The Care and Feeding of the Enlarged Prostate Gland

If you are a man, then you have a prostate gland.  If you have a prostate gland, then you are likely to be one of the 14 million American men who experience bothersome symptoms beginning around age 50.  This article will discuss the diagnosis of the enlarged prostate gland and what are some of the available treatment options that can reduce the symptoms associated with this common condition.  It is a walnut sized organ at the base of the bladder and surrounds the urethra or tube that is in the penis and transports urine from the bladder to the outside of the body.  It is common and even normal for the prostate gland to become enlarged as a man ages. Though the prostate continues to grow during most of a man’s life, the enlargement doesn’t usually cause problems until middle age or around 50. BPH rarely causes symptoms before age 40, but more than half of men in their sixties and as many as 90 percent in their seventies and eighties have symptoms of BPH.

The prostate gland encircles the urethra like a donut, so problems with urination can occur if the gland restricts urine flow through the urethra. As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the gland to press against the urethra like a clamp on a garden hose.

The following changes occur over a period of time.

• The bladder wall becomes thicker and will contract without the owner’s permission causing urgency of urination.
• The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination.
• Eventually, the bladder weakens and loses the ability to empty itself. Urine remains in the bladder.

The narrowing of the urethra and partial emptying of the bladder cause many of the problems associated with BPH.

Some problems associated with BPH are

• Urinating more often during the day
• Need to urinate frequently during the night
• Urinary urgency, which means the urge to urinate is so strong and sudden, you may not make it to the toilet in time and soil your clothing-very embarrassing!
• The urine stream is slow to start
• Dribbling after urination
• A sensation that the bladder isn’t emptied after urination
• Lack of force to the urine flow, which makes aiming more difficult
• The sensation of needing to go again a few minutes after urinating

Diagnoses

You may first notice symptoms of BPH yourself, or your doctor may find that your prostate is enlarged during a routine check-up. The doctor can determine the size of the prostate gland during a physical examination.

The diagnosis is made with several of the following tests:

Symptom Score

This is a brief questionnaire that provides a numerical value to the symptoms associated with urination.  The higher the score (maximum is 25), the more symptoms a man has and the more likely he will want to have treatment for relief of his symptoms.

Urinalysis

A urine sample is taken to look for signs of blood and infection.

Digital Rectal Examination (DRE)

Your doctor inserts a gloved finger into the rectum to feel the condition of the prostate that lies close to the rectal wall. If your doctor feels something suspicious such as a lump or bump, further tests will be carried out. Other tests are needed to enable a more accurate diagnosis. 

Prostate Specific Antigen (PSA) Test

A blood sample is taken by your doctor to check for prostate specific antigen (PSA), which is produced by the prostate and is increased by cellular abnormalities within the prostate.

As men get older the prostate gland grows and so the PSA is likely to rise. A high PSA may indicate some type of prostate disease. The level can be raised due to inflammation of the prostate (Prostatitis) and enlargement of the prostate gland (Benign Prostatic Hyperplasia or BPH).

Urine flow rate

This test consists of a man urinating in private over a funnel which measures the volume of urine and the time that it takes to empty the bladder.  The urine flow rate is expressed in milliliters per second.  Normal is greater than 15 ml\second.

Urodynamics

Sometimes the doctor will ask a patient to urinate into a special device that measures how quickly the urine is flowing. A reduced flow often suggests BPH.

Imaging studies

The ultrasound examination evaluates the size of the prostate gland which often determines the treatment option which is best for your situation.  It is a painless examination consisting of the insertion of a small pencil-size probe into the rectum and uses sound waves to determine the appropriate treatment for prostate gland enlargement.

Cystoscopy

In this exam, the doctor inserts a small tube through the opening of the urethra in the penis. This procedure is done after a solution numbs the inside of the penis so all sensation is lost. The tube, called a cystoscope, contains a lens and a light system, which help the doctor see the inside of the urethra and the bladder. This test allows the doctor to determine the size of the gland and identify the location and degree of the obstruction.

Treatment options

1. Watchful waiting-If the person has BPH but is not bothered by the symptoms, the patient and the doctor may decide to simply wait and monitor the condition regularly. This option requires regular check-ups with the doctor – usually once a year – to see if the condition is getting any worse.

