious problems caused by urine backing up into your system.

If you can’t pass urine, emergency treatment includes insertion of a tube (catheter) through the tip of your penis and into your bladder. This tube helps urine drain from your bladder. If your condition doesn’t require urgent care, your doctor might order tests to determine the underlying cause of your bladder outlet obstruction. Tests include imaging the bladder with sound waves (ultrasound) and viewing the bladder with a camera (cystoscopy). Treatment might include medications or surgery.

• Enlarged prostate: Does diet play a role?

May 09, 2019

Show references

1. McVary KT, et al. Lower urinary tract symptoms in men. https://www.uptodate.com/contents/search. Accessed May 6, 2019.
2. AskMayoExpert. Urinary retention. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2019.
3. Tintinalli JE, et al. Acute urinary retention. In: Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 8th ed. New York, N. Y.: The McGraw Hill Companies; 2016. http://accessmedicine.mhmedical.com. Accessed April 11, 2017.
4. Barrisford GW, et al. Acute urinary retention. https://www.uptodate.com/contents/search. Accessed May 6, 2019.
5. Castle EP (expert opinion). Mayo Clinic. Rochester, Minn. April 12, 2017.

See more Expert Answers

Products and Services

1. Book: Mayo Clinic Essential Guide to Prostate Health

.

Enlarged prostate: MedlinePlus Medical Encyclopedia

The treatment you choose will be based on how bad your symptoms are and how much they bother you. Your provider will also take into account other medical problems you may have.

Treatment options include “watchful waiting,” lifestyle changes, medicines, or surgery.

If you are over 60, you are more likely to have symptoms. But many men with an enlarged prostate have only minor symptoms. Self-care steps are often enough to make you feel better.

If you have BPH, you should have a yearly exam to monitor your symptoms and see if you need changes in treatment.

SELF-CARE

For mild symptoms:

• Urinate when you first get the urge. Also, go to the bathroom on a timed schedule, even if you don’t feel a need to urinate.
• Avoid alcohol and caffeine, especially after dinner.
• DO NOT drink a lot of fluid all at once. Spread out fluids during the day. Avoid drinking fluids within 2 hours of bedtime.
• Try NOT to take over-the-counter cold and sinus medicines that contain decongestants or antihistamines. These drugs can increase BPH symptoms.
• Keep warm and exercise regularly. Cold weather and lack of physical activity may worsen symptoms.
• Reduce stress. Nervousness and tension can lead to more frequent urination.

MEDICINES

Alpha-1 blockers are a class of drugs that are also used to treat high blood pressure. These medicines relax the muscles of the bladder neck and prostate. This allows easier urination. Most people who take alpha-1 blockers notice improvement in their symptoms, usually within 3 to 7 days after starting the medicine.

Finasteride and dutasteride lower levels of hormones produced by the prostate. These drugs also reduce the size of the gland, increase urine flow rate, and decrease symptoms of BPH. You may need to take these medicines for 3 to 6 months before you notice symptoms getting better. Possible side effects include decreased sex drive and impotence.

Antibiotics may be prescribed to treat chronic prostatitis (inflammation of the prostate), which may occur with BPH. BPH symptoms improve in some men after a course of antibiotics.

Watch out for drugs that may make your symptoms worse:

SAW PALMETTO

Many herbs have been tried for treating an enlarged prostate. Many men use saw palmetto to ease symptoms. Some studies have shown that it may help with symptoms, but results are mixed, and more research is needed. If you use saw palmetto and think it works, ask your doctor if you should still take it.

SURGERY

Prostate surgery may be recommended if you have:

The choice of which surgical procedure is recommended is most often based on the severity of your symptoms and the size and shape of your prostate gland. Most men who have prostate surgery have improvement in urine flow rates and symptoms.

Transurethral resection of the prostate (TURP): This is the most common and most proven surgical treatment for BPH. TURP is performed by inserting a scope through the penis and removing the prostate piece by piece.

Simple prostatectomy: It is a procedure to remove the inside part of the prostate gland. It is done through a surgical cut in your lower belly. This treatment is most often done on men who have very large prostate glands.

Other less-invasive procedures use heat or a laser to destroy prostate tissue. Another less-invasive procedure works by “tacking” the prostate open without removing or destroying tissues. None have been proven to be better than TURP. People who receive these procedures are more likely to need surgery again after 5 or 10 years. However, these procedures may be a choice for:

• Younger men (many of the less-invasive procedures carry a lower risk for impotence and incontinence than TURP, although the risk with TURP is not very high)
• Older people
• People with severe medical conditions, including uncontrolled diabetes, cirrhosis, alcoholism, psychosis, and serious lung, kidney, or heart disease
• Men who are taking blood-thinning drugs
• Men who are otherwise at an increased surgical risk

Benign prostate enlargement – NHS

Benign prostate enlargement (BPE) is the medical term to describe an enlarged prostate, a condition that can affect how you pee (urinate).

BPE is common in men aged over 50. It’s not a cancer and it’s not usually a serious threat to health.

Many men worry that having an enlarged prostate means they have an increased risk of developing prostate cancer.  This is not the case.

The risk of prostate cancer is no greater for men with an enlarged prostate than it is for men without an enlarged prostate.

Symptoms of benign prostate enlargement

The prostate is a small gland, located in the pelvis, between the penis and bladder.

If the prostate becomes enlarged, it can place pressure on the bladder and the urethra, which is the tube that urine passes through.

This can affect how you pee and may cause:  

• difficulty starting to pee
• a frequent need to pee
• difficulty fully emptying your bladder

Credit:

In some men, the symptoms are mild and do not need treatment. In others, they can be very troublesome.

Causes of benign prostate enlargement

The cause of prostate enlargement is unknown, but it’s believed to be linked to hormonal changes as a man gets older.

The balance of hormones in your body changes as you get older and this may cause your prostate gland to grow.

Video: prostate enlargement

This animation explains the possible causes of prostate enlargement or benign prostatic hyperplasia.

Media last reviewed: 12 January 2021
Media review due: 12 January 2024

Diagnosing benign prostate enlargement

You might have several different tests to find out if you have an enlarged prostate.

A GP may do some of these tests, such as a urine test, but others might need to be done at a hospital.

Some tests may be needed to rule out other conditions that cause similar symptoms to BPE, such as prostate cancer.

Find out more about diagnosing benign prostate enlargement

Treating benign prostate enlargement

Treatment for an enlarged prostate will depend on how severe your symptoms are.

If you have mild symptoms, you do not usually need immediate treatment, but you’ll have regular prostate check-ups.

You’ll probably also be advised to make lifestyle changes, such as:

Medicine to reduce the size of the prostate and relax your bladder may be recommended to treat moderate to severe symptoms of an enlarged prostate.

Surgery is usually only recommended for moderate to severe symptoms that have not responded to medicine.

Complications of benign prostate enlargement

Benign prostate enlargement can sometimes lead to complications, such as:

Acute urinary retention (AUR) is the sudden inability to pass any urine.

Symptoms of AUR include:

• suddenly not being able to pee at all
• severe lower tummy pain
• swelling of the bladder that you can feel with your hands

Go immediately to your nearest A&E if you experience the symptoms of AUR.

Page last reviewed: 10 February 2020
Next review due: 10 February 2023

Enlarged Prostate Causes, Symptoms, and Treatments

All their life, they slept like a stone. But now, there’s an annoying trip to the bathroom every night, sometimes once or twice a night.

For most men, these nightly bathroom runs may be the first sign of an enlarged prostate. Other symptoms may include trouble starting a stream of urine, leaking, or dribbling. And, like gray hair, an enlarged prostate is a natural by-product of getting older, doctors say. Trouble is, the nightly bathroom runs become more frequent — eventually edging their way into the daytime routine.

“They can’t sit through a meeting or a plane flight without getting up,” says Kevin Slawin, MD, a professor of urology at Baylor School of Medicine in Houston. “It’s very annoying … and when they have to go, they really have to go.”

It’s a problem that has several names — enlarged prostate, benign prostate hyperplasia, or simply BPH. According to the National Kidney and Urological Disease Information Clearinghouse, the most common prostate problem for men over 50 is prostate enlargement. By age 60, over one-half of men have BPH; by age 85, the number climbs to 90%, according to the American Urological Association (AUA).

