Andrew John Rynne, MD  
Male, 77
Dublin, Ireland

Specialties: sexual dysfunctions, reverse vasectomy

Interests: sexual medicine, Testosterone Therapy
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Prostate Disease or Benign Prostatic Hyperplasia. (BPH)

May 18, 2014 - 1 comments

enlarged prostate




prostate disease

BPH or Benign Prostatic Hyperplasia is a universal disease that will affect ALL men if they live long enough. The incidence of this troublesome condition is age related. That is to say that about 50% of men age 50 years or so will have BPH at least to some degree. 60% of them will be affected by age 60 and 80% by age 80.

What are the symptoms of Benign Prostate Hyperplasia?

The symptoms of BPH are:
• Lowering of the force of the urine stream. Men, as they get older, can no longer knock a fly off 6 feet up a wall.
• Frequency of urination. This is particularly bothersome at night. Suffers will complain that their sheep is being disturbed two or even three time during the night by the urge to go to the toilet.
• Difficulty in starting urination. This is made worse if they are in a busy public toilet. Men with BPH will often seek a cubical for urinating rather than share a line of urinals where pressure may be put on them to hurry up.
• Difficulty in ending urination. Finishing urination may take more time than usual and dribbling may be a feature. This is called urinary incontinence and can be a particularly nasty feature of an enlarging prostate gland.
• Urinary tract infections or UTI. This is caused by an inability to completely empty the bladder giving rise to urinary retention or stasis which facilitates infection.
• Acute urinary retention. This is an emergency where the man can not initiate the act of urination at all but his bladder continues to fill up. In this situation the man has to be taken to ER to be catheterized and the urine let our giving much relief! Once a man has reached this stage of BPH  surgery is inevitable.

What are the causes of BPH?  

The prostate gland is a chestnut sized structure that lies just below the urinary bladder and surrounds the urethra or tube that carries urine from bladder to the outside world. With age the prostate glands tends to enlarge and press down on the urethra and it is this design fault that inevitably leads to the emergence of symptoms of BPH.

What are the treatment options for men with BPH?

Men with enlarged prostates can be treated surgically or medically. The former has not advanced very much in the past quarter of a century whereas the latter has. As a general rule of thumb you would be well advised to medically treat your BPH at an early stage of its development and to postpone surgery for as long as ever possible.

Medical treatment of enlarged prostate:

• Alpha blockers. This is a family of drugs that relax smooth muscle and that were discovered some 15 years ago. Flomax would be a popular form on Alpha blocker. The daily use of an oral preparation like this has the capacity to make life much more comfortable for the BPH sufferer.
• Tadalafil. Recently it was discovered that this drug was very effective in relieving BPH symptoms. An example of this is Cialis and since Cialis is also used in the management of erectile dysfunction, in older men it may often be used to kill two birds with one stone!
• 5-alpha reductase or Finasteride. This drug has the capacity to reduce prostate bulk be about 25% and thus relieve the symptoms of prostate disease. But since it obliterates testosterone levels to near zero it carries with it many demasculating side effects. In my view this is too high a price to pay and never prescribe this drug for that reason.

Surgical management of BPH.

In many ways the surgical management of prostate disease is stuck in a time warp. It is an operation called trans-urethral prostatectomy or TURPS - a procedure that reams out prostate tissue via your penis and allows for the easier flow of urine. It is effective but does carry quite a few side-effects that you need to be aware of. Among these are retrograde ejaculation, incontinence and erectile dysfunction.

Finally, it remains my conviction that you are better off treating BPH medically and at a very early stage of this disease’s development. That way you have the best chance of postponing surgery perhaps indefinitely.    

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by rovermonarch57, Jan 23, 2019
Having had surgery for BPH a few year ago problem has returned what are my options now would prefer to avoid further surgery i am 72 years old  

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