2. Drug therapy–Your doctor may advise drug therapy which aims at shrinking the enlarged prostate. The doctor will select the medication that best suits the condition, keeping in mind the person’s general health condition, medical history, medications taken for other conditions and quality of life considerations.

3. Minimally invasive treatments-The prostatic urethral lift or UroLift is an implant of several polyester sutures connected by two small metallic tabs that opens the prostate gland located in the urethra and improves the flow of urine thus decreasing the symptoms of the enlarged prostate gland. UroLift has been approved by the FDA to relieve the symptoms of the enlarged prostate gland. There have been nearly xx thousand of men who have had the treatment which reports favorable results up to 4 years. Most insurance companies will now pay for the UroLift procedure 

4. Surgery-Surgery is another option for the treatment of BPH. The most common type of surgery for BPH is TURP (Trans Urethral Resection of the Prostate). This procedure requires an admission to the hospital, a general anesthesia, a urinary catheter for several days, and the risk of sexual problems afterwards.

Bottom Line:  Nearly all men will experience the problems associated with the enlarged prostate gland.  The enlarged prostate gland impacts a man’s quality of life.  Help is available and nearly all men can be helped.  If you have symptoms associated with urination, speak to your doctor.

Don’t Beat the Band to Treat the Enlarged Prostrate Gland

The prostate is just a walnut sized gland that forms a part of the male reproductive system. The gland is constructed of two lobes, or areas, surrounded by an outer layer of tissue. For reasons not entirely understood, the prostate gland becomes enlarged, causes problems with urination, and affects a man’s quality of life.  That may be the bad news.  The good news is that there are ways to treat it.

 

The prostate can be found in front of the rectum and just beneath the urinary bladder, where urine is stored. The prostate also encompasses the urethra, the duct by which urine passes out from the body. For most men, the nightly bathroom runs can be the very first indication of an enlarged prostate. Other symptoms might include problem beginning a flow of urine, leaking or dribbling.

 

During the early stage of prostate enlargement, the urinary bladder muscle becomes thicker and forces pee through the narrow urethra by contracting more strongly. Like grey hair, an enlarged prostate is just a natural byproduct of getting older, doctors say.

Although it is just not known why only some males develop an enlarged prostate, it is clear that increasing age is the primary risk factor. The problem is, the nightly bathroom runs can be frequent, finally edging their way into the day routine. I recommend seeing your doctor if you develop urinary difficulties because of an enlarged prostate.

 

Benign prostatic hypertrophy is a non-cancerous enhancement of the prostate gland, often found in men over the age of fifty. Problem in passing urine or pain when passing urine, a burning or stinging feeling when passing urine, strong, regular urge to pass urine, even when there is just a small amount of urine are the signs of benign prostatic hypertrophy.

 

Treatment for an enlarged prostate is dependent upon the symptoms and signs and their severity. In case you have significant problems, like urinary bleeding, persistent bladder infections, urinary bladder and kidney harm, your physician will likely recommend treatment.

 

In case your prostate is enlarged, but your symptoms are not too bothersome, treatment might not be necessary. This is referred to as watchful waiting.  If you and your doctor select this option, you will be asked to return about once a year for a symptom check, a prostate exam and a PSA test or prostate specific antigen test which is a screen test for prostate cancer in men between the ages of 50 and 75.

 

There are two kinds of medication that help to control the signs of an enlarged prostate, they are alpha blockers and alpha reductase Inhibitors.

The alpha blockers work by calming the muscles at the neck of the urinary bladder making urination easier. Alpha reductase inhibitors work be actually shrinking the size of the prostate gland.  An enlarged prostate now is just easier to treat if the treatment begins early. These medications have side effects including reducing the volume of the ejaculate at the time of sexual intimacy.  The alpha blockers also affect the ability to have cataract surgery which is very common in older men.  Finally, the drugs must be taken for the rest of man’s life.

 

Now there are minimally invasive treatments such as lasers, prostatic urethral implants or UroLift to open the prostate to allow an improved flow of urine from the bladder to the outside of your body, and the use of steam or water vapor to heat the prostate tissue to reduce its size and affect urine flow.

 

Finally, there are surgical procedures to remove the prostate tissue.  The most common is the transurethral resection of the prostate or TURP.  These operations require admission to the hospital, a general anesthesia so the patient doesn’t experience any pain, the use of a catheter for a few days, and several weeks or moths to return to normal activity.

