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Benign prostatic hyperplasia, or BPH, is a noncancerous enlargement of the prostate gland. It is the most common benign tumor found in men. As the prostate gets bigger, it may constrict or partially block the urethra (the tube that moves urine from the bladder out of the body), causing lower urinary tract symptoms, and as a result cause significant reduction in quality of life. These symptoms include:
- Urinary frequency
- Inability to urinate
- Incomplete emptying of the bladder
- Difficulty starting urination
- Straining to urinate
- Weak stream
- Frequent awaking at night to urinate, also known as nocturia
Who is at risk of developing BPH?
Symptoms of BPH are present in more than half of all men in their 60s and as many as 90% of men aged 70 to 89. Treatment, however, is only necessary if symptoms become bothersome. By age 80, about 20 to 30% of men experience symptoms severe enough to require treatment.
Men with mild BPH symptoms are often treated with medications including 5-alpha-reductase inhibitors such as finasteride (Proscar) and/or alpha-adrenergic blockers such as tamsulosin (Flomax). Unfortunately, these medications often produce insufficient relief, and can have adverse effects such as impotence, dizziness, fatigue, and headaches.
When medical therapy for BPH fails, surgery is often recommended. Urologic surgeries include open prostatectomy and transurethral prostatectomy (TURP), as well as several TURP alternatives such as laser photovaporization (PVP), transurethral incision of the prostate (TUIP), and transurethral needle ablation (TUNA). Although these surgeries are effective in relieving urinary obstruction, they are invasive and can result in adverse effects such as impotence and urinary incontinence. Retrograde ejaculation (ejaculation into the bladder rather than out the urethra) often occurs after surgery. In addition, some patients may not be surgical candidates due to age or co-morbidities.
Prostate artery embolization, or PAE, is a minimally invasive treatment alternative for BPH. Multiple studies have demonstrated that PAE effectively relieves urinary obstruction caused by an enlarged prostate, with low risk of side effects.