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Dr. Gholami Urologist Silicon Valley

BPH - Benign Prostatic Hyperplasia

What is benign prostatic hyperplasia?

Benign prostatic hyperplasia also called BPH is a condition in men in which the prostate gland is enlarged and not cancerous. Benign prostatic hyperplasia is also called benign prostatic hypertrophy or benign prostatic obstruction.

The prostate goes through two main growth periods as a man ages. The first occurs early in puberty, when the prostate doubles in size. The second phase of growth begins around age 25 and continues during most of a man’s life. Benign prostatic hyperplasia often occurs with the second growth phase.

As the prostate enlarges, the gland presses against and pinches the urethra. The bladder wall becomes thicker. Eventually, the bladder may weaken and lose the ability to empty completely, leaving some urine in the bladder. The narrowing of the urethra and urinary retention—the inability to empty the bladder completely—cause many of the problems associated with benign prostatic hyperplasia.

What is the prostate?

The prostate is a walnut-shaped gland that is part of the male reproductive system. The main function of the prostate is to make a fluid that goes into semen. Prostate fluid is essential for a man’s fertility. The gland surrounds the urethra at the neck of the bladder. The bladder neck is the area where the urethra joins the bladder. The bladder and urethra are parts of the lower urinary tract. The prostate has two or more lobes, or sections, enclosed by an outer layer of tissue, and it is in front of the rectum, just below the bladder. The urethra is the tube that carries urine from the bladder to the outside of the body. In men, the urethra also carries semen out through the penis.

What causes benign prostatic hyperplasia?

The cause of benign prostatic hyperplasia is not well understood; however, it occurs mainly in older men. Benign prostatic hyperplasia does not develop in men whose testicles were removed before puberty. For this reason, some researchers believe factors related to aging and the testicles may cause benign prostatic hyperplasia.

Throughout their lives, men produce testosterone, a male hormone, and small amounts of estrogen, a female hormone. As men age, the amount of active testosterone in their blood decreases, which leaves a higher proportion of estrogen. Scientific studies have suggested that benign prostatic hyperplasia may occur because the higher proportion of estrogen within the prostate increases the activity of substances that promote prostate cell growth.

Another theory focuses on dihydrotestosterone (DHT), a male hormone that plays a role in prostate development and growth. Some research has indicated that even with a drop in blood testosterone levels, older men continue to produce and accumulate high levels of DHT in the prostate. This accumulation of DHT may encourage prostate cells to continue to grow. Scientists have noted that men who do not produce DHT do not develop benign prostatic hyperplasia.

Who is more likely to develop benign prostatic hyperplasia?

Men with the following factors are more likely to develop benign prostatic hyperplasia:

  • age 40 years and older
  • family history of benign prostatic hyperplasia
  • medical conditions such as obesity, heart and circulatory disease, and type 2 diabetes lack of physical exercise
  • erectile dysfunction
  • What are the symptoms of benign prostatic hyperplasia?
  • Lower urinary tract symptoms suggestive of benign prostatic hyperplasia may include
  • urinary frequency—urination eight or more times a day
  • urinary urgency—the inability to delay urination
  • trouble starting a urine stream
  • a weak or an interrupted urine stream
  • dribbling at the end of urination
  • nocturia—frequent urination during periods of sleep
  • urinary retention
  • urinary incontinence—the accidental loss of urine
  • pain after ejaculation or during urination
  • urine that has an unusual color or smell
  • Symptoms of benign prostatic hyperplasia most often come from
  • a blocked urethra
  • a bladder that is overworked from trying to pass urine through the blockage

How is benign prostatic hyperplasia diagnosed?

A health care provider diagnoses benign prostatic hyperplasia based on

  • a personal and family medical history
  • a physical exam
  • medical tests
  • Medical Tests

A health care provider may refer men to a urologist—a doctor who specializes in urinary problems and the male reproductive system—though the health care provider most often diagnoses benign prostatic hyperplasia on the basis of symptoms and a digital rectal exam. A urologist uses medical tests to help diagnose lower urinary tract problems related to benign prostatic hyperplasia and recommend treatment. Medical tests may include:

  • urinalysis
  • a prostate-specific antigen (PSA) blood test
  • urodynamic tests
  • cystoscopy
  • transrectal ultrasound
  • biopsy

Minimally Invasive Procedures

Researchers have developed a number of minimally invasive procedures that relieve benign prostatic hyperplasia symptoms when medications prove ineffective. These procedures include:

  • transurethral needle ablation
  • transurethral microwave thermotherapy
  • high-intensity focused ultrasound
  • transurethral electrovaporization
  • water-induced thermotherapy
  • prostatic stent insertion

Minimally invasive procedures can destroy enlarged prostate tissue or widen the urethra, which can help relieve blockage and urinary retention caused by benign prostatic hyperplasia.

Treatments for BPH include:

  • Watchful waiting. If your symptoms are not too bad, your doctor may suggest that you wait before starting any treatment. You will need regular checkups. Treatment can start later on if your symptoms get worse.
  • Alpha-blockers. These medicines can ease your symptoms. Side effects may include headaches, dizziness, or feeling lightheaded or tired.
  • Finasteride (Proscar®). This medicine lowers the amount of the male hormone (testosterone) in the body. The result is that the prostate shrinks and urinary problems get better. Side effects can include less interest in sex and problems with erection or ejaculation.
  • Surgery. An operation can improve the flow of urine but it can also cause other problems. Usually, men have surgery only if medicine hasn’t worked. Surgery does not protect against prostate cancer. Regular check-ups are important after BPH surgery. Talk with your doctor about this treatment choice. There are three kinds of surgery. All are done with anesthesia: 
    • Transurethral resection of the prostate (TURP) is the most common type of surgery. The doctor takes out part of the prostate through the urethra.
    • Transurethral incision of the prostate (TUIP) may be used when the prostate is not too large. The doctor makes a few small cuts in the prostate near the opening of the bladder.
    • Open surgery is used only when the prostate is very large. The doctor removes the prostate through a cut in the belly or behind the scrotum.
  • Other treatments. Other ways to relieve the symptoms of BPH use radiowaves, microwaves, or electrical current.

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