Enlarged Prostate Symptoms and Causes

In men, urine flows from the bladder through the urethra. BPH is a benign (noncancerous) enlargement of the prostate that blocks the flow of urine through the urethra. The prostate cells gradually multiply, creating an enlargement that puts pressure on the urethra — the “chute” through which urine and semen exit the body.

As the urethra narrows, the bladder has to contract more forcefully to push urine through the body.

Over time, the bladder muscle may gradually become stronger, thicker, and overly sensitive; it begins to contract even when it contains small amounts of urine, causing a need to urinate frequently. Eventually, the bladder muscle cannot overcome the effect of the narrowed urethra so urine remains in the bladder and it is not completely emptied.

Symptoms of enlarged prostate can include:

• A weak or slow urinary stream
• A feeling of incomplete bladder emptying
• Difficulty starting urination
• Frequent urination
• Urgency to urinate
• Getting up frequently at night to urinate
• A urinary stream that starts and stops
• Straining to urinate
• Continued dribbling of urine
• Returning to urinate again minutes after finishing

When the bladder does not empty completely, you become at risk for developing urinary tract infections. Other serious problems can also develop over time, including bladder stones, blood in the urine, incontinence, and acute urinary retention (an inability to urinate). A sudden and complete inability to urinate is a medical emergency; you should see your doctor immediately. In rare cases, bladder and/or kidney damage can develop from BPH.

Time to Do Something About Your Enlarged Prostate?

Most men put up with an enlarged prostate for months, even years, before seeing a doctor, says Slawin. “When they’re getting up several times a night, and have trouble falling asleep again, that’s when they come in,” he tells WebMD.

It’s not always obvious what’s going on, Slawin adds. “When men start having urinary problems, it’s hard to know the reason. They should see a doctor when anything changes, because there can be bladder cancer, stones, prostate cancer. BPH is often a diagnosis of exclusion … after we make sure nothing more serious is going on.”

Urologists use the BPH Impact Index, a symptom questionnaire developed by the American Urological Association to determine if a man’s symptoms from BPH require treatment. “It helps us understand how severe the problem is,” says Slawin. Higher scores indicate more severe symptoms.

Prostate growth — and the trouble it causes — varies greatly from person to person, says O. Lenaine Westney, MD, division director of urology at The University of Texas Medical School at Houston. “Some people have more growth than others. Some people with very large prostates don’t have trouble with voiding. It’s a very individual thing.”

Watchful Waiting With an Enlarged Prostate

When the symptoms of an enlarged prostate gland are mild, with low scores on the BPH Impact Index (less than 8), it may be best to wait before starting any treatment — what’s known as “watchful waiting.”

With regular checkups once a year or more often, doctors can watch for early problems and signs that the condition is posing a health risk or a major inconvenience. That’s where the BPH Index is especially helpful, Westney tells WebMD. “It lets us know how high the symptom score is … when to start treatment.”

The “driving force in treatment,” she explains, is whether the symptoms are affecting your quality of life — and whether a blockage is causing serious complications, such as inability to urinate, blood in the urine, bladder stones, kidney failure, or other bladder problems.

A few questions to ask yourself:

• How severe are your symptoms?
• Do symptoms prevent you from doing things you enjoy?
• Do they seriously affect your quality of life?
• Are they getting worse?
• Are you ready to accept some small risks to get rid of your symptoms?
• Do you know the risks associated with each treatment?
• Is it time to do something?

Deciding on Treatment for an Enlarged Prostate

A range of treatments can relieve enlarged prostate symptoms — medications, minimally-invasive office procedures, and surgery. The best one for you depends on your symptoms, how severe they are, and whether you have other medical conditions.

The size of your prostate gland, your age, and your overall health will also factor into treatment decisions. What’s best for men in their 50s might not be optimal for an 80-year-old. An older man may want immediate symptom relief through drugs or surgery, whereas a younger man may lean toward a minimally invasive treatment. According to the American Urological Association, surgery often does the best job of relieving symptoms, but it also has more risks than other treatments.

Consider the options carefully with your doctor, says Westney. “We can start with medications, and if there’s no improvement, we look at minimally invasive therapy to reduce a portion of the prostate,” she tells WebMD. “These procedures are very effective, and side effects are very rare.”

If symptoms are really bothersome — or if you have complications like urine retention — it may be best to bypass medication. The minimally invasive treatments have benefits over surgery, like quick recovery time; however, you may need a second procedure later on. There is also less risk of serious side effects like long-term incontinence or erection problems — which can occur rarely with surgery.

Medications for an Enlarged Prostate

Several drugs are FDA-approved to relieve common symptoms of an enlarged prostate. Each works differently, says Westney. They either shrink the enlarged prostate or stop the prostate cell growth, she explains. “For many men, medications are very effective,” Westney tells WebMD. “They have a significant change in symptoms, and side effects are very uncommon … so medications are an attractive treatment.”

Doctors use the BPH Index to gauge how the patient responds to medication, Westney adds. “We see how symptoms are progressing … if they’ve stabilized or not.”

Alpha blockers: These drugs don’t reduce the size of the prostate, but they are very effective at relieving symptoms. They work by relaxing the muscles around the prostate and bladder neck, so urine can flow more easily. These drugs work quickly, so symptoms improve within a day or two. They are most effective for men with normal to moderately enlarged prostate glands.

Continued

The drugs: Flomax (tamsulosin), Uroxatral (alfuzosin), Hytrin (terazosin), Cardura (doxazosin), and Rapaflo (silodosin).

Continued

Alpha blockers were originally created to treat high blood pressure; dizziness is the most common side effect; other side effects are generally mild and controllable. Possible side effects include headache, stomach irritation, and stuffy nose. These drugs are not for men with significant urine retention and frequent urinary tract infections.

5-Alpha reductase inhibitors: These drugs can partially shrink the prostate by reducing levels of a male hormone — dihydrotestosterone (DHT) — which is involved in prostate growth. These drugs take longer to work than alpha blockers, but there is urine flow improvement after three months. These drugs can reduce risk of acute retention (inability to urinate) — and also reduce the need for prostate surgery. You may need to take them for 6 to 12 months to see if they work.

The drugs: Proscar (finasteride) and Avodart (dutasteride).

Possible side effects include erection problems, decreased sexual desire, and reduced amount of semen. These side effects are generally mild and may go away when you stop taking the drugs — or after the first year of taking the drugs.

There is also drug combination therapy, which may be effective against symptoms associated with BPH. Some examples of combined drugs include an alpha-blocker and a 5-alpha-reductase inhibitor; or an alpha-blocker and an anticholinergic.

Minimally Invasive Treatments for an Enlarged Prostate

When medications don’t help your enlarged prostate, several procedures can relieve symptoms — without surgery. They are performed in a doctor’s office. “These procedures use various types of heat energy to shrink a portion of the prostate,” explains Westney. “They are very effective.”

TUMT (transurethral microwave thermotherapy): This therapy for mild to moderate blockage reduces urinary frequency, urgency, straining, and intermittent flow — but does not correct any bladder-emptying problems. In this procedure, computer-regulated microwaves are used to heat portions within the prostate to destroy select tissue. A cooling system protects the wall of the urethra during the procedure. TUMT is performed in a doctor’s office and requires only topical anesthesia and pain medications.

Possible side effects include painful urination for several weeks. Temporary urgency and frequency of urination is also possible. There may be less semen ejaculated. Many men must have this procedure repeated, either because symptoms return or do not improve.

Continued

TUNA (transurethral radio frequency needle ablation): This procedure also destroys prostate tissue to improve urine flow and relieve symptoms. It involves heating the tissue with high-frequency radiowaves transmitted by needles inserted directly into the prostate (some anesthesia is used). The procedure does not require a hospital stay. Possible side effects include painful, urgent, or frequent urination for a few weeks.

Continued

Prostatic stents: In some cases, a tiny metal coil called a stent can be inserted in the urethra to widen it and keep it open. Stenting is done on an outpatient basis under local or spinal anesthesia. Usually, stents are only for men who are unwilling or unable to take medications — or who are reluctant or unable to have surgery. The majority of doctors don’t consider stents a good option for most men.

