1. What is benign prostatic hyperplasia (BPH)?
Benign prostatic hyperplasia (BPH), also known as prostate enlargement, is a condition commonly seen in men over 40 and particularly in the older men. The enlargement may eventually cause problems with urination, because the gland presses on the urethra as it increases its size. About half of all men over 50 experience some symptoms. For more information, see the benign prostatic hyperplasia.
2. What causes BPH?
The cause of BPH is not well understood. It is probably related to aging process in men, caused by changes in hormone balance and cell-growth factors. For more information, see the causes of BPH.
3. Will BPH turn into prostate cancer?
Prostate enlargement is not the same as prostate cancer, and BPH cannot "turn into" prostate cancer. However, BPH and prostate cancer can exist together as both conditions are common in aging men. BPH and prostate cancer can give rise to similar urinary symptoms. It is therefore important to consult your doctor to see what actually is the cause of your urinary symptoms.
4. Does prostate enlargement affect erection?
While previously believed there was no relation, there is now evidence that men with LUTS (lower urinary tract symptoms) have a much higher incidence of ED (erectile dysfunction). In some patients the treatment of LUTS actually help erectile function as well. Both LUTS and ED need medical attention. They may be signals of severe illness that your doctor can help to diagnose. They affect quality of life that can be markedly improved in most cases with appropriate drug treatment. It is therefore important for you to see your doctor if you happen to have either of these conditions.
5. Why would BPH patients be referred to an urologist?
Urologists are doctors who specialize in diseases of the urinary system and male reproductive system. They are experts in treating prostate problems. Uncomplicated cases of BPH can often be managed by a general physician (GP), but patients will be referred to an urologist if they have one or more of the following:
- Symptoms appeared suddenly or otherwise not typical of BPH
- Repeated urinary infections
- Blood in urine
- PSA level is over 4 nanograms per milliliter (ng/ml) or suspicious nodule is palpable in the prostate.
- Suspicion of bladder stones
- Kidney damage
- Retention of urine or failure to empty the bladder with large amount of residue urine.
- Severe symptoms not responding to drug treatment.
6. What will the urologist do?
The urologist will ask about the patient’s symptoms, examine his body including a digital rectal examination and several tests may be performed to check for specific urinary functions such as urine and blood tests, the flow rate of the urine and whether the bladder is emptied on urination. PSA level may be rechecked, and if it is found to be higher than normal (that is, above 4 ng/ml), the patients may have a transrectal ultrasound-guided biopsy to check that the swelling is not cancerous. For more information, see the diagnosis of BPH.
7. Are these examinations painful?
These tests are not unduly uncomfortable. Nobody enjoys a digital rectal examination, but it is over in a few seconds. The flow test and bladder ultrasound are totally painless. Only a proportion of patients need a biopsy. The urologist will explain more about the biopsy to you should that be required.
8. Which drug is best for BPH?
Alpha-blockers act quickly to relieve symptoms regardless of the size of the prostate. 5-alpha-reductase inhibitors work more slowly, but as they seem to shrink the prostate, they seem to help avoid complications and reduce the need for surgery. Alpha-blockers therefore are a ‘quick fix’ but do not cure the underlying problem. 5-alpha-reductase inhibitors work better in patients with larger glands, but take 6 months or so to become effective. Different patients may require different drug treatments. Your doctor will discuss with you which treatment would be most appropriate for your condition. For more information, see the medical treatment of BPH.
9. What should I do if I am suddenly unable to pass urine?
Acute urinary retention (the sudden, painful inability to urinate) is a common complication of BPH. If you find that you cannot pass urine at all, contact your doctor or go to Emergency Department in the nearest hospital. Try to drink less fluid because your bladder is already full. You will usually be admitted to hospital and have a catheter passed via the penis to drain the over-distended bladder. Retention of urine usually indicates a more serious degree of obstruction. The patient may need to consult his urologist for consideration of surgery.
10. How painful is the TURP procedure?
The actual surgery does not have to be uncomfortable, as spinal or general anesthesia would be applied. After the operation, there may be some discomfort associated with the urinary catheter and irrigation. This will improve after the catheter is removed. There is no open wound and patients can usually move about early after the operation. For more information, see the surgical treatment of BPH.
11. Will TURP affect my sex life?
It shouldn’t affect your sex drive, erection or sensation at orgasm, but you will have a dry orgasm with no ejaculate. Fertility would be greatly diminished due to the absence of ejaculation but this is not harmful to health. This doesn’t usually bother patients as long as they know about it before they have the surgery. Most men report that their sex life after a TURP is quite satisfactory. TURP usually will not damage erectile function, however, aging men could start to experience deterioration of sexual function at any time and this could occur after a TURP. Your urologist will be able to help if this occurs.
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