Benign prostatic hyperplasia (BPH) is an enlarged prostate gland. The prostate gland surrounds the urethra, the tube that carries urine from the bladder out of the body. As the prostate gets bigger, it may squeeze or partly block the urethra. This often causes problems with urinating.

Benign prostatic hyperplasia (BPH) is probably a normal part of the aging process in men, caused by changes in hormone balance and cell-growth factors. Genetics may also play a role. This is especially true for severe BPH requiring surgery in men younger than 60.

Men who are older than 50 have a higher chance of developing BPH. But why some men have more severe symptoms than others is not known.

Many men with benign prostatic hyperplasia (BPH) have no symptoms. When symptoms (known as lower urinary tract symptoms, or LUTS) occur, they may range from mild and barely noticeable to serious and disruptive. The amount of prostate enlargement is not always related to the severity of the symptoms. Some men with only slight enlargement have serious symptoms, and some men with a great deal of enlargement have few symptoms.

Your symptoms may become worse during cold weather or as a result of physical or emotional stress.

Some medicines can make your symptoms worse. These include over-the-counter cold medicines such as diphenhydramine (Benadryl, for example), pseudoephedrine (such as Sudafed), oxymetazoline spray (such as Afrin), and prescription medicines such as antidepressants, water pills (diuretics), testosterone (gels, implants, or injections), and pain medicines (narcotics).

The symptoms of BPH may involve problems emptying the bladder or problems with bladder storage.

●Difficulty starting a urine stream (hesitancy and straining).

●Decreased strength of the urine stream (weak flow).

●Dribbling after urination.

●Feeling that the bladder is not completely empty.

●An urge to urinate again soon after urinating.

●Pain during urination (dysuria).

●Waking at night to urinate (nocturia).

●Frequent urination.

●A sudden, uncontrollable urge to urinate.

These symptoms are not always related to prostate enlargement and can be caused by other conditions. BPH symptoms are often balanced between the two types of symptoms. If symptoms come on rapidly, or if you have more of one type of symptom than the other type, you may have another condition. Other conditions that may cause similar symptoms include urinary tract infections, prostatitis, prostate cancer, diabetes, heart failure, and neurologic diseases.

Men who are older than 50 have a higher risk of developing BPH.

The hormone testosterone, which is produced mainly by the testicles, is necessary in order for BPH to develop. Men who have their testicles removed before puberty never develop BPH. Men who have their testicles removed after puberty (but before they have symptoms of BPH) rarely develop BPH.

A family history of BPH may increase your risk for needing treatment for this condition, especially if a relative needed treatment before age 60.

A vasectomy does not increase your risk of BPH.

The doctor will first want to make sure that your urination problem is caused by BPH and not by something else. This can usually be determined from your medical history, a physical exam that focuses on the urinary tract, a urinalysis, and a blood test. A neurological exam should also be done to determine whether your symptoms are related to a problem with the nerves to the bladder. A questionnaire such as the American Urological Association (AUA) symptom index may be used to evaluate how bothersome your symptoms are. It is not used to diagnose BPH.

●A digital rectal exam checks the size and firmness of the prostate. The size of the prostate does not always determine the severity of the symptoms. A man with only a small degree of prostate enlargement may have more severe symptoms than a man with more enlargement.

●A urinalysis and urine culture check for a urinary tract infection that might be the cause of the symptoms.

●A blood creatinine test checks how well your kidneys are working.

●A prostate-specific antigen (PSA) test helps check for prostate cancer, which can cause the same symptoms as BPH.

If the patients' symptoms are moderate to severe, additional tests, called urodynamic studies, may be done.

●Post-void residual urine test (PVR) measures the amount of urine left in the bladder after urination. This test is done using ultrasound or a small tube (catheter) put into the bladder through the urethra.

●Pressure flow studies measure pressure in the bladder while urinating. They may help distinguish between urinary symptoms caused by obstruction, such as BPH, and those caused by a problem affecting the bladder muscles or nerves.