There could be serious side effects, and some men find that stents don’t improve their symptoms. Sometimes a stent shifts position, which can worsen the symptoms. In some cases, men experience painful urination or have frequent urinary tract infections. Stents are expensive, and there can be difficulty in removing them.

Surgery for an Enlarged Prostate

For most men with very enlarged prostates, surgery can relieve symptoms — but there are both risks and benefits with each type of operation. Discuss them with your doctor. After a careful evaluation of your situation and your general medical condition, your doctor will recommend which is best for you.

Continued

TURP (transurethral resection of the prostate): This is the most common surgery for an enlarged prostate, and considered to bring the greatest reduction in symptoms. Only the tissue growth that is pressing against the urethra is removed to allow urine to flow easily. The procedure involves an electrical loop that cuts tissue and seals blood vessels. Most doctors suggest using TURP whenever surgery is required, as it is less traumatic than open surgery and requires shorter recovery time.

With the TURP procedure, patients can expect to have retrograde ejaculation afterwards, says Westney. This is a condition in which a man ejaculates backward into the bladder instead of through the urethra. “Retrograde ejaculation generally isn’t painful,” she tells WebMD. “It shouldn’t be an issue unless fertility is a concern.” Other possible side effects include blood loss requiring transfusion (rare), painful urination, recurring urinary tract infections, bladder neck narrowing, and blood in the urine.

Continued

After TURP, the odds of erection problems range from 5% to 35%. However, this is often temporary — and the ability to have an erection and an orgasm returns after a few months.

Continued

TUIP (transurethral incision of the prostate): This procedure involves making cuts in the prostate instead of removing prostate tissue. These cuts reduce pressure on the urethra, making urination easier. Patients go home the same day, and wear a catheter for a day or two.

Symptom relief is slower with TUIP, compared with TURP. However, most men are satisfied with their ultimate symptom relief from this. Also, retrograde ejaculation is less common and less severe than after TURP. Risk of erection problems is similar to TURP.

Laser Surgery: This procedure uses a high energy vaporizing laser to destroy prostate tissue. It is done under general anesthesia and may require an overnight stay at the hospital. It provides immediate relief of symptoms, yet men may suffer from painful urination for a few weeks. In general this procedure causes less blood loss, and side effects can include retrograde ejaculation. These procedures include:

• Transurethral holmium laser ablation of the prostate (HoLAP)
• Transurethral holmium laser enucleation of the prostate (HoLEP)
• Holmium laser resection of the prostate (HoLRP)
• Photoselective vaporization of the prostate (PVP)

Continued

Open Prostate Surgery (Prostatectomy): When a transurethral procedure cannot be used, open surgery (which requires an incision in the abdomen) may be used. This allows the surgeon to remove tissue in the prostate. Open prostatectomy is typically done when the prostate gland is greatly enlarged, when there is bladder damage, if there are bladder stones, or if the urethra is narrowed. The inner part of the prostate is removed. This surgery is done under general or spinal anesthesia, and recovery can take a few weeks to several months.

Side effects are similar to TURP, including blood loss requiring a transfusion, urinary incontinence, erection problems, and retrograde ejaculation.

Herbal Therapies for an Enlarged Prostate

Several herbal supplements are marketed for enlarged prostates. Saw palmetto, beta-sitosterol, and pygeum are all are widely used in Europe. They are available in the U.S. and don’t require a prescription.

Continued

However, researchers and doctors are cautious about advising patients to try herbal supplements. Because they are not FDA-regulated, there are concerns about a product’s quality from batch to batch, according to the NIH’s Office of Dietary Supplements. Also, the safety of an herbal product depends on many things — the chemical makeup, how it works in the body, how it is prepared, and the dosage.

Continued

Something else to consider: Like any drug, a herbal remedy can affect how other medications or treatments work, or interact dangerously with your other medications. They can also have side effects. And, the AUA points out, they have not been well-studied for effectiveness or safety.

Before trying any alternative treatment, learn as much as you can about it, the AUA says. Most importantly — talk to your doctor before you try an herbal remedy. Many doctors consider alternative therapies like saw palmetto to “have no effect on symptoms, except as expensive placebos,” Slawin tells WebMD.

Saw palmetto: Saw palmetto is one of the most popular herbal supplements taken for BPH. The extract comes from ripened berries of the saw palmetto shrub. Extracts are thought to prevent testosterone from breaking down and triggering prostate tissue growth, similar to the 5-alpha reductase inhibitor medications. Studies of this supplement have had varied results.

“Saw palmetto does not work,” Slawin tells WebMD. He points to a recent “very nicely done” randomized study that found palmetto was no more effective than a placebo in relieving BPH symptoms. However, other studies have found it to be as effective as Proscar, a BPH medication. Varying quality of herbal products (dosages, ingredients, or purity) may account for the conflicting results, researchers say. Also, many studies of herbals have not been well-controlled.

Continued

Beta-sitosterol: This compound is extracted from pollen of rye grass. There has been some evidence that it provides relief from urinary symptoms. However, in four studies the supplement did not increase urinary flow rates, shrink the prostate, or improve bladder emptying.

Pygeum: This extract comes from the bark of the African plum tree. Numerous studies have found positive results for pygeum. In 18 studies, this extract relieved BPH symptoms twice as often as the placebo; it also increased urinary flow by nearly 25%.

Enlarged Prostate Treatments in the Pipeline

Researchers continue to investigate new therapies for enlarged prostates. “Another category of drugs is under development,” says Slawin. “We’ve come a long way in treating BPH. It’s no longer the life-threatening disease it once was. Now, in treatment, we’re working on quality of life issues… reducing side effects of treatment.”

Also being studied is a procedure called water-induced thermotherapy (WIT), an experimental procedure that involves destroying excess prostate tissue utilizing heated water and an air-filled balloon, which protects normal prostate tissue. The procedure is performed with only local anesthesia. Results may not be fully apparent for three to four months. However, preliminary studies examining WIT have shown positive results, with a near doubling in urine flow. However, the American Urological Association has not thus far endorsed WIT as a viable treatment option for symptoms of BPH.

What Is It & What Causes It?

You can do a lot to take care of yourself and give your body what it needs. Still, as you get older, your body changes in ways you can’t always control. For most men, one of those changes is that the prostate gets bigger.

It’s a natural part of aging, but at some point, it can lead to a condition called BPH, or benign prostatic hyperplasia.

Your prostate surrounds part of your urethra, the tube that carries urine and semen out of your penis. When you have BPH, your prostate is larger than usual, which squeezes the urethra. This can cause your pee stream to be weak, waking you up a lot at night to go to the bathroom along. it also could lead to other bothersome urinary symptoms. 

BPH isn’t prostate cancer and doesn’t make you more likely to get it.

It’s a common condition, especially in older men, and there are a lot of treatments for it, from lifestyle changes to medication to surgery. Your doctor can help you choose the best care based on your age, health, and how the condition affects you.

What Causes BPH?

Doctors aren’t sure exactly what makes this happen. Some think it may have to do with normal hormonal changes as you age, but it’s not clear.

Early in puberty, your prostate actually doubles in size. Later in life, around age 25, it starts to grow again. For most men, this growth happens for the rest of their lives. For some, it causes BPH.

Symptoms

As the prostate gets larger, it starts to pinch the urethra. This causes symptoms that affect your urine flow, such as:

• Dribbling when you finish
• A hard time getting started
• A weak stream, or you pee in stops and starts

When your urethra is squeezed, it also means your bladder has to work harder to push urine out. Over time, the bladder muscles get weak, which makes it harder for it to empty. This can lead to:

• Feeling like you still have to pee even after you just went
• Having to go too often — eight or more times a day
• Incontinence (when you don’t have control over when you pee)
• An urgent need to pee, all of a sudden
• You wake up several times a night to pee

• Urinary tract infections, bleeding, bladder damage, and bladder stones

Continued

It rarely leads to other conditions, but it can, and a couple of them are serious. For example, BPH can lead to kidney damage or, worst-case, cause a problem where you can’t pee at all.

A larger prostate doesn’t mean you’ll have more or worse symptoms. It’s different for each person. In fact, some men with very large prostates have few, if any, issues.

Diagnosis and Tests

Your doctor will first talk to you about your personal and family medical history. You might also fill out a survey, answering questions about your symptoms and how they affect you daily.

