Prostate Enlargement

Transcription

1 wrien by Harvard Medical School Prosae Enlargemen Benign Prosaic Hyperplasia

2 The prosae is a walnu-shaped gland a he base of he bladder. I s par of he male reproducive sysem. Is job is o produce fluid for semen. Bu when hings go wrong, he gland can cause problems wih urinaion, no sex. Tha s because he urehra, he ube ha carries urine ou from he bladder, runs hrough he prosae (see figure). As men ge older, he gland enlarges, and i may cause benign prosaic hyperplasia (BPH) in he process. Even a small amoun of prosae enlargemen can make i hard o urinae. Wha Causes BPH? The cause of BPH is one of he grea myseries of modern medicine. Docors know ha wo hings are essenial: 1) age and 2) esoserone. Bu hey don know why some men develop BPH as hey age while ohers don. Alhough he cause of BPH is unknown, here are some imporan risk facors o know abou, such as: 2 Abdominal obesiy Cigaree smoking Lack of exercise Poor die Excessive alcohol inake These same risk facors conribue o hear disease, cancer, sroke, and diabees, so healhy living is a smar choice for everyone. For more informaion abou BPH from Harvard Healh Publicaions, go o Sympoms The sympoms of BPH vary. One group of problems is caused by urehra narrowing; picure he way you can slow he flow of liquid hrough a sraw by pinching i beween your humb and index finger. These problems include: Having o srain and wai o sar urinaing Having a weak, slow sream Taking a long ime o urinae and dribbling a he end No empying he bladder compleely. Some - imes his means a man canno urinae a all, an urgen problem called acue urinary reenion. The oher group of sympoms is due o irriaion of he bladder. They include: An urgen, someimes unconrollable need o urinae, ofen passing only small amouns of urine. Frequen nighime urinaion Pelvic Bone Urehra Penis Prosae Bladder Anus 3

3 AUA Sympoms Index for BPH The American Urologic Associaion (AUA) has developed a es for BPH. You can ake he es here o see where you sand. Simply circle one answer o each quesion. Then add up he numbers o deermine your score. (Circle one answer for each quesion) 1. During he las monh or so, how ofen have you had a sensaion of no empying your bladder compleely afer you finished urinaing? 2. During he las monh or so, how ofen have you had o urinae again less han 2 hours afer you finished urinaing? 3. During he las monh or so, how ofen have you found ha you sopped and sared again several imes when you urinaed? 4. During he las monh or so, how ofen have you found i difficul o pospone urinaion? 5. During he las monh or so, how ofen have you had a weak urinary sream? 6. During he las monh or so, how ofen have you had o push or srain o begin urinaion? 7. During he las monh or so, how many imes did you ypically ge up o urinae from he ime you wen o bed a nigh unil he ime you go up in he morning? AUA scores: 0 7 are considered mild; 8 19 indicae moderae sympoms; sugges severe BPH. Talk o your docor abou your score o see if you should be reaed for BPH. Diagnosis Diagnosis is easy; your docor may perform a simple evaluaion of sympoms using he AUA index or similar quesions. Your docor may also check for oher condiions, such as diabees and neurological disorders. A digial recal exam may be needed o evaluae he size of he prosae and o check for abnormaliies ha could indicae cancer or infecion. Urinalysis and blood ess of kidney funcion are also imporan. Treamen In a few men, BPH is severe enough o require immediae reamen. Bu because BPH progresses slowly, mos men can decide for hemselves when and if hey should be reaed. Wachful Waiing For men wih low AUA scores, i s he only opion. I s a reasonable choice for men who find ha simple lifesyle adjusmens can ake he BPH boher ou of daily life. Here are a few ips: Reduce your inake of fluids, especially afer dinner. Limi your inake of alcohol and caffeine. Avoid drugs ha simulae muscles in he bladder neck and prosae, such as pseudophedrine and oher decongesans. 4 5

4 Avoid medicaions ha weaken bladder conracions, such as anihisamines, ani - depressans, or drugs ha conrol spasms. Ask your docor o lower your dosage or subsiue anoher drug for diureics, which increase he need o urinae. Never pass up a chance o use he bahroom, even if your bladder does no feel full. Take your ime and empy your bladder as much as possible. When you are in new places, learn he locaion of he bahroom before you really need i. If you can live comforably wih BPH, do i. Bu if your sympoms boher you, several opions are available. Medicaions Prescripion drugs can reduce he sympoms of BPH. Two ypes are available: Alpha-blockers, such as erazosin, doxazosin, amsulosin, alfuzosin relax smooh muscle cells in he prosae and bladder. All of hese drugs ac wihin weeks, and abou 70% of men wih BPH improve. Hormone blockers, finaseride and duaseride, acually shrink he gland. These drugs work slowly, over 6 monhs or longer, and are only helpful for men wih large prosaes. Combinaion herapy wih an alpha-blocker and a hormone blocker may reduce he risk of complicaions for men wih moderae or severe BPH. Surgery Alhough many men wih BPH do well wih drugs, ohers sill need surgery. Transurehral resecion of he prosae (TURP) has been he mos common BPH reamen. I does no require an incision hrough he skin. However, he 90-minue operaion does require a hospial say and aneshesia. A resecoscope is passed hrough he urehra, cuing away prosae issue ha is slowing he flow of urine. A caheer is lef in place o empy he bladder for a day or wo, afer which he paien can urinae on his own. Alhough resuls vary, TURP reduces BPH sympoms in 80% o 90% of paiens. Complica - ions may include infecion or bleeding, dry ejaculaion (50% o 75%), erecile dysfuncion (5% o 10%), and inconinence (1% o 3%). Because he prosae can grow back, up o 20% of TURP paiens require more reamen wihin 10 years. New Choices for an Old Problem Many new, less-invasive surgical reamens are being inroduced jus as medical herapies are improving. And all hese choices are arriving when new informaion suggess ha i s safe for men who are no grealy bohered by heir sympoms o choose wachful waiing raher han any acive herapy. I s a new era ha will allow well-informed men o ake conrol of an old problem. 6 7

5 To learn more abou BPH, visi he Paien Educaion Cener a Brough o you by: HARVAR D MEDICAL SCHOOL Paien Educaion Cener nd Ave Norh For Dodge, IA service@paienedu.org Abou This Brochure: This brochure was wrien by pracicing physicians from Harvard Medical School. I is par of a series developed and disribued by he Paien Educaion Cener. All he informaion in his brochure and on he associaed Web sie ( is inended for educaional use only; i is no inended o provide, or be a subsiue for, professional medical advice, diagnosis, or reamen. Only a physician or oher qualified healh care professional can provide medical advice, diagnosis, or reamen. Always consul your physician on all maers of your personal healh. Harvard Medical School, he Paien Educaion Cener, and is affiliaes do no endorse any producs. Consuling Physician: Anhony L. Komaroff, MD Ediorial Direcor: Keih D Oria Creaive Direcor: Jon Nichol Copyrigh Harvard Medical School. Prined on 10% pos-consumer recycled paper. PEC-PC-BPH-002