Q&A Topic: Over 50? Difficulty Urinating? You May Need Treatment for an Enlarged Prostate.

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Warren Bromberg, MD, FACS

Q. What are the signs that I have an enlarged prostate—also called benign prostatic hyperplasia (BPH)?

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A. The prostate can grow at different rates, to different sizes, and in slightly different shapes. Generally, as it gets bigger, men have more troubles — I’ve seen prostates the size of small grapefruits — but sometimes it’s the configuration of the prostate, the length or width, that causes symptoms. Symptoms of BPH include difficulty urinating, a weak or interrupted urine stream, a feeling of urgency, and more frequent urination, particularly at night. Half of men in their 50s have enlarged prostates, and 9 out of 10 men in their 70s or 80s.

Q. What causesBPH?

A. Often the enlarged gland presses on the urethra—the duct through which urine exits the body—and the flow of urine is blocked. The problem can be exacerbated by decongestants, diuretics (water pills), antihistamines, alcohol, caffeine, anesthesia, and sleeping medications.

Q. How serious can the condition get?

A. If you’re getting up six times a night to urinate, it affects your sleep. And that means it can affect job performance and sexual activity. If left untreated, an enlarged prostate can also lead to urinary infections, bladder stones, and blood in the urine. Sometimes a man retains urine in the bladder and cannot urinate at all, which is very painful and causes kidney failure. I’ve had patients come in with three quarts of urine in their bladder. They’re in failure and they don’t even know it.

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Q. Does BPH put me at a greater risk of getting prostate cancer?

A. Not at all. Although BPH and prostate cancer both involve an enlarged prostate, BPH does not lead to cancer.

Q. How is BPH diagnosed?

A. Difficulty urinating may be the first clue that you have the condition. A physician typically diagnoses BPH with urine and blood tests, a digital rectal exam (DRE), and an ultrasound of the prostate.

Q. How is it treated?

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A. The first line of treatment is often lifestyle change: cutting back on alcohol, caffeine, and certain medicines that make the condition worse. Medications to treat BPH include alpha-blockers, 5-alpha-reductase inhibitors, and the erectile dysfunction drug Cialis. Most procedures are minimally invasive and performed through the urethra. We may use an electric current, laser, steam, or heat to remove or shrink prostate tissue. Another simple therapy uses an implant to compress the prostate. If the prostate is extremely large, the surgeon may need to remove prostate tissue through an incision in the lower abdomen. The choice of treatment depends on the associated conditions of the prostate, the prostate size, and the man’s preference. The nice thing is that there are a lot of options, and they can be tailored to patients’ preferences once they hear the risks and benefits. After treatment for BPH, you’ll need to restrict physical activity, exercise, and sexual activity for about a month.

Learn More About Dr. Bromberg
Chief, Urology
Director, Center of Excellence, Institute for Robotic and Minimally Invasive Surgery
Director of Prostate Program
Northern Westchester Hospital

Northern Westchester Hospital is a proud member of Northwell Health.

Read Past Topics from Dr. Bromberg: 
Prostate Cancer 
Incontinence In Women
Kidney Stones
Bladder Cancer
Male Sexual Dysfunction 

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