Next, your doctor will do a physical exam. This may include a digital rectal exam. During this, they put on a glove and gently insert one finger into your rectum to check the size and shape of your prostate.

Basic tests: Your doctor may start with one or more of these:

• Blood tests to check for kidney problems
• Urine tests to look for infection or other problems that could be causing your symptoms
• PSA (prostate-specific antigen) blood test. High PSA levels may be a sign of a larger-than-usual prostate. A doctor can also order it as screening for prostate cancer.

Advanced tests: Based on the results of those tests, your doctor may order additional tests to rule out other problems or to see more clearly what’s happening. These might include:

• Different types of ultrasound to measure your prostate and see if it looks healthy.
• A bladder ultrasound to see how well you empty your bladder.
• Biopsy to rule out cancer.
• Urine flow test to measure how strong your stream is and how much pee you make. 
• Urodynamics testing to evaluate your bladder function.
• Cystourethroscopy is a procedure using a  camera to examine the inside of the prostate, urethra and bladder. 

Treatments

How your doctor handles your case varies based on your age, health, the size of your prostate, and how BPH affects you. If your symptoms don’t bother you too much, you can put off treatment and see how it goes.

Lifestyle changes: You may want to start with things you can control. For example, you can:

• Do exercises to strengthen your pelvic floor muscles
• Lower the amount of fluids you drink, especially before you go out or go to bed
• Drink less caffeine and alcohol

Medicine: For mild to moderate BPH, your doctor might suggest medicine. Some medications work by relaxing the muscles in your prostate and bladder. Others help shrink your prostate. For some men, it takes a mix of medicines to get the best results.

Procedures: If lifestyle changes and medications don’t work, your doctor has a number of ways to remove part or all of your prostate. Many of these are called “minimally invasive,” meaning they’re easier on you than regular surgery. They use probes or scopes and don’t require large cuts in your body.

Continued

Examples are TUMT, TUNA, Rezūm, and laser therapy to remove part of your prostate gland.

• Transurethral resection of the prostate, or TURP, in which the doctor uses a scope and cuts out pieces of the gland with a wire loop

• Transurethral incision of the prostate or TUIP, in which a few small cuts are made in the prostate to reduce the gland’s pressure on the urethra.

UroLift system is a permanently placed device used to lift and hold the enlarged prostate tissue out of the way, so it no longer blocks the urethra which use a varied form of energy to destroy part of the prostate.

In some cases, your doctor may also suggest a traditional, open surgery or a robotic procedure to remove your prostate.

Any Complications?

With any BPH surgery, there may be side effects or complications such as bleeding, narrowing of the urine tube also known as urethral stricture, urinary incontinence or leakage, erectile dysfunction, and retrograde ejaculation.

BPH doesn’t lead to prostate cancer or make you more likely to get it.

Prostate Gland Enlargement | Causes and Treatment

Symptoms

The symptoms of prostate enlargement are called lower urinary tract symptoms (LUTS). See the separate leaflet called Lower Urinary Tract Symptoms in Men for more details. LUTS can also be caused by other conditions.

As the prostate enlarges it may cause narrowing of the urethra. This may partially obstruct the flow of urine. This can lead to obstructive symptoms such as:

• Poor stream. The flow of urine is weaker and it takes longer to empty your bladder.
• Hesitancy. You may have to wait at the toilet for a while before urine starts to flow.
• Dribbling. Towards the end of passing urine, the flow becomes a slow dribble.
• Poor emptying. You may have a feeling of not quite emptying your bladder.

The enlarged prostate may also make the bladder irritable, which may cause:

• Frequency. You may pass urine more often than normal. This can be most irritating if it happens at night. Getting up several times a night to pass urine is a common symptom and is called nocturia.
• Urgency. This means you have to get to the toilet quickly when you need to go.

Usually the symptoms are mild to begin with – perhaps a slightly reduced urine flow, or having to wait a few seconds to start passing urine. Over months or years the symptoms may become more troublesome and severe. Complications develop in some cases.

An enlarged prostate does not always cause symptoms. Only a quarter to a half of men with an enlarged prostate will have symptoms. Also, the severity of the symptoms is not always related to the size of the prostate. It depends on how much the prostate obstructs the urethra.

Not all urinary symptoms in men are due to an enlarged prostate. In particular, if you pass blood, become incontinent, or have pain, it may be due to bladder, kidney or other prostate conditions. You should see a doctor if these symptoms occur.

What are the causes of benign prostatic hyperplasia?

The exact cause is not known. Enlargement of the prostate gland is a normal process that develops as men get older. Therefore it becomes more common with increasing age. it is thought that changes in the male sex hormones that occur with ageing may be at least part of the cause.

Prostate gland enlargement can be caused by other conditions such as prostate cancer, acute prostatitis and chronic prostatitis. See the separate leaflets called Prostate Cancer, Acute Prostatitis and Chronic Prostatitis.

What are the possible complications?

Urinary symptoms do not worsen in everyone. Serious complications are unlikely to occur in most men with an enlarged prostate. Complications that sometimes occur include:

• In some cases, a total blockage of urine occurs so you will no longer be able to pass urine. This is called urinary retention. It can be very uncomfortable and you will need to have a small tube (catheter) inserted to drain the bladder. It occurs in less than 1 in 100 men with an enlarged prostate each year. See the separate leaflet called Urinary Retention.
• In some cases, only some of the urine in the bladder is emptied when you pass urine. Some urine remains in the bladder at all times. This ongoing condition is called chronic retention. This may cause repeated (recurring) urine infections, or incontinence (as urine dribbles around the blockage rather than large amounts being passed each time you go to the toilet).

Note: the risk of prostate cancer is not increased. Men with a benign prostate enlargement are no more or less likely to develop prostate cancer than those without benign prostate enlargement. 

Do I need any tests?

Benign prostatic enlargement is usually diagnosed based on the typical symptoms as described earlier. Tests are not needed to confirm the diagnosis but to make sure no complications have developed. Tests are also useful in ruling out other causes of your symptoms and sometimes give the doctor an idea of the size of your prostate. The following tests may be done:

• A doctor may examine your prostate to see how big it is. This is done by inserting a gloved finger into your back passage (through the anus into the rectum) to feel the back of the prostate gland. The size of your bladder may be assessed by examining your tummy (abdomen).
• Urine and blood tests may be done to check the function of your kidneys, to exclude a urine infection and to check there is no blood in the urine.
• A referral to a bladder specialist (urologist) may be advised if your symptoms are troublesome or if complications develop. Tests may be done in these more severe cases, particularly if surgery is being considered as a treatment. For example:
• Voiding diary. You may be asked to complete a diary over a week or so. This will have information about the number of times during the day and night you void, the amount passed and also the number and types of drinks you have had.
• A prostate specific antigen (PSA) blood test may be offered, although this test is not done routinely. This can be used as a marker for the size of the prostate. Larger prostates make more PSA. See the separate leaflet called Prostate Specific Antigen Test (PSA).

Note: a high PSA level is also found in people with prostate cancer. It has to be stressed that most men with prostate symptoms do not have prostate cancer.

Is treatment always necessary?

No. In most cases, an enlarged prostate does not do any damage or cause complications. Whether treatment is needed usually depends on how much bother the symptoms cause. For example, you may be glad for some treatment if you are woken six times a night, every night, with an urgent need to go to the toilet. On the other hand, slight hesitancy when you go to the toilet and getting up once a night to pass urine may cause little problem and not need treatment.

What are the treatment options for prostate enlargement?

Enlarged Prostate Management Options

Each treatment option for an enlarged prostate has various benefits, risks and consequences. In collaboration with health.org.uk, we’ve put together a summary decision aid that encourages patients and doctors to discuss and assess what’s available.

No treatment is likely to clear all symptoms totally, although symptoms can usually be greatly improved with treatment. The treatments considered usually depend on how severe and bothersome your symptoms are.

Not treating may be an option (often called watchful waiting)

If symptoms are mild then this may be the best option. You may be happy just to see how things go if the symptoms are not too bothersome and are not affecting your life very much. The situation can be reviewed every year or so, or sooner if there is a change in symptoms. Symptoms do not always become worse. They may even improve.

