Ed Shaheen
The prostate, which is slightly larger than a walnut, is a gland that sits just below the male bladder wrapped around the tube that exits the bladder (the urethra), like someone holding the end of an inflated balloon. The inflated balloon is the urinary bladder and the urine from the bladder passes through the prostatic urethra on its way out of the body. The main purpose of the prostate is to provide lubricating fluids and secretions to the sperm and semen which exit during ejaculation. When the prostate is young, the urine usually flows through without difficulty. As the prostate ages, it usually becomes larger. This gradual enlargement tightens its grasp around the urethra like a fist. This results in most of the complaints that you hear from commercials on the TV, such as hesitation or delay in urination, a slow stream, frequency of urination, dribbling at the end or a sense of incomplete emptying. This condition is called benign prostatic hyperplasia, abbreviated as BPH. The prostate gland can sometimes increase 10 fold over time usually beginning at the age of 50. By the age of 80, 75% of men have BPH. It is not always symptomatic, however. As it turns out, it is not just the size that causes the symptoms of obstruction but the local growth of the prostate around the urethra together with changes at the bladder neck (or base of the bladder where the prostatic urethra begins).
Medications for BPH work in one of two ways. One type of pill relaxes the bladder neck (the exit from the bladder to the urethra). The other type of pill shrinks the prostate tissue by reducing the amount of DHT, one of the testosterone by-products that causes the enlargement. Usually the relaxation of the bladder neck is easier to do and can be effective in a shorter amount of time. Shrinking the prostate tissue can take months or more to accomplish. Most patients with symptomatic BPH usually respond to the oral medications, at least for a little while. The main problem with prostate enlargement is that eventually it can completely obstruct the urethra and cause urinary retention. This requires the temporary insertion of a catheter to relieve the obstruction. When this type of symptom occurs, the next step is often surgery. The most common surgery is called transurethral resection of the prostate (TURP). This is done under anesthesia of one type or another. The urologist inserts into the urethra a surgical scope that enables him to look at and to carve out the excess prostate tissue, much like reaming out a clogged pipe. This relieves the obstruction and the patient usually has no further problems with urination.