The prostate gland produces seminal fluid that nurtures the sperm to assist in reproduction. It is situated at the base of the bladder, and the tube, which men urinate through, the urethra, runs through the center of the prostate. In a young healthy man the prostate is little

more that the size of a walnut. As men age, it is a normal consequence that the prostate enlarges. This enlargement is non-cancerous, however, the constriction on the urethra often causes difficulty urinating as well as other potentially serious urinary problems.

This condition, Benign Prostatic Hyperplasia, is a virtual inevitability. It occurs in half of all men by the age of 60, and approximately 90 percent of men by age 85. 

There are two basic symptoms produced by BPH. The first type is obstructive symptom. The enlargement of the prostate obstructs the flow of urine causing the stream to be slow and weak. Often a man will have difficulty initiating his urine stream and may experience dribbling when he finishes urinating. As the symptoms progress, the bladder may

not empty completely, raising the risk of urinary tract infections and bladder stones. If the blockage worsens still, the patient may be unable to urinate, creating horrific pain and potentially damaging the kidneys. They second type of symptom involves

urinary irritability. In the early phase of the prostate enlargement, the bladder is able to force urine through the obstruction by contracting more forcefully. As with any other muscle the bladder muscle compensates, gradually becoming stronger, thicker and overly

sensitive, causing the need to urinate more frequently, particularly at night. 

Fortunately there are many options for treatment of BPH ranging from watchful waiting to invasive surgery. The decision to consider treatment must be based on each man’s individual situation, the severity of his symptoms, the risks he is willing to take, and treatment limitations due to other medical conditions. 

Watchful waiting is considered when symptoms are mild and not particularly bothersome. This approach involves occasional examinations to monitor the symptoms of BPH, and assess the possible development of serious complications. If there is progression of the disease, alternative treatments may be considered. Numerous medications are available, which are quite successful in managing moderate symptoms of BPH. There are two categories of medication effective in managing these symptoms. The first include medications that relax the smooth muscle of the prostate and the bladder neck, thus improving the flow of urine. These medications are known as alpha-blockers, and are typically the first medications tried to alleviate symptoms. The second category of medications actually works to shrink the size of the prostate by blocking the major male hormone inside the prostate. These are known as 5-alphareductase- inhibitors. These drugs are effective for many men, but it may take up to three or more months to establish a noticeable difference in urine flow. For certain situations, your physician may recommend a combination of both medications. 

The next category of treatments is collectively known as minimally invasive procedures. These are minor  procedures performed in the office, without the need for a general anesthetic or a hospitalization. These procedures use different types of energy to destroy the prostate tissue and eliminate the blockage. These treatments offer long-term resolution of symptoms by eradicating the obstructing tissue. Common types of minimally invasive procedures are radio frequency needle ablation, or microwave thermotherapy of the prostate. The final option is surgical treatments to remove the obstructing prostate tissue. These are performed in the operating room under general anesthetic and may require a hospital stay overnight. Most are performed via the urethra and do not require an incision. They tend to have superior long-term results in terms of symptom relief, but are a greater undertaking.

Invasive treatments include open prostatectomy and transurethral resection, which are classic operations. Laser enucleation, or green light laser vaporization are newer approaches with equivalent results and longevity, but typically can be performed on an

outpatient basis. BPH does not always require treatment. Treatment should be initiated only if the symptoms are severe enough to bother you, or serious complications occur such as urinary retention, recurrent infections, and kidney or bladder damage. The presence of an enlarged prostate in and of itself is not reason enough to seek treatment. A

man and his doctor should discuss the benefits of treatment when a diagnosis of BPH is made. The best treatment is not the same for all men. Your doctor may refer you to a urologist, a physician who specializes in the diseases and conditions of the male and female urinary systems.

Dr. Troy Malcom is a board certified urologist at Longmont Clinic. He joined the Clinic in

September 2007. Dr. Malcom can be reached at 720.494.3137.