Medicines

The decision to treat with medicines usually depends on how much bother the symptoms are causing you. There are two groups of medicines that may help: alpha-blockers and 5-alpha reductase inhibitors. Medicines do not cure the problem, nor do they usually make symptoms go completely. However, symptoms often ease if you take a medicine.

Alpha-blocker medicines. These medicines work by by relaxing the smooth muscle of the prostate and bladder neck. This can improve the flow of urine.

5-alpha reductase inhibitor medicines. These are alternatives to alpha-blockers. These work by blocking the conversion of the hormone testosterone to dihydrotestosterone in the prostate. They do this by blocking a chemical (an enzyme) called 5-alpha reductase.

Surgery

Removal of part of the prostate is an option if symptoms are very bothersome or if medicines do not help. Around one in four men with an enlarged prostate will have an operation at some stage. In these operations, only the central part of the prostate is removed (creating a wide channel for urine to flow through), leaving the outer part behind. This is different to prostate cancer when, if surgery is carried out for cure, all the prostate is removed.

There are many different types of operation now available that can remove prostate tissue. Your surgeon will discuss the most suitable operation for you in more detail. Some of the more commonly done operations are listed below:

Transurethral resection of the prostate (TURP). This is the most common operation carried out for an enlarged prostate. Under anaesthetic, either spinal or general, a rigid cystoscope is inserted through the urethra into the bladder. A cystoscope is a narrow tube-like telescope through which small instruments pass to allow the operation to be carried out. A semicircular loop of wire has an electrical current passed through it. It is this loop that sticks out from the end of the cystoscope and cuts out small chips of prostate that are then washed out at the end of the operation. This operation nearly always gives good relief of symptoms. 80-90% of men after this operation will have retrograde ejaculation. This means that semen goes backwards into the bladder at climax producing a ‘dry’ orgasm. Impotence and incontinence are rare complications after a TURP.

Transurethral incision of the prostate (TUIP). This may be offered if you only have a slightly enlarged prostate. For this operation, the surgeon makes small cuts in the prostate where the prostate meets the bladder. This then relaxes the opening to the bladder, resulting in there being an improved flow of urine out of the bladder. There is less risk of retrograde ejaculation with this operation.

Open prostatectomy. This is a more traditional operation which involves cutting the skin to get to the prostate. It is now rarely done. It is only performed when the prostate is very large and when it would not be practicable to remove an adequate amount of prostate tissue through a narrow cystoscope inserted through the urethra.

Laser prostatectomy. This is simply the application of newer technologies to achieve the same goal as either TURP or open prostatectomy. It has the advantage of fewer side-effects, a shorter period of having a catheter in and a shorter stay in hospital (often just one night). There are two types of lasers:

• Green light which vaporises the prostate tissue to create a cavity.
• Holmium laser enucleation (HoLEP). Lasers can very effectively core out large pieces (lobes) of prostate which, in turn, are chopped into small pieces in order to be removed from the bladder. Thulium lasers can also be used.

In the hands of experienced laser surgeons, very large prostates, which in the past could only be dealt with by open surgery, can be removed by this technique.

UroLift®

The UroLift® system creates a ‘lift’ of the prostatic urethra by using an implant. This moves excess prostate tissue away so that it does not narrow or block the urethra. The device is designed to relieve symptoms of urinary outflow obstruction without cutting or removing tissue. There appears to be little or no risk of erectile dysfunction (ED) or problems with ejaculation with UroLift®.

The National Institute for Health and Care Excellence (NICE) has concluded that the UroLift system is effective in relieving symptoms of benign prostatic hyperplasia.

Editor’s note

New treatment approved by NICE

Dr Sarah Jarvis, 24th June 2020.

NICE has approved the use of Rezum® – a minimally invasive procedure that involves injecting steam to destroy excess prostate tissue for non-cancerous prostate enlargement. Rezum® is different from other prostate treatments because it uses water vapour thermal energy. It does not use a laser.

There is little evidence that men develop problems with erectile dysfunction after treatment with Rezum®. However, a few men get issues with ejaculation after treatment.

90,000 Prostate enlargement – search for specialists and doctors

Hyperplasia of the prostate – enlarged prostate

Are you looking for a specialist in the treatment of prostatic hyperplasia or detailed information about this disease? Our specialist and clinic search system allows you to find suitable doctors and medical centers in Germany and Switzerland. Learn about the symptoms, diagnosis, treatment of an enlarged prostate.

Definition: what is prostatic hyperplasia?

Prostatic hyperplasia (also: benign prostatic hyperplasia, BPH, prostate adenoma) is a benign enlargement of the prostate gland.This disease causes severe discomfort during urination. The first symptoms include frequent urination, especially at night, and poor urine flow.

About half of men over 50 suffer from prostate enlargement. Since the symptoms of the disease can lead to a significant deterioration in the quality of life and complications, early diagnosis and treatment by a urologist is of great importance.

Reasons: what is the prostate and why is it enlarged

The prostate is a gland that surrounds the urethra and is located under the bladder in the pelvic region.The normal adult prostate gland is about the size of a chestnut. The prostate is tightly intertwined with many nerve fibers, which are responsible in particular for erectile function and urinary retention. During life, the prostate gland enlarges.

According to the latest data, the etiology of prostatic hyperplasia has not yet been clarified, it is assumed that one of the reasons is the change in male hormones with age. As a rule, there is a benign enlargement of the inner glandular part, i.e.That is, where the urethra passes through the prostate. As a result of the enlarged prostate, the urethra is compressed, making it difficult to urinate.

Symptoms: How is prostate enlargement detected?

Symptoms are not only related to the size of the prostate. Even minor hyperplasia can cause great discomfort.

The most common symptoms are:

• Weak urine flow
• Prolonged emptying of the bladder
• Leakage of urine after urinating
• Residual urine (feeling unable to empty the bladder completely)
• Pollakiuria (frequent urination)
• Urgent urge to urinate (a feeling of pressure arises quickly, which necessitates an immediate visit to the toilet)
• Urinary incontinence (uncontrolled loss of urine)
• Nocturia (urination at night)

Possible complications:

• Retention of urine (the bladder cannot be completely emptied, a urinary catheter is required to completely empty)
• Urinary tract infections
• Bleeding
• Bladder stones
• Kidney damage

Diagnosis: How is Prostatic Hyperplasia Detected?

Patient interview

The diagnosis of benign prostatic hyperplasia is initially established through targeted patient interviews (history taking).In order to assess urinary problems objectively, questionnaires are used.

Palpation rectal examination

In addition, the prostate is examined through the anus by palpation (palpation rectal examination). It evaluates size, surface structure, tenderness, and shear capacity.

Urinalysis and ultrasound

The urine is checked for latent inflammation and blood. The use of ultrasound (ultrasound) of the prostate gland and surrounding organs also makes it possible to clarify the picture of the disease.Ultrasound of the prostate is performed transrectally, that is, through the rectum.

Dog test

Also, a urologist often detects the presence of prostate-specific antigen (PSA) in a blood test. It is not enough to use only this analysis, but it helps in identifying

prostate cancer

or a progressive enlargement of the prostate (increased PSA levels).

Uroflowmetry

With uroflowmetry, urinary flow during urination can be measured in milliliters per second.A change in the flow rate of urine may indicate a narrowing of the urethra (due to a scar or prostatic hyperplasia) or nerve disorders of the bladder.

Further diagnostics

As an additional diagnosis, the patient may follow a urination protocol, undergo urodynamic examination, or

cystoscopy

…

Treatment: how is BPH treated?

Different therapeutic approaches can be chosen depending on the symptoms, specific complaints and complications.These include watchful waiting, drug therapy, or surgery.

For unbearable symptoms, a large amount of residual urine, bladder stones, bleeding, or the ineffectiveness of conservative measures, they resort to surgical reduction or enucleation of the prostate.

For

conservative treatment

Various drug groups are available, such as herbal medicines, alpha-blockers, 5-alpha-blockers, or anticholinergics.

There are several different techniques in invasive surgery.

