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Enlarged Prostate Treatment
The prostate is a small, walnut-sized gland located in front on the rectum and below the bladder. It surrounds the urethra, the tube that carries urine from the bladder and out of the body.
During puberty, the prostate gland doubles in size. At around 25, it begins to grow again. In some men, the enlarging prostate eventually begins to squeeze the urethra, causing problems with urination. This condition is called benign prostatic hyperplasia (BPH, or enlarged prostate). Men may experience a weak or slow flow of urine, slow starting or hesitation of urination, incomplete ability to empty the bladder, frequent need to urinate (especially at night), and straining while urinating.
Generally, patients with enlarged prostates don't need treatment unless the symptoms become bothersome or the condition causes complications. In watchful waiting, the patient receives regular follow-ups to detect changes in symptoms that may indicate the need for medical intervention. Currently, four medications are approved to treat the symptoms associated with BPH. Finasteride (PROSCAR®) and dutasteride (Avodart®) inhibit the production of dihydrotestosterone (DHT, a hormone that plays a role in prostate enlargement). Tamsulosin HCl (FLOMAX®) and alfuzosin HCl (Uroxatral®) are alpha blockers, medications that relieve symptoms by relaxing the muscle in the prostate and in the neck of the bladder, easing the flow of urine out of the body. Two other alpha blockers, terazosin HCl (HYTRIN®) and doxazosin mesylate (CARDURA®), were originally developed to treat high blood pressure but are sometimes prescribed for BPH. According to the American Foundation for Urologic Disease, about 50 percent of men over 60 have prostate enlargement. By 80, about 80 percent of men are affected, but only 40 to 50 percent experience symptoms. The size of the prostate doesn't seem to correlate with symptom severity. Some men with large prostates have no symptoms while others with small prostates may experience severe symptoms.
Over time, partial obstruction of urine flow can cause problems. Patients may experience urinary tract infections, bladder or kidney damage, bladder stone, or incontinence. In some cases, the ureter may suddenly become completely blocked (acute urinary retention). There are also several other interventions for BPH that may be used when medications aren't effective. In transurethral microwave thermotherapy (TUMT), catheter-delivered microwave energy is used to heat and destroy excess tissue in the prostate gland. Transurethral needle ablation (TUNA) works in a similar fashion, but the treatment is delivered through radiofrequency energy. For long-term improvement, doctors may recommend surgery. In transurethral resection of the prostate (TURP), a special instrument is inserted into the urethra and doctors cut away an inner core of prostate tissue. In transurethral incision of the prostate (TUIP), no tissue is removed. Instead, small cuts are made into the prostate and into the bladder neck. The procedure widens the passageway through the urethra. Some doctors use a laser to shrink excess prostate tissue.
Sam Fields
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