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ASK DR.K: P is for Prostate

Updated: May 5

Dear Dr. K, I've started having to get up at least once a night, sometimes more often, to pee. What's the deal?


Sincerely,

Augusta P. Nightly



Getting up at night to urinate (nocturia) is usually a symptom of an enlarged prostate. The medical term is benign prostatic hypertrophy or BHP. There are other causes such as drinking caffeinated or alcoholic beverages late in the evening. Prostate infections (prostatitis) also causes symptoms of frequency and nocturia, But these are self-limited events and conditions. BPH is a chronic, ongoing issue, often worsening over time. About 50% of men over sixty may develop symptomatic enlargement of the prostate. It is a non-cancerous condition.


The prostate is a walnut-shaped gland that sits at the base of the urinary bladder. Fluid secreted by the prostate is the primary component of semen. The urethra, which carries urine, passes through the middle of the gland. As the gland enlarges, the urethra is constricted, impeding the flow of urine. This makes the bladder have to squeeze harder to pass the urine. The bladder wall thickens and is able to hold smaller volumes of urine. This leads to more frequent trips to the bathroom.


What causes the prostate to enlarge? Current medical thought is that "super-testosterone," dihydrotestosterone or DHT, is the culprit. DHT is formed from testosterone by enzymes (5-alpha reductase, for those who want to know) located in cells in the tissue of the prostate and seminal vesicles. DHT stimulates cell growth in the prostate, gradually enlarging the gland. (DHT is also formed in hair follicles and contributes to male baldness.)


Can BPH be treated?


There are several prescription drugs available to treat either BPH itself or the symptoms of BPH. Finasteride (Propecia, Proscar), which blocks the action of the reductase enzyme, is used to treat male baldness can have beneficial effects on prostatic enlargement. Several medications are available to treat the symptoms of frequency and urgency. Among these are tamsulosin, alfuzosin, and doxazosin.


Health food stores offer several nutraceuticals that may help with the symptoms of BPH, saw palmetto being one of the better known ones. There are many combination products as well that are promoted for relief of symptoms from BPH.


In some men the symptoms are pronounced and prolonged enough that surgery is recommended. The basic idea behind the surgery is to enlarged the passageway of the urethra through the prostate to relieve the blockage to the flow of urine. The are several different modalities used for performing this surgery. Your urologist will discuss all these with you.


Neither BPH nor the surgery for it leads to ED. After the surgery, some men will experience retrograde ejaculation in which the semen flows backward into the bladder instead of out the penis.


The staff and physicians at Renewal Medical Centers of North Texas are available to provide more information and answer questions on this and other topics about men's sexual and general health.



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