• Open

  
  
  prostate surgery
  
  

  (rarely used today, only with a very large gland)

• Transurethral electroresection (TUR of the prostate, a standard procedure in the invasive treatment of BPH)
• Transurethral incision (TUIP, used only for small glands, re-incision is also possible)
• Laser method
• Transurethral needle ablation (TUIA)

• 
  
  Transurethral microwave thermotherapy (TUMT)
  
  

• Stenting (rarely required for complications)
• Bladder catheterization (emergency, temporary or permanent)

Transurethral electroresection of the prostate is a proven treatment for BPH that has been used in medicine for many years.TURP stands for “transurethral resection of the prostate”. In this procedure, using an electric portable loop through the urethra, the prostate tissue is “cut” from the inside and evacuated to the outside.

Today urologists have many different treatment techniques with which they are able to help the patient! Do not hesitate and immediately contact a trusted specialist with your problem. He will examine your complaints and help you regain health and improve your quality of life.

Sources:

www.urologenportal.de

Information for patients with benign prostatic hyperplasia provided by the NCO German Society of Urology.

Benign enlargement of the prostate (prostate)

What causes benign enlargement of the prostate?

Benign Prostatic Hyperplasia is a consequence of an enlargement of the inner part of the prostate for unknown reasons.Symptoms – problems with urination: weak stream, feeling of incomplete emptying of the bladder, problems with emptying of the bladder, urge to urinate and nocturnia.

Diagnosis

Diagnosis is clinical and is based on characteristic urinary problems and denial of other factors. In addition, as part of a medical examination, the prostate is palpated to measure the extent of enlargement and to deny suspicion of prostate cancer.

In the urology clinic of the Kaplan Medical Center, the following tests can be carried out:

Uroflow – an objective check of the power of urination. The patient is invited to urinate in a special apparatus that measures the amount of urine and the force of the stream.

Urodynamic examination – checks the function and capacity of the bladder, as well as the sensitivity and ability to contract the bladder. During the examination, a thin catheter is inserted into the bladder through the urethra and fluid flows through it until the bladder fills.During the examination, the patient’s sensitivity and his reaction to the filling of the bladder, as well as the pressure inside it, are checked.

Ultrasound of the kidneys and ureters – a general examination of the function of the kidneys, bladder and prostate gland.

Treatment of benign enlargement of the prostate

There are several methods of treatment: medicinal and surgical.

First of all, the medicinal method is used, which includes two types of drugs:

1.Medicines that relax the muscles of the bladder and prostate gland – these medications begin to work after a few days and usually have a positive effect on the jet power and the ability to empty the bladder

2. Medicines that lower the hormonal effect of the prostate gland and affect its shrinkage. Such drugs work for a longer period.

Today it is known that the combination of drugs of each group simultaneously leads to the most significant improvement in the condition.

A surgical decision is usually made in the event of complications such as urinary accumulation, chronic infections in the ureters, bleeding from the ureters, etc.

There are several types of surgical approach, all designed to remove the inside of the prostate:

1. TURP – an endoscopic operation, during which an optical device is inserted through the urethra and resection of the inside of the prostate is performed. After surgery, the patient remains with the catheter, which is usually removed after 2 days.

2. SPP – removal of the inner part of the prostate by the abdominal method. It is used in cases of a large gland.

3. PVP – vaporization of the prostate with a green laser through endoscopy, through the urethra. The Department of Urology of the Kaplan Medical Center has become one of the first places in Israel to use this technology. The green laser allows the treatment of cases in which patients are taking blood-thinning drugs. In such cases, the catheter is usually removed the next day.

causes of occurrence, the latest methods of treatment.

Adenoma of the prostate gland is an increase in its size, which is caused by the natural proliferation of prostate tissue. The synonym term in medical practice is “benign prostatic hyperplasia” (BPH).

It is important to understand that the term “benign hyperplasia” reflects the ongoing changes in the prostate, the absence of an oncological process, but does not speak of a benign course of the disease.Advanced prostate adenoma can be a life-threatening condition.

REASONS

Until now, the causes of the disease are not exactly known. It is assumed that the reason for this development of glandular cells of the prostate tissue may be hormonal changes occurring in the male body with age. In particular, a decrease in the concentration of male sex hormones – androgens. Despite this, prostate adenoma is treated quite successfully by various methods.

DEVELOPMENT OF PROSTATE ADENOMA

Adenoma of the prostate is a nodular hyperplasia (ie, an increase in the number) of cells of the prostate gland. The initial signs of prostate adenoma can be detected as early as 30-40 years of age. First, small nodules are formed, consisting of rapidly multiplying cells. For a long time, there can simply be an increase in the number of nodules, and only after a certain (sometimes quite long) time, their gradual growth in size occurs.

Gradually expanding, these nodes compress the urethra, thereby narrowing its lumen, then the first manifestations of prostate adenoma appear, requiring treatment – urinary disorders.

CLINICAL MANIFESTATIONS

There are 3 stages of prostate adenoma.

Stage 1 (compensated) is manifested by impaired urination in varying degrees: a sluggish stream of urine, difficulty urinating, intermittent urination, frequent urge, especially at night.At this stage, the bladder is completely emptied – there is no residual urine. Compensatory hypertrophy of the bladder muscle (detrusor) develops.

At stage 2 (subcompensated) the symptoms of prostate adenoma increase, the feeling of incomplete emptying of the bladder increases, as the urethra is squeezed, the bladder is no longer able to completely expel urine, residual urine appears, which is a common cause of urinary tract infection, urinary formation stones.

Against the background of these stages, a condition sometimes develops when urine does not pass at all through the narrowed urethra – acute urinary retention, requiring emergency assistance in a urological hospital.

At 3 stages (decompensated or paradoxical ischuria) with a large amount of residual urine, the bladder is overstretched, urine is continuously excreted drop by drop, and urinary incontinence occurs. Due to the deterioration of the outflow of urine, renal function is impaired, renal failure occurs, which can lead to death in the absence of urological care.

It is extremely important not to delay the treatment of prostate adenoma, and when the first symptoms of the disease appear, consult a doctor.

TREATMENT METHODS

Treatment of prostate adenoma is a responsible task, which is carried out only by qualified specialists. Often, while treating prostate adenoma with folk remedies, patients only aggravate their condition. Such “traditional” medicine steals precious time, and sometimes only surgical intervention is possible in the future.It should be noted that in recent years there has been great progress in the treatment of BPH. This applies to both surgical and conservative treatments. The percentage of surgical interventions has decreased significantly, conservative (drug) treatment currently prevails in the world.

MEDICAL TREATMENT

Specialists of the Urology Department of City Clinical Hospital No. 29 have access to a wide range of drugs – the latest advances in pharmacology, providing comfortable and effective treatment of prostate adenoma at different stages.The most effective drugs are used in optimal combinations for long courses.

There are three groups of drugs that help fight BPH.

1. Alpha blockers. These substances are designed to expand the urethra by relaxing the smooth muscles of the prostate. The goal of therapy, in which alpha-blockers are prescribed, is to improve the outflow of urine, to exclude its stagnation in the bladder, its stretching and atony.

2. 5-alpha-reductase inhibitors.Drugs of this type prevent excessive proliferation of prostate cells. Inhibitors prevent the formation of a hormone that stimulates the growth of prostate glandular cells. As a result, prostatic hyperplasia slows down or stops altogether. The prostate itself is reduced in size by 20-30%. The patency of the urethra is restored.

3. Phytopreparations. Phytopreparations are understood as various kinds of natural plant substances that inhibit the growth factors of prostate cells.At the moment, the therapeutic effect of the use of this kind of medicines has not been sufficiently studied, and only drugs of the first two groups are used in general medical practice, however, the competent use of herbal medicines gives positive results

Drug treatment may be contraindicated in some patients. That is why the approach to solving delicate problems in City Clinical Hospital No. 29 involves a comprehensive examination and the search for the optimal, safest and most effective methods of treatment for each patient of the clinic.

90,000 Prostate adenoma. Symptoms Treatment methods.

Prostate adenoma. What is it?

Adenoma of the prostate – a benign tumor of the prostate, also called BPH – benign hyperplasia (enlargement) of the prostate gland.
Due to hormonal changes, about a third of men over 40 have an enlarged prostate gland. Adenoma of the prostate in men begins to develop actively after 50 years, every second man of this age is diagnosed with adenoma of the prostate gland.

