May 17, 2006 Benign Prostate Enlargement The prostate is a walnut-sized gland found in men. It weighs about one ounce and is located beneath the bladder and in front of the rectum. Benign prostatic hyperplasia (BPH) is a condition marked by a non-cancerous enlargement of the prostate. As the gland increases in size, it can squeeze the urethra (the tube that carries urine from the bladder out of the body). Men may experience a frequent need for urination (particularly at night), a weak stream of urine, a sense of incomplete emptying of the bladder, dribbling of urine and hesitancy, or difficulty initiating/continuing urination. In severe cases, the urethra can become closed off, causing an inability to empty the bladder (urinary retention). This is a medical emergency and requires immediate treatment to prevent damage to the urinary tract, bladder or kidneys. BPH is common in older men. According to the American Urological Association, the condition affects half of those 51 to 60 and up to 90 percent of men over 80. Family history of BPH increases the risk of developing the condition. Research suggests cigarette smoking, male pattern baldness, race and geographic location may also be associated with BPH risk. Diagnosis and Treatment of BPH There are several tests that may be done when a man seeks help for symptoms of BPH. The physician will want to rule out the presence of prostate cancer, which can also cause similar symptoms. In a digital rectal exam, the physician inserts a gloved finger into the rectum to "feel" the size and condition of the prostate gland. A prostate specific antigen (PSA) blood test measures levels of the PSA protein, which is usually elevated in men with prostate cancer. In rectal ultrasound, a probe is inserted into the rectum to obtain ultrasound images of the gland. Urine flow studies look at the rate and/or pressure of urine flow. If treatment is needed, doctors may first recommend medications. Two types of drugs are typically prescribed for BPH - alpha blockers (Hytrin®, Cardura®, Flomax® and Uroxatral®) and 5-alpha-reductase inhibitors (Proscar® and Avodart®). When medications arent effective, surgery may be needed. The most common surgical treatment for BPH (used in 90 percent of cases) is transurethral resection of the prostate (TURP). A special instrument, called a resectoscope, is inserted through the end of the urethra up to the area of the prostate. The resectoscope contains a light, a wire loop and irrigation controls for fluid. The loop is electrified and used to cut away sections of the enlarged prostate. Fluid from the irrigation system carries the pieces of tissue into the bladder. The tissue is flushed out of the body at the end of the procedure. A catheter is left in place overnight to continually flush and drain the bladder. Some risks of TURP include bleeding, urinary tract infection, urinary incontinence, erectile dysfunction and retrograde ejaculation (sperm and fluid back up into the bladder instead of exiting the penis). Photoselective Vaporization of the Prostate Some physicians are using a different kind of treatment for BPH, called the GreenLight PV® laser system. Instead of cutting, the green light laser (also known as the 80 watt KTP) uses a beam of high-powered, green laser light energy to vaporize prostate tissue. The procedure is known as Photoselective Vaporization of the Prostate. A special fiber is inserted through a viewing tube (cytoscope) placed inside the urethra. Once in position, the light energy is turned on. As the laser light hits the prostate tissue, it vaporizes the target. Doctors view the treatment as it progresses to ensure the right amount of tissue is safely removed. The channel in the urethra is opened immediately and patients are often able to go home late in the day. Many men are back to work (with restricted activity) within three days. Unlike TURP, there is no blood loss with Photoselective Vaporization of the Prostate because the laser seals the tissue. The treatment appears to have no effect on sexual potency or ejaculation. The GreenLight PV laser system was approved by the FDA in May 2001. The treatment is recommended for men with significant symptoms associated with BPH. All men with BPH should continue their routine screening as recommended by their physician for prostate cancer. For information on the GreenLight PV® laser system, or to locate a nearby physician, http://www.laserscope.com AUDIENCE INQUIRY For information on the GreenLight PV® laser system, or to locate a nearby physician, http://www.laserscope.com For information on prostate enlargement: American Urological Association, public website, http://www.urologyhealth.org National Kidney and Urologic Diseases Information Clearinghouse, http://kidney.niddk.nih.gov BIBLIOGRAPHY "Adult Conditions: Prostate," Linthicum: American Urological Association, downloaded from public website ( http://www.urologyhealth.org), March 15, 2006. Chapple, Christopher, "Pharmacological Therapy of Benign Prostatic Hyperplasia/Lower Urinary Tract Symptoms," BJU International, September 2004, Vol. 94, No. 738, pp. 738-744. Gjertson, Carl, M.D., et al., "Benign Prostatic Hyperplasia," Cleveland Clinic Journal of Medicine, November 2004, Vol. 71, No. 11, pp. 857-880. 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