●Cystometrogram measures the bladder's pressure, compliance, and capacity during urinary storage. This may include a uroflowmetry test, which measures how fast the urine flows out of the bladder.

The following tests may be done if the patients have complications of BPH or if there is a need to look for other causes of the symptoms.

●Ultrasound uses sound waves to check the size and structure of the kidneys, bladder, and prostate. A small device called a transducer is inserted into the rectum (transrectal ultrasound) to evaluate the prostate.

●Cystoscopy allows the doctor to look inside the urethra and bladder. This may allow the doctor to see the extent of blockage of the urethra caused by an enlarged prostate and estimate its severity.

●Intravenous pyelogram (IVP) uses X-rays to show the function of the kidneys and the flow of urine from the kidneys to the bladder.

●Spiral (helical) computed tomography (CT) scan uses X-rays to make detailed pictures of structures inside the body. These scanners can check for an enlarged prostate gland, blockage, and urine flow from the kidneys.

There is no routine screening test for prostate enlargement. But it may be detected during other screening tests that are regularly done to check for prostate or rectal cancer, such as the digital rectal exam and prostate-specific antigen (PSA) test.

Benign prostatic hyperplasia (BPH) cannot be cured, so treatment focuses on reducing your symptoms. Treatment is based on how severe your symptoms are, how much they bother you, and whether you have complications.

Deciding how to treat BPH is greatly influenced by how bothersome your symptoms are. The American Urological Association (AUA) symptom index is an interactive questionnaire that can help you tell how bad your symptoms are and measure how well your treatment is working. This questionnaire ranks the severity of your symptoms on a numerical scale. The higher the number, the more you are bothered by your symptoms and the more aggressive you may want to be in your treatment.

The American Urological Association (AUA) makes the following treatment recommendations for benign prostatic hyperplasia (BPH) based on how bad your symptoms are.

●Symptoms that are mild or that do not bother you (AUA score of 0 to 7) may be best treated by watchful waiting. This means you may make small changes to your lifestyle to control your symptoms, but you do not take medicines or have surgery. You have regular checkups to be sure your symptoms are not getting worse.

●The treatment of moderate to severe symptoms (AUA score of 8 or more) depends on how much you are bothered by them. If the symptoms are not greatly affecting your quality of life, you may choose watchful waiting or treatment with medicine. If the symptoms are bothersome or you want more aggressive treatment, you may be offered surgery or less invasive therapies, such as transurethral microwave therapy (TUMT) or transurethral needle ablation (TUNA).

●Severe symptoms, such as ongoing inability to urinate, bladder stones, kidney damage, or ongoing blood in your urine, should be treated with surgery.

There are some things you can do that may help reduce how much BPH affects your quality of life.

●Do not try to rush your urination. Try to relax while using the bathroom.

●Spread your fluid intake throughout the day. Limit fluid intake in the evening if you often wake up at night to urinate.

●If possible, avoid medicines that make your symptoms worse.

●Consider trying an herbal therapy for BPH, such as saw palmetto or betasitosterol. Talk with your doctor before starting any herbal therapy.

Medicines are sometimes used to help relieve bothersome, moderate to severe urination problems caused by benign prostatic hyperplasia (BPH). If you stop using medicine, the symptoms will usually return.

The American Urological Association (AUA) symptom index is an interactive questionnaire that can help you determine how bad your urinary symptoms are and check how well your treatment is working. But the most important thing in deciding whether to use medicines is not your AUA score but how much the symptoms bother you and affect your quality of life. A high score on the AUA does not necessarily mean you need medicines.

In general, the side effects of the most commonly used medicines are minor. And the side effects stop when you stop taking the medicine.

●Alpha-blockers, such as terazosin (Hytrin), relieve symptoms within a few weeks but do not stop the process of prostate enlargement.

●5-alpha reductase inhibitors, such as dutasteride (Avodart) or finasteride (Proscar), may reduce the size of an enlarged prostate but may take 6 months or more to show any effect on symptoms.