Due to the fact that the urethra (urethra – lat.Urethra) passes through the center of the prostate, and prostate tissue with adenoma grows inside the gland (see figure), there is a possibility that the urethra may be completely or partially clamped due to which causes complaints associated with urination. Complaints only occur when the prostate enlarges so much that the muscles in the bladder are no longer able to push urine through the narrowed urethra. The stream of urine becomes weaker and the man needs more time and effort to start urinating, false urge to urinate is also possible.

Complaints with prostate adenoma

In order to pump all urine from the bladder through the urethra compressed by the prostate gland, the muscle tissues of the bladder must additionally work, but they do not always cope well with this, which leads to the accumulation of a large amount of residual urine in the bladder. This can lead to inflammation of the bladder, ureters and kidney problems. 25% of men over 50 have complaints of urination.This is a characteristic sign of prostatic hyperplasia.

Prostate adenoma. Symptoms

In order to pump all urine from the bladder through the urethra compressed by the prostate gland, the muscle tissues of the bladder must additionally work, but they do not always cope well with this, which leads to the accumulation of a large amount of residual urine in the bladder. As a result, unpleasant diseases such as inflammation of the bladder, ureters and kidney problems may occur.50% of men over 50 have urinary complaints. This is a characteristic sign of prostatic hyperplasia:

• Difficult (or impossible) to hold urine
• Weak urine stream
• Frequent urination
• Little amount of urine when urinating
• It takes time to start urinating
• Burning sensation when urinating
• Turbid urine or blood in urine

after

• urination
• Feeling of incomplete emptying of the bladder
• Frequent nighttime urge to urinate

Causes of prostate adenoma

The prostate in men grows since childhood and stops growing by the age of 20-25.The normal volume of the prostate is 23-25 ​​cm3, the normal weight of the prostate in an adult male is approximately 20 grams. After 40 years, the prostate begins to grow again in all men – this is a natural process. The growth of the prostate is associated with age-related hormonal changes in the body of a man.

An enlarged prostate does not cause problems for all men due to the individual physiological characteristics of each. In some men, the prostate begins to grow later, and in some, the urethra is naturally wider than in others, as a result of which the patient does not experience symptoms of prostate adenoma.

Treatment of prostate adenoma

Treatment of prostate adenoma involves several types of treatment. In the initial stages, drug treatment can be effective, but practice shows that in most cases, the symptoms of prostate adenoma return after a while. In this case, surgical removal of prostate adenoma is indicated.

Get a qualified diagnosis

Do you have symptoms of BPH and have doubts about the diagnosis? It is important to remember that prostate cancer makes itself felt only in the later stages of development, when effective treatment is unlikely, so timely diagnosis is vital.An extended urological examination will give you a complete picture of the health of the prostate gland

90,000 Causes of prostate enlargement

An enlarged prostate is a common problem in older men.

It disrupts the urination process, as fluid usually flows through the tubes in the body that stretch through the area where the prostate is located. When the prostate enlarges, these tubes become blocked. What are the causes of enlargement of the prostate? These are prostate adenoma, prostate cancer, and infectious diseases of the prostate.You will learn more about them in this article.

Prostate adenoma

This is a benign enlargement of the prostate. The problem can affect men after 30 years, and it manifests itself in 50% of men at the age of 50 and in 75% of men at the age of 80.

Adenoma of the prostate is a tumor, but it is benign (that is, not cancerous). And it appears in most older men. It is believed that the cause of this tumor is the long-term effects of male hormones on the body.

Although the tumor is benign and cannot spread to other parts of the body, it still causes problems. The main problem is urine blockage. If this situation is too aggravated, it can lead to kidney damage.

There are several treatments for BPH. With medication, you can reduce the swelling of the prostate gland to make it easier to urinate. If this option is not suitable, surgery may be required.

Prostate cancer

In addition to hormones, prostate cancer can be caused by prostate cancer (that is, the tumor can be malignant), which is more serious.However, a relatively simple adenoma compared to cancer gives the same symptoms as in prostate cancer. Therefore, be as careful and careful as possible. It is clearly not worth delaying the visit to the doctor.

Prostatitis

Prostatitis caused by inflammation or infection can cause enlargement of the prostate. When the prostate is inflamed, it often swells and causes urinary obstruction.

Prostatitis caused by infections can be treated with antibiotics, and prostatitis caused by other causes usually goes away quickly if a doctor’s advice is followed.

Be healthy!

symptoms, causes, diagnosis, treatment and prevention

The author of the article: Mkrtchyan Karen Gagikovich, Candidate of Medical Sciences, member of the European Association of Urology and the Russian Society of Urological Oncology

The prostate gland is one of the most important components of the body system. Adenoma is a pathological proliferation of tissue. This process differs from oncological disease in that tissue degeneration is benign.Therefore, in medical practice, pathology is also commonly called benign prostatic hyperplasia. Has a prostate adenoma symptoms of a certain nature, with the manifestation of which a number of diagnostic measures should be carried out.

• overhanging eyelids, which obstruct the view;

90,025 rusty sediments and sacks;

• drooping eyelid or pathology of the lacrimal canal;

90,025 excess skin of the lower eyelid;

• profound age-related changes;
• asymmetry, congenital abnormalities;
• damage to the skin due to injury.

Symptoms and signs of prostate adenoma

The first subjective sensation that men may notice with the development of prostate adenoma is problems with urination.

All signs of prostate adenoma are usually divided into two groups:

• filling symptoms. They are associated with fluid retention in the bladder. Manifested in the form of frequent urination both during the day and at night, and sudden urge to urinate;
• symptoms of emptying.They are based on the development of an obstruction to the excretion of urine. Narrowing of the lumen of the urethra leads to a delay in the beginning of urination and a weakening of the urine stream.

Causes of occurrence

With age, the activity of the prostate decreases significantly, and the cells responsible for the synthesis of secretions are replaced by connective tissue, and their atrophy occurs. As a result, the development of stagnation of the secretion and a further increase in the volume of the prostate gland, the prostate adenoma in men is actively developing.In parallel with this, the formation of nodules occurs, which over time increase and compress the lumen of the urethra. Their development is associated with hypertrophy of small glands located in the submucosa of the bladder neck. If you do not treat BPH, the consequences can be quite serious.

Risk factors

Risk factors include:

• age. Men over 40 years old should undergo a medical examination annually, since by the age of 65, one in three has a prostate adenoma;
• hereditary predisposition.There is a certain pattern between the development of the disease in older men, if their relatives (for example, the father) also had adenoma in history. A person is not excluded from the risk group even if the disease completely disappeared from blood relatives after removal of the prostate adenoma;
• diabetes mellitus and diseases of the cardiovascular system;

90,025 lifestyle. Lack of exercise and obesity increase the risk of developing prostate adenoma.

Complications

The main complications associated with prostate adenoma arise from a violation of the outflow of urine. The most common are:

• acute urinary retention. This condition develops due to the complete overlap of the lumen of the urinary canal. In such a situation, the patient needs immediate hospitalization. In severe cases, an operation is prescribed for prostate adenoma. If the pathology is in the early stages of development, then medications for prostate adenoma are prescribed;
• urinary retention in the bladder.This pathological process can lead to the development of inflammatory processes and the formation of calculi. More often, specialists prescribe the removal of prostate adenoma using modern methods;

90,025 bleeding. They develop due to the expansion and changes in the veins of the prostate gland and bladder;

• bladder diverticulum;
• Vesicoureteral reflux.

In parallel with the proliferation of prostate tissue, its inflammation can also develop.Therefore, treatment of prostate adenoma should be started at the first signs of the disease.

When to see a doctor

A specialist should be consulted when the first manifestations of prostate adenoma occur. They are often associated with urination. It becomes more frequent, at the beginning of the process there is a delay, and then a weak stream. Men also report a feeling of fullness in the bladder.

Specialists of a medical clinic in the center of Moscow, located at 10 2nd Tverskoy-Yamskaya lane, can help to solve the problem.Specialists of JSC “Medicine” (Clinic of Academician Roitberg) will tell you how to treat prostate adenoma. They will carry out a full range of diagnostic measures, prescribe therapy, and prescribe optimal medicines for prostate adenoma.

