Benign prostatic hyperplasia
Benign prostatic hyperplasia, or BPH, is very common in older men. The prostate is enlarged, but it is not cancerous. Over time, an enlarged prostate may press against the urethra, making it hard to urinate.
BPH may cause dribbling after urinating or a need to urinate often, especially at night. A doctor will do a rectal exam to check for BPH. And he may suggest having special x-rays or scans to check the urethra, prostate, and bladder.
- Estimating a volume of more than 30 ml on rectal examination has a sensitivity of less than 50% in detecting a gland of more than 30 ml.
- Estimated a posterior surface area of more than 7 cm2 has a sensitivity of 70% for detecting a volume of more than 30 ml. Of note, an area of 7 cm2 indicates a circle with diameter of 3 cm or a square with diameter of approximately 2.5 cm2.
The American Urological Association Urinary symptom score is a validated measure of severity of symptoms.
American Urological Association Urinary symptom score: ASK THE FOLLOWING QUESTIONS: Over the past month:
ANSWER THE QUESTIONS AS FOLLOWS, POINTS ARE BELOW: Not at < 1 < than 1/2 About 1/2 > than 1/2 Almost all time in 5 the time the time the time always 0 1 2 3 4 5 Total Score: 0-7 mild 8-19 moderate 20-35 severe
If the symptoms are not too bad, the doctor may suggest "watchful waiting" before starting any treatment. This includes regular checkups. Treatment can start later on if symptoms get worse.
- Alpha adrenergic blockers can reduce the symptoms. Drug toxicity may include headaches, dizziness, or feeling lightheaded or tired. Vascular drug toxicity may be less with tamsulosin due to more selectivity to α1-A and α1-D adrenergic receptors according to a meta-analysis supported by Boehringer Ingelheim Pharmaceuticals, the maker of tamsulosin.
- Testosterone 5-alpha-reductase inhibitors such as finasteride (Proscar®) can lower the amount of the male hormone (testosterone) in the body. The result is that the prostate shrinks and urinary problems get better. Drug toxicity can include less interest in sex and problems with erection or ejaculation.
- Saw palmetto plant extract (Serenoa repens). Despite initial positive reports, a more recent randomized controlled trial found no benefit.
- If symptoms of urge and overactive urinary bladder are present, an antimuscarinic cholinergic antagonist such as tolterodine can be combined with an alpha adrenergic blocker such as tamsulosin.
(% AUA score increase by ≥ 4 points)
|Combination||Alpha adrenergic blocker only||5-alpha-reductase inhibitor only|
Uncontrolled factorial trial
|Mean prostate volume was 54 ml||tamsulosin 0.4 mg and/or dutasteride 0.5 daily||Placebo||Composite at 4 years||8.6%||14.2%||13.1%|
| Medical Therapy of Prostatic Symptoms (MTOPS) Research Group
|Mean prostate volume was 36 ml||doxazosin 8 mg and finasteride 5 mg daily||Placebo||Composite at 4.5 years||5%||7%||9%|
| Veterans Affairs Cooperative Studies Benign Prostatic Hyperplasia Study Group
|terazosin 10 mg and finasteride 5 mg daily||Placebo||Various at one year|
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. This surgery does not protect against prostate cancer. Regular check-ups are important after BPH surgery. There are three kinds of surgery:
- Transurethral resection of the prostate (TURP) is the most common type of surgery. The surgeon 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.
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