Benign Prostatic Hyperplasia and Erectile Dynfunction
BPH can be defined as an enlarged of the prostate. There are two main growth cycles for the prostate during a man’s life. The first cycle occurs early in puberty, when the prostate doubles in size. The second phase of growth starts around the ages between 25-30 and goes on for most of the rest of a man's life. BPH usually occurs during this second growth phase.
As the prostate enlarges, it presses against the urethra road. The bladder wall becomes thicker and eventually the bladder may weaken and lose the ability to empty fully, which causes leaving some amount of urine in the bladder. Narrowing of the urethral size and urinary retention; namely being unable to empty the bladder fully cause many of the problems of BPH.
BPH is a benign condition and it does not cause to cancer. However, BPH and cancer can be occur co-incidentally.
BPH is commonly seen condition and it is presented in about 50% all men between ages of 51 and 60 years of age. Moreover up to 90% of men over the age of 80 have BPH
Although the exact role of prostate is unknown, it is believed that the prostate is part of the male reproductive system. Normally, the shape of prostate is like a walnut and weighs about 20-25 gram. The prostate is located below the bladder and in front of the rectum. It goes all the way around a urination canal called the urethra, which carries urine from the bladder out through the penis.
The prostate’s main role is to make fluid for semen. During sexual intercourse, in particular during ejaculation, sperm made in the testicles moves to the urethra. In the meantime, secretions from the prostate and the seminal vesicles also moves into the urethra. This combination called as – semen – goes through the urethra and out through the penis.
SYMPTOMS
When the prostate is enlarged, it can cause to an obstruction or block the bladder. Difficulty to urinate is a commonly seen symptom of BPH. This symptom occurs often every 1 to 2 hours and mainly at night.
Some other symptoms include:
. Feeling that the bladder is full, even right after urinating
. Feeling that urinating "can't wait"
. A weak flow of urine
. Needing to stop and start urinating several times
. Trouble starting to urinate
. Needing to push or strain to urinate
If BPH becomes severe, the patient might not be able to urinate at all. This is an emergency that must be treated right away.
DIAGNOSIS
See your doctor if you have symptoms that might be related to BPH. See your doctor right away if you have blood in your urine, pain or burning when you urinate, or if you cannot urinate.
Your doctor can diagnose BPH based on
. Personal or family history
. A physical exam
. Medical tests
PSA BLOOD TEST
Prostate-specific antigen (PSA) is a marker which is produced only by the prostate. When the prostate is healthy, very little PSA is detected in the blood.
A low PSA is better for prostate health. A rapid rise in PSA may be a sign for prostate cancer. On the other hand, BPH is one possible cause of a high PSA level. Inflammation of the prostate, or prostatitis, is another common cause of a high PSA level.
TREATMENT
There are many options for treating BPH. Usually the patient and the physician will decide together which treatment is right for the individual patient. Mild cases may need no treatment at all. In some cases, minimally invasive procedures (surgery without anesthesia) are good choices. And sometimes a combination of treatments works best.
The main types of treatments for BPH are:
ACTİVE SURVEİLLANCE
Usually, BPH will only require active surveillance. If you and your doctor choose this treatment option, your BPH will be closely watched but not actively treated. This means that BPH is monitored with regular visits to your urologist. A yearly exam is common.
Active surveillance is best for men with mild to moderate symptoms. It is also an option for men who are not bothered by the effects of BPH. If your symptoms get worse, or if new symptoms appear, your doctor may suggest that you begin active treatment.
PRESCRİPTİON DRUGS
ALPHA BLOCKERS
Alpha blockers relax the muscles of the prostate and bladder. They improve urine flow, reduce blockage of the urethra and reduce BPH symptoms. They do not reduce the size of the prostate. Men with moderate to severe BPH and men who are bothered by their symptoms are good candidates. Alpha blockers are not a good choice for men who are about to have cataract surgery.
These prescription drugs are pills taken by mouth. Alpha-blocking drugs include alfuzosin, doxazosin, silodosin, tamsulosin and terazosin.
Side effects may include dizziness, lightheadedness, fatigue and trouble ejaculating. One benefit of alpha blockers is they start to work right away.
5-ALPHA REDUCATASE INHİBİTORS
5-alpha reductase inhibitors block the production of DHT, a male hormone that can build up in the prostate and may cause prostate growth. They shrink the prostate, increase urine flow and reduce the risk of BPH complications. They also make it less likely that you will need surgery. These drugs may be best for men with very large prostate glands.
These prescription drugs are pills taken by mouth and include dutasteride and finasteride. They may take many months to become fully effective.
Side effects include erectile dysfunction and reduced libido (sex drive). You must keep taking the pills to prevent symptoms from coming back.
SURGICAL TREATMENT
In severe cases of BPH, or when other options fail, more invasive surgery is recommended. More invasive surgery is best if you:
. Are unable to pass urine
. Have kidney damage
. Have frequent urinary tract infections
. Have a lot of bleeding
. Have stones in the bladder
There are several options. The best option will depend on your health, your doctor’s expertise and your personal choice.
TYPES OF SURGERİES
Options below appear in order of least invasive to most invasive.
Transurethral Incision of the Prostate (TUIP)
TUIP may be used if you have a smaller prostate but still have major blockage of the urethra. Instead of cutting and removing tissue, TUIP widens the urethra. The surgeon uses a laser beam or an electrical current to make small cuts in the bladder neck, where the urethra joins the bladder, and in the prostate. This reduces the pressure of the prostate on the urethra and makes urination easier. A catheter is left in your bladder for one to three days after surgery. The hospital stay is one to three days.
TUIP may improve the ability to pass urine. It may ease symptoms. Temporary urine retention, urinary tract infection, dry orgasm, incontinence and erectile dysfunction are possible side effects. Some men need additional treatment after TUIP.
Men who have a smaller prostate or do not want a more complete prostate resection but need surgery are good candidates for TUIP. The procedure is less likely to interfere with ejaculation than the more substantial TURP.