Preparing to visit a doctor

When visiting a specialist in connection with the development of prostate adenoma in men, there are no specific training rules. Therefore, it is enough just to make an appointment and at the specified time to arrive at the 2nd Tverskoy-Yamskaya lane.

Diagnosis of prostate adenoma

The disease can be diagnosed in the initial stages. Therefore, experts strongly recommend that men over 40 years old undergo a preventive medical examination every year. Collecting complaints and conducting an objective examination allow you to detect a prostate adenoma in time. In such a situation, it is very important to make sure that it is benign hyperplasia.

To carry out diagnostics in the central district of Moscow, you can consult a urologist at Medicina JSC (Academician Roitberg’s clinic) at 2nd Tverskoy-Yamskaya per 10.Specialists will be able to timely detect the signs of prostate adenoma and prescribe effective treatment.

Treatment

In the initial stages of the disease, conservative therapy may also be quite effective. Treatment of prostate adenoma with drugs helps to reduce the severity of the clinical picture. For this, herbal preparations, alpha-blockers and 5-alpha reductase inhibitors are used. There are several types of operations for prostate adenoma:

• transurethral resection;
• adenomectomy;
• laser vaporization of the prostate;
• laser enucleation (this is an effective and quick removal of prostate adenoma with a laser).

Timely removal of prostate adenoma is a quick normalization of a man’s health. Treatment of prostate adenoma in our clinic is carried out in a comprehensive manner.

Home remedies

The most effective home remedy is rectal suppositories. You can find out about their effectiveness with a specialist during an appointment.

For cooking, you need to use 20 g of cocoa butter and 1 g of propolis.The butter needs to be melted and propolis mixed in. Then form small rectal suppositories and place them in the refrigerator. You need to use suppositories twice a day for two months.

But this is an auxiliary measure. Therefore, one cannot be sure that “if I treat BPH at home, it means that I will completely get rid of the disease.” No unconventional method of therapy has yet given 100% results. It is recommended to exclude self-medication altogether.

Myths and dangerous misconceptions in treatment

There are misconceptions among the population that:

• Prostate adenoma in men is not treatable.
• This disease is NOT a cause of infertility.
• Only older men are susceptible to its development.
• Prostate adenoma is NOT a risk factor for cancer.

For a comprehensive consultation regarding your health condition and this disease, seek the help of a urologist.

Prevention

Prevention of this disease consists in changing the lifestyle:

• systematically engage in physical activity;
• avoid hypothermia;
• to limit the use of alcoholic beverages;
• limit the intake of excessively spicy, spicy and fatty foods;
• Eat enough fiber with vegetables and fruits.

How to make an appointment with a specialist

You can make an appointment with a specialist by calling +7 (495) 775-73-60 or using the feedback form on the website.Our clinic is located at the address: Moscow, 2nd Tverskoy-Yamskaya lane, 10, Mayakovskaya metro station.

Attention!

You can cure this disease free of charge and get medical care at Medicina JSC (Academician Roitberg’s clinic) under the program of the State Guarantees of Compulsory Medical Insurance (Compulsory Medical Insurance) and VMP (high-tech medical care).
For more details, please call +7 (495) 775-73-60, or on the VMP page for OMS

Prostate adenoma: symptoms and causes

Prevalence of prostate adenoma

Benign prostatic hyperplasia is the most common disease in elderly and senile men in the Russian Federation.According to epidemiological studies 25 percent! men over 50 years old experience excruciating symptoms, associated with prostate adenoma. And in the age group 70 years and more than they suffer from them already every second.

The prostate gland is a very important organ of the male reproductive system, normally the size of a walnut, located between the bladder and the penis.Localization of the prostate allows palpation through the rectum. The secretory function of the pancreas is to produce a special secretion, which, after ejaculation, ensures the dilution of the sperm and preserves the vitality of the sperm due to the presence of nutrients such as fructose and zinc citrate.

The secret of the prostate is 20-30 percent of the volume of semen (semen). Another special function of the pancreas is the metabolism of male sex hormones, in particular testosterone, which, under the influence of the enzyme 5α-reductase, is converted into an active form – dihydrotestosterone (DHT).

Prostate adenoma symptoms:

With a pronounced proliferation of the prostate gland – in particular, the tissues around the prostatic urethra, narrowing of the urethral lumen inevitably occurs – with the development of infravesical (subvesical) obstruction (IVO). This results in problems with urination – the so-called “emptying symptoms”. In addition, IVO leads to a reflex increase in the muscle tone of the internal urethral sphincter and an increase in the sensitivity (irritability) of the nerve endings in the bladder neck.This, in turn, leads to “accumulation symptoms”: increased urge to urinate, going to the toilet at night, and so on.

Main complaints with prostate adenoma:

• Frequent urination in small portions is one of the most common symptoms presented when talking to men with BPH. However, it is necessary to distinguish between increased urination caused by polyuria, when there are large volumes of urine released, for this purpose you can fill out a urination diary.
• nightly going to the toilet more than 1 time per night, a symptom significantly reducing the quality of life due to sleep disturbance,
• a weak pressure of the urine stream leads to the fact that the duration of urination can reach several minutes,
• intermittent urination,
• Urgent urge to urinate, in other words, very strong and sudden with a feeling of fear about possible urinary incontinence,
• sensation of incomplete emptying of the bladder, sometimes it may not depend on the volume of urine released
• The need to strain to start urinating.In patients with cardiovascular diseases, this symptom can lead to syncope (loss of consciousness, fainting) or even the development of a cerebral stroke.
• blood impurity in urine (hematuria), long-term chronic urinary retention due to IVO, leads to complications such as stones and bladder infections

To standardize, quantify patient complaints and determine the severity of prostate adenoma, a special questionnaire is used – the International Index of Prostatic Symptoms (IPSS).This tool, despite its apparent simplicity, has a high sensitivity and specificity (over 80%). According to the IPSS, the severity of prostatic hyperplasia is assessed as follows:

• up to 7 points – EASY,
• 8-19 points – MODERATE,
• 20-35 points – HEAVY.

The above symptoms are just the tip of the iceberg. Sooner or later, a serious complication of prostate adenoma occurs – acute urinary retention (inability to urinate due to narrowing of the urethral lumen and the inability of the bladder to adequately contract).In addition, the development of prostate adenoma is accompanied by a gradual increase in the amount of “residual urine”, that is, urine that is not evacuated from the bladder during urination.

This contributes, on the one hand, to the development of infection and the formation of stones in the bladder, on the other hand, it disrupts the outflow of urine from the kidneys through the ureters. Unfortunately, as hyperplasia progresses, the stage of decompensation (irreversible depletion) of the muscular wall of the bladder begins, which is forced to make great efforts, “squeezing” the urine.Subsequently, hydronephrosis gradually develops – an expansion of the cavity system of the kidneys, which ultimately leads to chronic renal failure (CRF).

Stages of prostate adenoma (prostate adenoma):

Currently, it is customary to distinguish the following stages in the course of prostatic hyperplasia:

• Stage I – compensation (minor urination disorders, no residual urine),
• Stage II – subcompensation (moderate or severe complaints, the presence of residual urine, the onset of damage to the upper urinary tract (kidneys), the risk of acute urinary retention, urinary tract infections and other complications),
• Stage III – decompensation (depletion of the bladder, hydronephrosis, development of renal failure).

Reasons for the development of prostate adenoma (prostate adenoma)

The causes of prostate adenoma are still not completely clear. The most common theories indicate that development is a consequence of age-related hormonal imbalances.

According to one theory, with age in men, the level of DHT in the blood increases, which stimulates the growth of the glandular tissue of the prostate.

Another theory suggests that the balance of the hormones testosterone and estrogen plays a major role in the development of the disease.In young men, testosterone levels are higher than estrogen levels, and with age, this ratio shifts in the opposite direction. Relatively high estrogen levels can stimulate prostate tissue proliferation.

It is important to note that adenoma, prostatitis and prostate cancer are completely different diseases (with different causes and mechanisms of development). Therefore, an adenoma cannot “go” into cancer, as well as prostatitis in BPH.

Risk factors for prostate adenoma

According to some studies, patients with benign prostatic hyperplasia, in addition, suffered from arterial hypertension (AH) and diabetes mellitus (DM).However, the above pathologies are most likely natural aging processes, and there is no direct relationship between these three diseases.