Male Voiding Dysfunction

Most men over the age of 50 years have a condition called the enlarged prostate gland or BPH which stands for benign prostate hyperplasia.

The prostate gland is a walnut sized organ located at the base of the bladder and surrounds the urethra or tube inside the penis that transports urine from the bladder to the outside of the body. This enlargement of the prostate gland is a benign condition and is not to be confused with prostate cancer, which is a malignancy and an entirely different disease. The prostate gland produces the fluid that mixes with sperm and exits the body as semen at the time of ejaculation and orgasm. When men reach middle age, for reasons not entirely clear, the prostate gland enlarges. As it enlarges it compresses the urethra, the tube in the penis that transports urine from the bladder to the outside of the body. As a result of this compression, men have difficulty with urination. The symptoms include frequency of urination, urgency of urination, a decrease in the force and caliber of the urinary stream and getting up at night to urinate.

The diagnosis of prostate gland enlargement is made by a careful history and physical exam including a digital rectal exam. A few tests such as a urinalysis and PSA or prostate specific antigen blood test is performed to be sure that the symptoms are not due to a urinary tract infection or to prostate cancer. Additional tests may include a cystoscopy, which is a look into the bladder with a tiny lighted tube.

One treatment option is watchful waiting or no treatment and have the man return on an annual basis for a symptom check, a digital rectal exam and a PSA test. This option is for men who have mild to moderate symptoms, a negative digital rectal exam and a normal PSA test.

First line treatment usually consists of medication. There are two classes of drugs that are used to treat the enlarged prostate gland. They are alpha-blockers and 5-alpha reductase inhibitors. Alpha-blockers relax the muscles in the prostate and the urethra which improve the flow of urine through the urinary tract. The 5-alpha-reductase inhibitors block a hormone that actually causes the prostate gland to shrink in size. These drugs are effective but may lose their effectiveness with time and they also have side effects such a decrease in the volume of the ejaculation and becoming lightheaded.

Surgical therapy includes transurethral resection of the prostate gland or TURP and surgery that requires an incision to remove the blockage that causes the symptoms. The TURP has been the standard of care for nearly 50 years. The procedure consists of the insertion of special instrument that allows visualization of the prostate gland and then an electric current is transmitted to a wire that cuts through the prostate tissue. The procedure takes 30-60 minutes and requires a spinal or general anesthetic and hospitalization for 1-3 days and several weeks of restricted activity.

The risks and side effects of the GreenLight Laser include a small amount of bleeding, a slight risk of a urinary tract infection which can be treated with antibiotics, backward ejaculation where the semen moves into the bladder at the time of orgasm and then is evacuated with the next urination. The GreenLight Laser procedure does not effect potency or your erections. Erectile dysfunction is a rare side effect of the procedure. Finally, the procedure, which is usually very successful in improving your urinary symptoms, may not improve the symptoms and another procedure needs to be performed to treat the urinary problem.

Now there is a new minimally invasive system that treats the symptoms of BPH by lifting or holding the enlarged prostate tissue out of the way. There is no cutting, heating or removal of prostate tissue. this new treatment is the UroLift® System Treatment.

In summary, prostate enlargement is a common condition that affects most men after age 50. The diagnosis is easily made and there are several treatment options for treating the enlarged prostate gland. For more information about any of the above treatments, talk to Dr. Threatt.

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