(BPH) - Enlarged Prostate
The Prostate
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The prostate, located below the bladder and in front of the rectum, is a walnut sized gland that makes the fluid that composes semen, the fluid that carries sperm. The urethra, the tube that carries urine from the bladder and out through the penis, is surrounded by the prostate. |
The Symptoms of BPH
A normal effect of the aging process is the gradual enlargement of the prostate, affecting at least half of all men by age 60. As the prostate enlarges, it squeezes around the urethra and may press on the neck of the bladder. When this happens, commonly when a man is in his 50s, symptoms of Benign Prostatic Hyperplasia can occur. Some of these symptoms include:
| Weak stream | Hesitancy of stream |
| Nighttime urination | Frequent urination |
| Urgent urination | Sensation of incomplete bladder emptying |
| Starting and stopping of urination | Painful or burning urination |
The Causes of BPH
There are several theories on the causes of Benign Prostatic Hyperplasia. Though the cause is not fully understood, we do know that BPH occurs mostly in older men.
One of the causes may be hormonal. Testosterone is the hormone that men produce. All men also produce small amounts of estrogen. As aging occurs, the testosterone production decreases. This leaves a higher proportion of estrogen to testosterone than before. It is possible that BPH may occur because the estrogen increases cell growth of the prostate.
Another theory suggests that dihydrotestosterone may be involved. Dihydrotestosterone (DHT) is a substance in the prostate that is derived from testosterone. DHT is believed to help control prostate growth. As men age and their testosterone levels drop, DHT continues to be produced. The DHT accumulates in the prostate, which may cause the prostate to grow. It is known that men who do not produce DHT do not develop BPH.
The prostate grows tremendously at puberty, and about age 25, begins to grow again at a slower rate. There is a theory that the prostate cells may be "programmed" early in life to "reawaken" and begin growing or become more sensitive to hormones that influence their growth.
The Exam and Diagnosis
If you are experiencing any of the symptoms of BPH, you need to visit your doctor for an exam. All men over 40, whether or not they are experiencing symptoms, should be examined yearly. In addition to checking your urine and reviewing your medical history, your doctor will give a fast and painless rectal exam to determine the size, shape, and condition of your prostate.
If you are over 50 (or 40 if you are African-American or have a family history of prostate cancer), your doctor may also give you a blood test that tracks a protein made my the prostate. This test is called PSA, and it can aid in the diagnosis of prostate cancer.
You should be examined by a doctor if you experience changes in the way you normally urinate regardless of your age.
With early diagnosis and treatment, the risk of developing complications is minimized. Without a doctor's care, urination will become more difficult. The bladder may not empty, and the retention of urine may cause urinary tract infections, damage to the bladder, bladder stones, kidney damage, or incontinence.
Your exam might include the following:
| Ultrasound | A rectal ultrasound may be indicated if your doctor suspects prostate cancer. |
| Urine Flow / post void residual Study | You may be asked to urinate into a device which measures the rate of urine flow. If the flow is reduced, BPH may be suspected. Afterwards the amount of urine left in the bladder is determined by ultrasound. |
| Intravenous Pyelogram (IVP) | IVP is an x-ray of the urinary tract. Dye is injected into a vein, making urine visible in the x-ray. Any blockage of the urinary tract is shown. |
| Cytoscopy |
The inside of the penis is numbed and a small tube called a cytoscope is inserted into the urethra. The cytoscope has a tiny lens and light that allows the doctor to see the urethra and bladder. The size and shape of the prostate can be determined, and the obstruction can be evaluated. |
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