 

Your doctor will explain the different treatments and which might be best for your situation.

 

Prostate Cancer

What do Jose Torres, John Kerry, and Jerry Lewis have in common?  They all have prostate cancer and have been successfully treated.  Nearly 250,000 men will be diagnosed with prostate cancer this year and nearly 30,000 men will die of prostate cancer.  This article will discuss the symptoms of prostate cancer and what can be done to diagnose the

The most common prostate problems are an enlarged prostate, prostatitis and prostate cancer.

Prostate cancer frequently has no symptoms and most men will have prostate cancer and not be aware of the diagnosis.  Symptoms that occur as a result of any prostate condition including benign enlargement of the prostate gland and prostate cancer include:

• Frequent urination
• Getting up at night to urinate
• Pain with urination
• Difficulty starting to urinate
• Blood in the urine
• Bone pain
• Impotence or Erectile dysfunction (ED)

 

Risk factors associated with prostate cancer include:

The condition is rare in men under 40 years of age, but most cases are found in men aged 50 or older. At age 80+ nearly all men will have prostate cancer but will seldom succumb to the disease or they have prostate cancer but will not die from it. 

Genetic factor may contribute to prostate cancer risk. Men who have a father, brother, uncle or cousin with prostate cancer are 2 to 3 times more likely to get the condition as compared to men without prostate cancer in a close relative. 

African-American men also have an increased risk of having prostate cancer. It is suggested that African-American men start seeing a doctor for a digital rectal exam and a PSA test after age 40.

Studies have found that obese men have a greater risk of developing more advanced prostate cancer as well as a higher risk of metastasis and death from the condition.

Many studies have found a link between smoking and getting prostate cancer as well as an increased the risk of dying from the condition.

High fat diet has been shown to put men at high risk of prostate cancer. Some studies show that men who have diets high in red meat may raise a person’s chances of developing prostate cancer. 

Bottom Line:  Prostate cancer is the second most common cause of death in men due to cancer (lung cancer is number one), and is very treatable if the diagnosis is made early.  This can be accomplished with a rectal examination and a PSA test.  Speak to your doctor for more information.

 

FAQs on the Enlarged Prostate

 

What is BPH?
 Benign prostatic hyperplasia is commonly known as enlarged prostate. BPH is a non-cancerous condition in which prostate cells grow, enlarging the gland and causing it to squeeze the urethra. A variety of symptoms may result, including difficult, frequent or urgent urination.

When Should I Seek BPH Treatment?
If you are experiencing BPH symptoms that are affecting your quality of life, such as losing sleep because you need to wake during the night to urinate, you are unable to urinate, you are unable to delay urination, have hesitancy, or a weak urine stream, check with your urologist to discuss if it is time to seek treatment.

BPH is not cancerous and is not life threatening, but it does create bothersome symptoms can significantly impact quality of life.

What Are the Long Term Risks of BPH?

If left untreated, BPH can progress and cause subsequent medical issues. When the bladder does not empty completely, you become at risk for developing urinary tract infections. Other serious problems can also develop over time, including bladder stones, blood in the urine (hematuria), incontinence, or urinary retention. In rare cases, bladder and/or kidney damage can develop from BPH.

What are the Treatment Options?

Based on the AUA Guidelines for the treatment of BPH, there are four recommended treatment options: Watchful Waiting, medications, in-office therapy, and surgery.

Are In-Office Therapies Safe?

Yes, these treatments are safe. UroLift has been cleared by the FDA to treat BPH. In-Office BPH Treatments are associated with few side effects and adverse events.

Are In-Office Therapies Effective?

Based on clinical studies, in office procedures is proven to be a safe, effective and durable option for BPH with very few side effects.

Are In-Office Therapies Covered By Insurance?

Medicare and many commercial insurance plans provide coverage for the UroLift procedure. Ask your doctor’s office to assist you by providing the information your insurance plan may require.

Do In-Office Therapies Hurt?

Some men describe the UroLift as causing some discomfort, while most men report no discomfort at all.

Will I need a catheter after the treatment?

Most patients will not need a catheter after the procedure.

Can I go home right after the procedure?
 Yes. You should arrange for someone to drive you home because you may have been given some medication to help you relax during the procedure. Your urologist will give you post-treatment instructions and prescriptions and explain the recovery period to you.