●Using a combination of an alpha-blocker with a 5-alpha reductase inhibitor may help your symptoms more than either medicine alone.

Alpha-blockers and 5-alpha reductase inhibitors affect different prostate tissues. How much your symptoms improve may depend on which tissue is contributing most to your symptoms. None of these medicines will work for everyone.

Alpha-blockers may help symptoms caused by a blockage at the opening to the bladder. With this type of obstruction, you may have a hard time starting to urinate, and you may have a weak urine stream. Alpha-blockers relax the smooth muscle tissue in the prostate and the opening to the bladder. This muscle tissue must relax to allow urine to flow.

5-alpha reductase inhibitors can reduce the size of your prostate and can slow the rate of enlargement. Men with smaller prostates see less benefit than those with larger prostates. Men who have only slightly enlarged prostates usually find alpha-blockers more helpful.

5-alpha reductase inhibitors may cause you to have less desire to have sex (decreased libido).

If you have difficulty urinating because of benign prostatic hyperplasia (BPH), you probably will not need surgery unless you:

●Cannot urinate. If you cannot urinate, you will need catheterization. In catheterization, a tube is passed up the penis into the bladder and urine is drained. Half of these men will be able to urinate again after catheterization. Those who do not improve may need surgery.

●Have a partial blockage in your urethra that is causing repeated urinary tract infections, bladder stones, or bladder damage.

●You have blood in your urine that is not getting better and is causing other problems such as clots that make it hard to urinate.

●Have kidney damage.

If you have no complications but have symptoms that bother you or if other treatment has not worked, you may choose to have surgery. In this case, think about:

●How bad your symptoms are.

●How much you expect the surgery to improve your symptoms.

●How you feel about the risk of developing a complication because of the surgery.

Surgery that does not require an incision through the skin is usually used. The surgical instruments are passed up the urinary opening in the penis to the location of the prostate. This is described as a transurethral surgery of the prostate.

Transurethral resection of the prostate (TURP) is the surgery for benign prostatic hyperplasia that has been studied the most. It is the surgery that is used the most to treat symptoms of BPH. All other surgeries are compared to TURP. In TURP, part of the prostate is removed.

Some of the other surgeries that have been studied and compared to TURP include:

●Transurethral incision of the prostate (TUIP), in which incisions are made in the prostate that cause it to press less on the urethra.

●Laser therapy (transurethral laser coagulation and transurethral laser vaporization), in which a laser is used to make incisions in or remove a portion of the prostate.

●Transurethral microwave therapy (TUMT), in which microwave energy is used to destroy a portion of the prostate through heating.

●Transurethral needle ablation (TUNA), in which a heated needle is used to destroy a portion of the prostate.

In most cases, these treatments have been studied for only a few years, so their long-term effectiveness is not yet known. There are also some other surgeries.

The oldest surgical method to treat BPH is an open prostatectomy, in which an incision is made through the skin to reach the prostate. Doctors use this method less often now, but it is still preferred if the prostate is very large.

Surgery is the most reliable way to relieve symptoms. But surgery may not relieve all your symptoms. And it puts you at risk for certain surgical complications, including erection problems (erectile dysfunction). Other complications include the inability to control the release of urine (urinary incontinence) and ejaculation of semen into the bladder instead of out through the penis (retrograde ejaculation). The complication depends on which type of surgery is used.

Men who have severe symptoms often notice great improvement in the quality of life following surgery. Men whose symptoms are mild may find that surgery does not greatly improve quality of life, and they may want to think carefully before deciding to have surgery to treat BPH.

If you have decided to have surgery, or if there are clear medical reasons to have surgery, the best surgical option depends on the size and shape of your prostate and the experience of the surgeon.

●Transurethral resection of the prostate (TURP) is the most common surgery for BPH.

