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Enlarged Prostate: Causes, Symptoms, Diagnosis, Treatment, and Prevention

The condition of enlarged prostate, also known as benign prostatic hyperplasia (BPH), affects many men as they age. Prostates are small glands that produce semen and surround the urethra, which transports urine from the bladder. As the prostate grows larger, the urethra can be squeezed and urination can become difficult.

Causes of Enlarged Prostate

The exact cause of BPH is not well understood, but it may be related to hormonal changes that occur as men get older. Some factors that may increase the risk of developing BPH include:

• Age: BPH is more common in men over 50 and becomes more prevalent with age.

• Family history: Having a father or brother with BPH may increase the risk of having it as well.

• Ethnicity: BPH is more common in men of African or Asian descent than in men of European or Hispanic descent.

• Obesity: Being overweight or obese may increase the risk of BPH by affecting hormone levels and inflammation.

• Diabetes: Having diabetes may increase the risk of BPH by affecting blood flow and nerve function in the prostate.

• Lifestyle: Smoking, drinking alcohol, and having a sedentary lifestyle may worsen the symptoms of BPH.

Symptoms of Enlarged Prostate

The symptoms of BPH vary from person to person and may change over time. Some common symptoms include:

• Frequent or urgent need to urinate, especially at night

• Difficulty starting or stopping the urine stream

• Weak or interrupted urine flow

• Dribbling or leaking of urine

• Feeling of incomplete bladder emptying

• Straining or pushing to urinate

• Urinary tract infections or bladder stones

• Blood in the urine

• Kidney damage or failure

Diagnosis of Enlarged Prostate

To diagnose BPH, a doctor will ask about the symptoms, medical history, and family history of the patient. The doctor will also perform a physical exam, which may include:

• Digital rectal exam: The doctor will insert a gloved finger into the rectum to feel the size and shape of the prostate.

• Urinalysis: The doctor will test a sample of urine for signs of infection, blood, or other abnormalities.

• Blood test: The doctor will measure the level of prostate-specific antigen (PSA), a protein produced by the prostate, in the blood. A high PSA level may indicate BPH, prostate cancer, or other conditions.

• Uroflowmetry: The doctor will measure the speed and volume of urine flow using a device called a uroflowmeter.

• Post-void residual: The doctor will measure the amount of urine left in the bladder after urination using an ultrasound or a catheter.

• Cystoscopy: The doctor will insert a thin, flexible tube with a camera and light (cystoscope) into the urethra and bladder to examine the inside of the urinary tract.

• Urodynamic tests: The doctor will use various methods to measure the pressure and flow of urine in the bladder and urethra.

Treatment of Enlarged Prostate

There are several possible treatments for BPH, depending on the severity of the symptoms, the size of the prostate, the patient's age and health, and the doctor's opinion.

• If the symptoms are mild or not bothersome, the patient may choose to monitor the condition and make lifestyle changes, such as drinking less fluids at night, avoiding caffeine and alcohol, and exercising regularly.

• If the symptoms are mild or not bothersome, the patient may monitor the condition and make some lifestyle changes, such as drinking less fluidr both. These include:

• Tamsulosin, alfuzosin, doxazosin, and terazosin are alpha blockers that relax the smooth muscles of the bladder and urethra that allow urine to flow more easily.

• Finasteride and dutasteride are examples of 5-alpha reductase inhibitors, which block the enzyme that converts testosterone to dihydrotestosterone (DHT), a hormone that promotes prostate growth.

• The combination of an alpha blocker and a 5-alpha reductase inhibitor may provide better results for some patients than either drug alone.

• Tadalafil is an example of a phosphodiesterase-5 inhibitor, which is mainly used to treat erectile dysfunction, but may also improve the symptoms of BPH by increasing blood flow to the penis and prostate.

• Using local anesthesia or sedation, these procedures can be performed in the doctor's office or in an outpatient setting. With the use of heat, lasers, or other energy sources, they aim to reduce prostate size or widen the urethra. For example:

• Transurethral microwave thermotherapy (TUMT): The doctor inserts a catheter with a microwave antenna into the urethra and heats the prostate tissue, causing it to shrink.

• In transurethral microwave thermotherapy (TUMT), the doctor inserts a catheter with a microwave antenna into the urethra and heats the prostate tissueausing it to die and shrink.

• Water vapor therapy (Rezum): The doctor injects steam into the prostate tissue, causing it to swell and die, and then reabsorbs the dead tissue over time.

• Prostatic urethral lift (UroLift): The doctor inserts tiny implants into the prostate that lift and hold the enlarged tissue away from the urethra, creating more space for urine flow.

• Laser therapy: The doctor inserts a catheter with a laser fiber into the urethra and vaporizes or enucleates the excess prostate tissue, leaving a clear channel for urine flow.

• UroLift: A doctor inserts tiny implants into the prostate that lift and hold the enlarged tissue away from the urethravere symptoms, large prostates, or complications such as urinary retention, bladder stones, or kidney damage. The most common surgical procedure for BPH is:

• An electric loop, a laser, or a plasma device is used to cut away the excess prostate tissue using a transurethral resection of the prostate (TURP). The tissue is flushed out with fluid and sent for testing.

Other surgical procedures for BPH include:

• A transurethral incision of the prostate (TUIP) relieves pressure on the urethra by making a few small cuts in the prostate and bladder neck.

• During an open prostatectomy, the doctor makes an incision in either the lower abdomen or the perineum and removes the whole inner part of the prostate. This is usually the only option if the prostate is very large or if other methods are not feasible.

Prevention of Enlarged Prostate

There is no sure way to prevent BPH, but some lifestyle changes may help reduce the risk or delay the onset of the condition. These include:

• Eating a healthy diet rich in fruits, vegetables, whole grains, and lean proteins, and low in fat, salt, and sugar.

• Drinking plenty of water and avoiding dehydration.

• Limiting the intake of caffeine, alcohol, and artificial sweeteners, as they may irritate the bladder and worsen the symptoms of BPH.

• Quitting smoking, as it may damage the blood vessels and increase the risk of BPH and prostate cancer.

• Exercising regularly, as it may improve the blood circulation and the muscle tone of the pelvic floor.

• Maintaining a healthy weight, as obesity may increase the risk of BPH and other health problems.

• Managing stress, as it may affect the hormone levels and the nervous system, which may influence the prostate function.

• Having regular check-ups and screenings, as they may help detect and treat BPH and other prostate conditions early.

When men know the causes, symptoms, diagnosis, treatment, and prevention of BPH, they can make informed decisions about their health and quality of life.