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VOTED AS AMERICA'S TOP UROLOGISTS A Division of Westchester Medical Group Treatment for Enlarged Prostate (BPH) Overview Benign prostatic hyperplasia [BPH], the most common benign neoplasm in American men is a chronic condition that is associated with progressive lower urinary tract symptoms and a non-cancerous enlargement of the prostate gland. It affects more than 50 percent of men over the age of 60 and almost 3 of 4 men during the seventh decade of life. As the prostate grows, it presses against and narrows the urethra, causing a urinary obstruction that makes it difficult to urinate. The most common reason for patients to be treated is bothersome symptoms. However, if left untreated and progresses, BPH has the potential to cause permanent damage to the urinary system. Anatomy and Physiology The prostate gland is a muscular, walnut-shaped gland in men. It is located right below the bladder and surrounds the urethra (the tube that carries urine out of the body). It is responsible for making the fluids that carry sperm. As a man ages, the prostate begins to slowly enlarge and may begin to squeeze the urethra, causing problems with urination. The normal adult prostate weighs 18 grams; measures 3cm in length, 4cm in width, and 2cm in depth. The prostate is composed of approximately 70% glandular elements and 30% of fibromuscular stroma. Although anatomically divided into different zones, the prostate is described as having 2 palpable lateral lobes separated by a central sulcus and one nonpalpable median lobe that may project into the bladder in older men. Signs and Diagnosis As the prostate enlarges and obstructs the urethra, a patient progressively develops lower urinary tract symptoms [LUTS]. These symptoms are variable and include nocturia, hesitancy, urgency, frequency, and incomplete voiding. Size alone does not diagnose BPH. It is a combination of criteria, including symptom severity, increased prostate size, abnormal uroflow results, and an increased postvoid residual of urine that aids in the diagnosis of BPH. Typical symptoms of include:
Treatment Options (All offered at our practice) Watchful waiting is an acceptable approach in men with mild symptoms of BPH. However, in men who are suffering from LUTS (lower urinary tract symptoms), medical treatment of BPH with the use of alpha blockers and 5 alpha reductase inhibitors is an option as first line of therapy. The downside of medical therapy is that it requires a lifetime of treatment as opposed to the various procedures/surgical options available. Alpha blockers are the initial choice of medical therapy. These drugs act on the dynamic component of bladder outlet obstruction and relax the prostatic smooth muscle. 5 alpha reductase inhibitors act on the static component of bladder outlet obstruction and reduce prostate size by inhibiting the conversion of testosterone to dihydrotestosterone. In the Medical Therapy Of Prostatic Symptoms trial, the combination of the two classes of medications was found useful in men with larger prostates, specifically those greater than 40 grams. When medical therapy is no longer effective, tolerated, or desired by the patient on a long term basis, surgical therapy is the next option. Over the last several years, new minimally invasive surgical techniques have been developed to treat BPH including transurethral microwave therapy and laser therapy. The gold standard of BPH surgery that all the minimally invasive treatments must be compared to is transurethral resection of the prostate. Regardless of what therapy is used, BPH is an important chronic condition that is highly prevalent and requires long term care and evaluation. Medications In cases of mild BPH symptoms that require treatment, medications may provide relief for many men. Drugs are costly, must be taken every day for the rest of your life, and may stop working over time. Side effects can include lowered sexual drive, erection problems, dizziness, low blood pressure and nasal congestion. Minimally Invasive Options
Surgery Surgery (prostatectomy) may be recommended if your BPH symptoms are severe or other treatment options haven't been successful for you. BPH surgeries remove large amounts of prostate tissue. They are performed in a hospital and require general anesthesia. Although there is a low risk of serious side effects, they do exist and include retrograde ejaculation ("dry climax"), erectile dysfunction (ED), and incontinence (the inability to control your bladder). Transurethral resection of the prostate (TURP) is the most common BPH surgery and can provide long-term relief. It requires a 2-3 day hospital stay.
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Center for Robotics, Laparoscopy, and Advanced Urology Westchester Medical Group 210 Westchester Avenue Department of Urology White Plains, NY 10604 Tel: 914.682.6470 Fax: 914.681.5264 VIEW MAP >>
1 Theall Road Visit Westchester Medical Group's website at www.westchestermed.com
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