●Other types of surgery have fewer risks and a shorter recovery period than TURP. But they may not work as well to stop symptoms. And you may need more treatment or surgery in the future.

bladder ['blædə] n.膀胱

block [blɒk] vt.阻止；阻塞；限制

bothersome ['bɒðəsəm] adj.麻烦的；令人讨厌的

catheter ['kæθitə] n.导管；导尿管；尿液管

catheterization [,kæθitəri'zeʃən] n.导管插入，尿管插入

clot [klɔt] n.血块

complication [kɒmpli'keiʃ(ə)n] n.并发症

desire [di'zaiə] n.欲望；要求；性欲

disruptive [dis'rʌptiv] adj.破坏的；分裂性的

diuretics [,daijuə'retiks] n.利尿剂，利尿药

dribble ['dribl] n.漏泄；v.滴下；尿滴沥

dysuria [dis'jʊəriə] n.排尿困难

ejaculation [i,dʒækjʊ'leiʃ(ə)n] n.射精

erection [i'rekʃ(ə)n] n.阴茎勃起

genetics [dʒi'netiks] n.遗传学

kidney ['kidni] n.肾脏

hesitancy ['hezit(ə)nsi] n.踌躇，犹豫

hormone ['hɔːməun] n.激素；荷尔蒙；性激素

hyperplasia [,haipə'pleiziə] n.［病理］增生；畸形生长

hypertrophy [hai'pɜːtrəf] n.［病理］肥大；过度增大

laser ['leizə] n.激光

libido [li'biːdəʊ] n.性欲；生命力

nocturia [nɔk'tjuəriə] n.夜尿症；遗尿症

penis ['piːnis] n.［解剖］阴茎

prostate ['prɒsteit] n.［解剖］前列腺

prostatectomy [,prɒstə'tektəmi] n.前列腺切除术

prostatitis [,prɒstei'taitis] n.［泌尿］前列腺炎

puberty ['pjuːbəti] n.青春期

questionnaire [,kwestʃə'neə] n.问卷；调查表

semen ['siːmən] n.精液；精子

squeeze [skwiːz] vt.挤；紧握 vi.压榨

testicle ['testikəlz] n.睾丸

testosterone [te'stɒstərəʊn] n.［生化］睾酮，睾丸素

ultrasound ['ʌltrəsaʊnd] n.超声；超音波

urethra [jʊ'riːθrə] n.［解剖］尿道

urinate ['juərineit] vi.排尿，撒尿，小便

urinalysis [,jʊəri'nælisis] n.验尿；尿分析

urological [jʊ'rɑlədʒi] adj.泌尿道的；泌尿科学的

vasectomy [və'sektəmi] n.［泌尿］输精管切除术

alpha-blocker α受体阻滞剂

American Urological Association (AUA) 美国泌尿外科学会

benign prostatic hyperplasia (BPH) 良性前列腺增生症

bladder stones 膀胱结石

digital rectal exam (DRE) 直肠指检

erectile dysfunction (ED) 勃起功能障碍

5-alpha reductase inhibitors 5-α还原酶抑制剂

heart failure 心力衰竭

herbal therapy 中药治疗

intravenous pyelogram (IVP) 静脉肾盂造影

lower urinary tract symptoms(LUTS) 下尿路症状

medical history 病史

prostate-specific antigen (PSA) 前列腺特异性抗原

post-void residual urine test (PVR) 残余尿量测定

retrograde ejaculation 逆行射精

risk factors 危险因素

side effects 副作用

spiral (helical) computed tomography (CT) scan 螺旋CT扫描

transrectal ultrasound (TRUS) 经直肠超声

transurethral incision of the prostate (TUIP) 经尿道前列腺切开术

transurethral microwave thermotherapy (TUMT) 经尿道微波热疗术

transurethral needle ablation of the prostate (TUNA) 经尿道前列腺针刺消融术

transurethral resection of the prostate (TURP) 经尿道前列腺电切术

urinary tract infections 尿路感染

urinary incontinence 尿失禁；遗尿

watchful waiting 观察等待