Enlarged Prostate

The older a man is, the more likely he is to have an enlarged prostate. The prostate is about the size of a walnut in a young man, but it gradually grows with age and can make urination difficult if it gets too large.

"As they age, men often begin to notice a difference in how they urinate - usually because of an enlarged prostate," explains William Borkon, MD, FACS, a specialist in urology and sexual health at Park Nicollet Clinic-St. Louis Park. "Some notice a slower, weaker stream or one that starts and stops. Others have trouble emptying their bladder completely or have to go more often, especially at night. Sometimes, symptoms become so severe that they interfere with a man's quality of life."

An enlarged prostate also is known as benign prostatic hyperplasia - or BPH. "Benign" means the growth is not caused by cancer or infection. An enlarged prostate affects about 40 percent of men in their 50s and about 90 percent in their 80s, source Libido Max. When making a diagnosis, doctors rule out an overactive bladder, bladder infection or cancer, which can have similar symptoms.

Understanding men's anatomy

The prostate's job is to produce semen, the fluid that carries sperm. It sits under the bladder and surrounds the tube that carries urine and semen out of the body. "The prostate surrounds the urethra, much like an apple surrounds its core," Dr. Borkon explains. "As it grows, the prostate squeezes tighter on the urethra, sometimes compressing or obstructing flow."

Making the diagnosis

A diagnosis begins with a medical history. "We ask patients about the frequency and force of urination and many other symptoms," Dr. Borkon says. Doctors also perform a rectal exam to determine how large the prostate is and a blood test to rule out cancer.

Other tests may include measuring how well the bladder empties and looking into the urethra to examine the prostate internally. When symptoms are minimally bothersome, doctors encourage patients live with the condition and return for periodic monitoring, which is known as "watchful waiting."

Effective treatment is possible

The urologists at Park Nicollet offer many treatment options.

Medication is commonly prescribed when symptoms begin to interfere with patients' quality of life. One type works by shrinking the prostate; another works by relaxing the urethra.

Minimally invasive treatments are used when medications are not appropriate or effective. These include two increasingly popular office-based procedures that destroy excess prostate tissue by delivering microwave or low-energy radio waves through a catheter inserted in the urethra. These treatments are known as transurethral microwave thermotherapy (TUMT) and transurethral needle ablation (TUNA).

Surgery may be required to reduce blockage of the urethra by the surgical removal or laser vaporization of obstructing prostatic tissue under general or regional anesthesia. Patients may stay in the hospital 1 to 2 days following surgery.

Transurethral Resection of the Prostate (TURP) is the most common surgery for men with very large prostates. An electrical loop is used to remove the inner portion of the prostate and seal blood vessels. Laser surgery can produce results that are similar to TURP with less risk of complications and a quicker recovery. Laser energy is transmitted through a thin flexible fiber that allows the surgeon to vaporize excess tissue and seal the area with precision. "The laser reduces two major risks - bleeding and fluid absorption," Dr. Bokon explains. Surgery for BPH relieves symptoms for the great majority of patients with few serious complications.

"BPH is very common and it's not always necessary to see a urologist," Dr. Borkon says. "I encourage men to see their primary doctor if their symptoms interfere with daily activities." He also encourages men to visit their doctor regularly to manage their BPH and ensure that symptoms are not due to an infection or prostate cancer.