Benign prostate enlargement, enlarged prostate, benign prostatic hyperplasia, often abbreviated as BPH, are all different names for the same thing.
About the prostate
The prostate is a gland which, in adult males, is the size of a walnut and which weighs about 25 grams. It is situated directly beneath the urinary bladder and it surrounds the urethra at the point where it leads from the bladder to the penis.
The prostate's primary function is to produce a secretion which is released along with sperm into the urethra during ejaculation. In most men the prostate grows steadily in size with age. This growth is referred to as benign prostate enlargement.
The prostate consists of glands, muscles and connective tissue. The prostate contains muscles that are not voluntary and which can have an indirect effect on the flow of urine. As the prostate grows, the urethra is constricted and as a result urine may have difficulty passing through it. This is when many men experience problems. The sensation of not completely emptying the bladder, reduced urine flow and difficulties starting urination are signs of possible benign prostatic enlargement. These complaints may also be symptoms of other diseases, and so they should always be checked out by a doctor.
Investigation by a general practitioner
Treatment for the symptoms of benign prostatic enlargement is both simple and quick. The diagnosis is made by a general practitioner at the health centre. If the general practitioner finds reason to suspect a disease of the prostate that requires further investigation, it may be appropriate to refer the patient to a urologist, who is a specialist in diseases of the urinary organ. In order to find out the cause of the complaints, the general practitioner first conducts an initial investigation, which will usually involve some of the following:
General medical history, including a physical examination - the doctor finds out about medication, recent symptoms etc. After a talk, the doctor will normally examine the heart, lungs, abdomen and blood pressure.
Rectal palpation - the doctor feels the prostate by means of a digital rectal examination. A healthy prostate is smooth, firm and elastic.
Urine chart - the patient is given a questionnaire on which he writes down how often and how much he urinates, and how long it takes to pass the first decilitre.
Symptom form - this contains questions about the patient's symptoms in recent months.
Urine sample - an analysis is carried out, amongst other things to find out whether the urine contains bacteria .
Blood sample - the doctor decides whether a blood sample is required in order to check the PSA count and also the renal function.
Treatment with drugs
Initially treatment with an alpha-blocker is recommended. Alpha-blockers cause the muscles in the prostate to relax so that the urethra is not constricted. The advantage of alpha-blockers is that they work quickly, within two to four weeks, and the treatment works regardless of the size of the prostate. Alpha-blockers have only a few side-effects and these are mild. The most common are dizziness, headache, digestive problems and tiredness. The side-effects are usually experienced at the beginning of the treatment and they usually go over time. Severe side-effects are rare.
Benign prostatic enlargement can also be treated using a 5-alpha reductase inhibitor. This form of treatment affects the hormones in the prostate gland. It takes three to six months before treatment with 5-alpha reductase inhibitor has any effect. 5-alpha reductase inhibitor reduces the size of the prostate and the advantage with this form of treatment is that it reduces the risk of surgery being required in the future. The prostate must be enlarged for the treatment to work. The most common side-effects are impotence and reduced libido. The side-effects disappear if the medicine is stopped.
Surgery
Surgery is a very effective form of treatment for benign prostatic enlargement and it is recommended if the prostatic enlargement has resulted in urinary stasis, an effect on the kidneys, haemorrhaging from the prostate or repeated urinary tract infections.
The most common method is TURP (transurethral resection of the prostate). The aim of this method and all other surgical methods is to reduce the size of the prostate by removing prostate tissue. The drawbacks of surgery are the side-effects, and it can result in impotence.