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This fact sheet has been produced by the Andrology Special Advisory Group (SAG)
of the Urological Society of Australia and New Zealand
Benign Prostatic Hyperplasia (BPH) - the enlarged prostate
The prostate is a gland that sits below the bladder and is wrapped around the water
pipe(urethra). Its major function is to produce seminal fluid or semen which is then stored in a
small gland called the seminal vesicle until the time of ejaculation. As the prostate is at the
junction of the urinary and reproductive systems for men, this means that any change in the
prostate or enlargement can cause trouble passing urine.
As men get older, the prostate enlarges and this may cause the prostate to squeeze in on
the urethra and push up on the bladder and make passing urine more difficult. Many men as
they get older will therefore report symptoms such as decreased urinary flow, having to wait
for the flow to start, an interrupted flow, a feeling of incomplete emptying and getting up at
night to pass urine. Going more frequently during the day and feeling an urgent need to pass
urine may also be symptoms. Having these symptoms does not mean that men are more
likely to develop prostate cancer or are more likely to have prostate cancer. These are simply
the symptoms of an ageing and enlarged prostate and bladder. These structural changes in
the prostate are called BPH or benign prostatic hyperplasia and the symptoms are refererred
to as LUTs' or lower urinary tract symptoms (formerly prostatism ). Medical and surgical
intervention can relieve both the obstruction (BPH) and the symptoms (LUTs).
Medication for this condition includes alpha-blockers such as terazosin, doxazosin and
tamsulosin which relax the prostate and 5-alphaýreductase inhibitors such as finasteride and
dutasteride which shrink the prostate. Occasionally the urgency is treated with anti-
cholinergics such as oxybutinin and tolteridine which act more on the bladder. These drugs
may be used alone or in combination. Potential side-effects and drug interactions should be
discussed with your urologist.
Traditionally, once drugs had failed, most patients underwent a so-called TURP or trans-
urethral resection of the prostate. TURP removes the obstructing tissue using electro-cautery
and the pieces of tissue are flushed out of the bladder. This treatment is still the most
commonly used today and is both safe and effective. Anesthesia and a short hospital stay is
necessary. The use of drugs has significantly decreased the need for this type of surgery.
There are also more recently developed minimally invasive treatments available. These
include treatments which can be done in the clinic such as microwave therapy (TUMT trans-
urethral microwave therapy) and treatments done under anaesthetic such as TUNA (trans-
urethral needle ablation) both of which heat the prostate and can relieve symptoms without
the need for drugs.
Different forms of treatment have different advantages and disadvantages and availability of
the newer treatments varies considerably in different parts of Australia and New Zealand.
Your urologist can help you to determine which form of treatment is best for you, taking into
account the many different factors involved.
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Herbal medicine is one of the most ancient forms of medical treatment. Written records of the use of plants for healing can be found in the oldest writings of the Chinese, of India, Sumeria, and the Egyptians. Clay tablets dug up in Iraq contained prescriptions written in Cuneiform, the ancient writing of Sumeria. They date from 2250 to 2000 BC and the 15 prescriptions contain ingredients such a