Bottom Line: BPH is a common problem and effective treatments are available.  For more answers, speak to your physician.

Testosterone and the Prostate Gland-Hormone Replacement Is Safe For Your Prostate Gland

I am also asked if using testosterone, injections, topical gels, or pellets, will worsen urinary symptoms in men suffering from testosterone deficiency.

Millions of Americans suffer from testosterone deficiency.  They have symptoms of loss of energy, erectile dysfunction, loss of libido, loss of muscle mass, and emotional mood swings.  The diagnosis is easily made with a testosterone blood test.

A recent review finds no evidence that testosterone replacement therapy causes or worsens urinary tract symptoms or increase the size of the prostate gland.

Although the Endocrine Society and other associations have suggested severe urinary symptoms as a contraindication to TRT treatment, investigators found little evidence to support it worsening urinary symptoms in men using testosterone replacement therapy.

The investigators discovered that men with mild urinary sympmtoms experienced either no change or an improvement in their symptoms following TRT.

Remarkably, the study explained that the therapy may actually improve voiding symptoms.

Bottom Line:  Testosterone replacement therapy is safe in men with urinary symptoms and will not worsen those symptoms but may actually improve their symptoms.

Source

Kathrins M, Doersch K, Nimeh T, Canto A, Niederberger C, and Seftel A. The Relationship Between Testosterone Replacement Therapy and Lower Urinary Tract Symptoms: A Systematic Review. Urology S0090-4295(15)01053-3. doi:10.1016/j.urology.2015.11.006.

Options for Treating The Enlarged Prostate Gland

For reasons not entirely known, the prostate gland starts to increase in size around age 50 and causes symptoms of difficulty with urination. The prostate gland is a walnut sized organ at the base of the bladder and surrounds the tube, the urethra, which transports urine from the bladder to the outside of the body. When the prostate gland grows, it compresses the urethra making urination difficult.

By the time men are in their 40s or 50s, many are already experiencing symptoms, such as having to get up at night to urinate. Into their 60s and 70s, they may have to get up two or three times.

In addition, an enlarged prostate can also result in other urinary symptoms such as having to go frequently during the day, having a weak stream or having to go urgently.

The “gold standard” is called a transurethral resection of the prostate (TURP), where an instrument is inserted up the urethra to remove prostate tissue that is blocking urine flow. It is sometimes colloquially referred to as a “roto-rooter” procedure. The purpose of the TURP to carve out the inner portion of the prostate and leave just the shell. The procedure allows a much stronger stream and men who have it will have to urinate much less frequently.

However, the procedure requires general anesthesia and a hospital stay. While it does not usually interfere with the ability to have an erection, more than half of those who have it will experience “retrograde ejaculation,” meaning that no fluid comes out of the penis during orgasm. Instead, the fluid goes into the bladder where it is eliminated during urination. Men will also have to wear a catheter for a few days after the procedure and will require several months before they can resume all activities including sexual intimacy and heavy lifting.

Similar procedures known as GreenLight Laser Treatment, which uses a high-energy laser to vaporize prostate tissue, and holmium laser enucleation of the prostate (HoLEP), which also uses a laser to destroy prostate tissue, are also available. They are pretty much the same in terms of outcomes. They just use different energy sources.

Now there is a new treatment, the UroLift, that doesn’t remove any tissue but relieves the compression on the prostate gland making urnation easier and reducing the symptoms. The procedure can be done in the office setting, does not require any catheter, and does not cause any sexual side effects or retrograde ejaculation.

Bottom Line: Many middle aged men have sympotms related to the enlarged prostate gland. There are multiple treatment options and men can plan to resume their activities after treatment for benign prostate disease.

If you are 50 or older and you have any of these symptoms and they are bothersome, talk to your doctor.

 

 

 

 

Benign Enlargement of the Prostate Gland Affects Millions of U.S. Men-New Treatment With Prostate Urethral Lift

Benign enlargement of the prostate gland affects nearly millions American men. In the past the procedure of choice was a surgical procedure, transurethral resection of the prostate gland, which is often referrd to as the rotor router procedure. Now a first line treatment is the prostate urethral lift PUL, is a new alternative. This blog will discuss the PUL, how it works, and what are the risks and complications of the procedure.

