Enlarged Prostate – BPH
The prostate in normally a golf ball sized gland that sits in the pelvis underneath the bladder. The gland makes most of the white fluid that is ejaculated when a man has an orgasm during sex. The tube that drains the bladder (urethra) passes through the middle of the gland and out through the penis. When the gland enlarges, as often occurs with age, the urethra can get compressed like squeezing a straw. The prostate can enlarge compressing the passage through it or enlarge upward into the bladder. This makes it difficult to empty the bladder and produces symptoms like a slow or prolonged stream, getting up at night (nocturia), straining, frequent and urgent to void. Other symptoms can be bloody urine (hematuria), overflow incontinence, incompletely emptying the bladder and ultimately acute urinary retention where the bladder fills and one is unable to urinate at all.
Prostatic enlargement is a common condition affecting many men as they age. It is rare before age 40, and develops progressively with each decade. It affects well over half of men by the age of 70.
The cause of BPH is a matter of intense research. It is clearly hormone dependent. The male hormone testosterone produced in the testicles, is transformed into a stronger male hormone called dihydrotestosterone or DHT. This hormone is required to maintain an enlarged gland. However other factors including genetic and inflammation seem to be involved as well. Ratios of DHT the male hormone and a female hormone estrogen or estradiol may be part of the cause as well.
Urology Group of New Mexico uses a wide variety of methods to evaluate and diagnose enlarged prostate. The patients story, his signs and symptoms, are the beginning of the evaluation. This history includes the AUA Symptom Index which is a series of questions, standardized to determine the presence and severity of BPH. This test is included in our new patient paper work and will be sent to you when you make an appointment. It is also available at the American Urological Association (AUA) website, http://www.aua.org. PSA testing helps differentiate between BPH problems and the presence of prostate cancer. The well known DRE or digital rectal examination is useful to help determine the size of the gland, presence of infection or possibilities of prostate cancer. The lubricated and gloved finger can only examine the back side of the prostate, so we use transrectal prostate ultrasound examinations as a highly sensitive and reproducible method of determining prostate size. Other forms of testing include uroflowmetry to determine the flow rate at which one is able to empty the bladder. Uroflow testing along with urodynamic testing provide pressure/flow studies that determine the degree of obstruction. Lastly post-void residual testing, done with an ultrasonic bladder scanner determines the amount of urine remaining in the bladder after urination is completed. Normally, there is about an ounce or so left behind.