Benign Prostatic Hypertrophy

Benign Prostatic Hyperplasia (BPH) is one of the most common diseases to affect men over 40. Almost half of all men over the age of 65 suffer from problems caused by an enlarged prostate gland. The development of new, effective drugs and treatments has reduced the need for surgery in treating prostate problems. However, many men simply adapt their lives to cope with their symptoms rather than to have any treatment.

What does the prostate gland do?

The prostate gland is at the base of the bladder. It secretes fluid into the semen. The gland gradually enlarges with age and can block the passage of urine from the bladder.

Who is at risk of BPH and what are the symptoms?

The risk of BPH increases with age and is more likely if a close relative has the disease. The gland can change slightly after the age of 40 and around 50% of men in their 60’s and 90% of men over 85 have BPH.

The symptoms of BPH are caused by the prostate gland enlarging and obstructing the flow of urine. This obstruction irritates the bladder. The symptoms tend to come on very slowly but they gradually affect the sufferer’s quality of life.

Ask yourself the following three questions

• Do you get up at night to pass urine?
• Is your urine flow slow?
• Are you concerned about your bladder’s function?

Many men find it difficult to start passing water. They have to stop and start and it feels like they have not quite emptied the bladder. The bladder may overflow, causing urine to leak. For example, the sound of running water can cause leakage before you reach the toilet and dribbling afterwards. Sometimes the need to pass urine will become very urgent and you will feel the need to urinate more often. Although the symptoms will get gradually worse in 55% of men, symptoms can vary. Up to 30% of men may find symptoms remain stable and 15% of mens symptoms will improve with time.

What happens if I can’t urinate?

The bladder muscles may strain to push urine through the narrowing passage. Having too much to drink can suddenly over stretch the bladder and stop the muscles from working. This is very uncomfortable and you will need to contact your GP immediately to have the urine drained away.

Your GP will do this by inserting a catheter (which is a thin flexible tube) gently up through the penis into the bladder. Following this, you will almost certainly need an operation.

What test will I have?

Your doctor will ask you about your symptoms and examine your abdomen and penis. He or she will also examine your prostate gland by putting his or her finger into your rectum (a digital rectal examination).

Your urine will be tested to make sure there is no infection or blood in it. Your doctor will also take a blood test to see how your kidneys are working and whether you might have prostate cancer.

You may be referred to a clinic which will give you a diary in which you write down how often you urinate and the number and type of drinks you have each day. You may be asked to urinate into a flow meter which measures the flow and volume. After this, your bladder may be examined with an ultrasound machine which tells your doctor whether or not you have completely emptied your bladder.

Can BPH be treated?

BPH can be treated by drugs or, if necessary, surgery. The treatment you have depends on how severe your symptoms are, how much your urine flow is reduced and whether or not there is a large volume of urine remaining in your bladder after you go to the toilet. You and your doctor may decide that a "watch and wait" approach is appropriate. Check out the points below to see how you can help yourself.

• Try to eat a well balanced diet with plenty of fruit and vegetables
• Get more exercise
• Avoid smoking and heavy drinking
• Try and reduce stress and get more sleep
• Tell your doctor if you notice blood in your urine, or burning, stinging sensation when you urinate
• Make a note of how much you drink during the day and try to avoid drinking strong tea and coffee
• Stop drinking after early evening

What treatment is available?

There are several options that you should discuss with your GP.

• Watch and Wait. Many men won’t need treatment especially if their prostate is only enlarged with minimum symptoms. Your doctor will see you regularly to monitor your condition.

• Treatment with drugs. There are two main types of drug for treating BPH. One type, alpha blockers, reduces muscular spasms at the base of the bladder so allowing urine to flow more freely. The other type, 5-alpha reductase inhibitors, shrinks the gland by blocking the effect of the male hormone, testosterone. Some of the bladder irritation can be reduced by drugs known as anti-cholinergics. Around a quarter of patients with BPH also have high blood pressure. This may also be treated with alpha blockers. Your doctor will select the alpha blocker which is best suited to your condition and circumstances. Follow up appointments will be necessary to monitor your condition.

• Surgery. The operation to relieve the obstruction caused by an enlarged prostate is called ‘prostatectomy’ Surgery will be necessary if the symptoms are severe, i.e. flow of urine is completely blocked or if there are complications (such as infection or bleeding). Surgery is very effective and two thirds of men who have surgery are pleased with the improvements within three months. The remaining third do have some improvement, but not all the symptoms improve. In some cases the surgery causes side-effects and a small number of patients find their symptoms are worse.

Before proceeding with surgery, however, you should talk to your doctor as the operation has risks and complications.

What does the operation involve?

When deciding whether or not to have an operation, you need to discuss the pros and cons with your GP or the surgeon. If you decide to have surgery, the surgeon will tell you which operation will be most suitable for you.

The operation performed 95% of the time is the TURP (Trans-urethral resection of the prostate). A slim telescope is carefully inserted up the penis. This allows the surgeon to examine the prostate and the inside of the bladder. The surgeon may then use heat from an electric current to cut away pieces of the prostate which are blocking the flow of urine. These are then washed out through the penis and sent away for further examination.

If the prostate gland is very large, it may have to be removed through a cut in the lower abdomen. There are also other treatments such as removing the excess prostate tissue with laser treatment, or simply cutting the neck of the bladder to improve urine flow.

Further information:

• Write to BAUS Royal College of Surgeons, 35/43 Lincoln’s Inn Fields, London WC2 3PN, for a booklet.
• Better Prostate Health Line on 0891 667788
• Send two first class stamps to the prostate help Association, Langworth, Lincoln, LN3

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