Lack of awareness about a common health condition may be causing millions of men to suffer unnecessarily. Benign prostate enlargement (BPE), affects more than 37 million men in the United States alone. Unfortunately, many men postpone treatment for this disorder because of concerns about side effects such as problems with ejacualtion and impotence or erectile dysfunctihowever, their concerns may be alleviated with additional information.BPE occurs when the prostate gland that surrounds the male urethra becomes enlarged with advancing age and begins to obstruct the urinary system. Symptoms include sleepless nights and urinary problems, and can cause loss of productivity, depression and decreased quality of life.

About one in four men experience BPH-related symptoms by age 55 and, by age 70, over 80 percent of men suffer from BPH. Most men blame their symptoms on aging. They may not be aware of the high prevalence of BPH or the available medical or surgical treatment options. There is a high risk to delaying treatment and so men should proactively talk with their doctors.

The prostatic urethral lift is a minimally invasive procedures the risks are low compared to medications or other surgeries. BPE can have a significant impact on quality of life for men as well as their partners, and can place limitations on their activities. For example, the need for frequent urination may make travel, sleep and sports activities difficult. We hope that with greater awareness of symptoms and treatment options, men will take a more active role in treating BPE, and live life with greater vitality.

A recent U.S. survey of more than 1,000 men over the age of 50 demonstrated that concerns about the risk of side effects, such as loss of sexual function or urinary incontinence, would cause a majority to postpone or avoid treatment of BPH.

This is unfortunate because, not only is early treatment important to alleviate symptoms and stop the
disorder from worsening, but a new minimally invasive treatment option is available that does not require cutting, heating or removal of prostate tissue, and as such does not result in loss of sexual function or urinary incontinence.

The survey results mirror other research and anecdotal evidence from patients that show that men
rarely mention their BPE-like symptoms.

The more recent survey, which was completed in October 2015, demonstrated that:
• A majority of men (61 percent) would postpone treatment for BPH because of the risk of sexual
• side effects or urinary incontinence from traditional treatments
• Eighty-four percent of respondents indicated they would be more open to seeking treatment for
• BPE if the treatment options available held less of a risk of impotence or incontinence
• Nearly half of the men surveyed (44 percent) were not aware that BPH is more common than
• prostate cancer. In fact, BPE impacts more than 12 times as many men in the U.S. as prostate cancer
• Concerns over surgical treatments was high among respondents, with 83 percent stating they
• were interested in a treatment option that could improve BPE symptoms without cutting, heating or
• removing prostate tissue1

In the past,mMedication is often the first-line therapy for enlarged prostate, but relief can be inadequate and temporary. Side effects of medication treatment can include sexual dysfunction, dizziness and headaches, prompting many patients to quit using the drugs. For these patients, the classic alternative is surgery that cuts or ablates prostate tissue to open the blocked urethra. While current surgical options can be very effective in relieving symptoms, they can also leave patients with permanent side effects such as urinary incontinence, erectile dysfunction and retrograde ejaculation (dry orgasm).

About NeoTract
The PUL is a minimally invasive and clinically effective device that address unmet needs for men with BPE. The PUL is a minimally invasive permanent implant system that treats symptoms while preserving normal sexual function.

The UroLift System consists of a delivery device and tiny permanent implants. FDA cleared in 2013, this
unique technology works by directly opening the urethra with tiny implants that hold the enlarged tissue out of the way, like tiebacks on a window curtain. No cutting, heating, or ablating tissue is involved, making the UroLift System the first and only BPE treatment that does not remove prostate tissue and does not negatively impact a man’s sexual function.

4 pins in the prostate open the gland and allow improvement in urinary symptoms

I have done over 40 cases using the PUL and none of the men have experienced any sexual side effects from
the procedure. Most men can have the procedure in the office setting. They can leave the office without
a catheter and have marked improvement immediately or in a few days. The side effects are frequency of
urination and small amount of bleeding which only last for a short period of time. Research has demonstrated
that the procedure lasts for at least three years.

Most insurance companies, including Medicare, pay for the PUL procedure.

If you would like to more about the PUL, go to my website, http://www.neilbaum.com, or go to YouTube and use the following URL: https://www.youtube.com/watch?v=cEJsJ3E0pJI

Bottom Line: BPE is a common condition affects millions of American men. A first line treatment that is effect is the prostate urethral lift. Give my office a call if you have
any questions.