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Benign prostatic hyperplasia (BPH)

Signs, dianosis and treatment of enlarged prostate

Benign prostatic hyperplasia is the enlargement of the prostate, especially among older men. More than half of men in the 60s and as many as 90 percent in their 70s and 80s have BPH, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

Symptoms of BPH include a hesitant, interrupted, weak stream; urgency and leaking or dribbling; and frequent urination, especially at night.
It is important to tell your doctor if you have urinary problems such as those described above. The symptoms can also signal other, more serious conditions.

Diagnosis

Diagnosis procedures include:

  • A digital rectal examination, in which the doctor feels for the size of the prostate.
  • Prostate-specific antigen (PSA) blood test, which can rule out cancer as a cause of urinary symptoms.
  • Rectal ultrasound and prostate biopsy, if there is a suspicion of prostate cancer. In this procedure, a probe inserted in the rectum directs sound waves at the prostate. If there is an abnormal-looking area, the doctor can use the probe and ultrasound images to guide a biopsy needle to the suspected tumor.
  • Urine flow study, in which a reduced flow can suggest BPH.
  • Cystoscopy, in which the doctor inserts a small tube through the opening of the urethra in the penis. A lens and light system can help the doctor see the inside of the urethra and bladder.

Treatment

Men who have BPH with symptoms need some kind of treatment. Although the need for treatment is not usually urgent, doctors generally advise going ahead with treatment once the problems become bothersome or present a health risk.

Options include:

  • Drug treatment. The FDA has approved six drugs to relieve common symptoms associated with an enlarged prostate.
  • Transurethral microwave procedures, which use heat to destroy excess prostate tissue. Although microwave therapy does not cure BPH, it reduces problems with urination.
  • Water-induced thermotherapy, which uses heated water to destroy extra prostate tissue. Water is injected to the prostate area through a catheter.
  • Transurethral surgery. The surgeon reaches the prostate by inserting an instrument through the urethra and removing it one piece at a time.
  • Open surgery. In rare cases when transurethral surgery isn’t possible, an open surgery requiring an external incision may be used. This is often done when the prostate is greatly enlarged, when there are complicating factors or when the bladder has been damaged and needs repaired.
  • Laser surgery. Several types of procedures that use lasers to vaporize prostate tissue through high bursts of energy have been approved by the FDA.