Benign Prostatic Hyperplasia: Symptoms, Treatments, and Side Effects

Benign Prostatic Hyperplasia (BPH)

Two years ago, I experienced nocturia, and an ultrasound examination revealed prostatic enlargement (41*33*47 mm).
I was prescribed a sustained-release capsule of 0.2 mg, which I took for about six months, but the improvement in symptoms seemed minimal.
The physician recommended continuing the medication for another three months.
After three more months, the symptoms remained the same, so I discontinued follow-up treatment.
Recently, I have had unexplained fevers for three consecutive months (intermittent), and during a urology outpatient visit in July, urinalysis showed signs of inflammation.
I was given antibiotics, and the physician advised that I should continue treatment for benign prostatic hyperplasia.
I was switched to a sustained-release film-coated tablet of 0.4 mg, and after taking it, I felt that urination was smoother than before.
I have a few questions for the physician: 1.
Is a size of 41*33*47 mm considered severe or moderate enlargement, and what are the normal size ranges? 2.
While the sustained-release film-coated tablet of 0.4 mg has improved my urination issues, I am experiencing a sensation of needing to ejaculate, which is somewhat uncomfortable.
Is this a side effect of the medication? Thank you.

LKK, 60~69 year old female. Ask Date: 2018/08/02

Dr. Xu Wencang reply Urology

The prostate is considered to be of medium size, primarily assessed based on symptoms or other objective examinations such as urinary flow rate and post-void residual urine.
It rarely causes the sensation of wanting to ejaculate.

Reply Date: 2018/08/02

More Info

Benign Prostatic Hyperplasia (BPH), commonly known as prostate enlargement, is a condition that affects many men as they age. It can lead to a variety of urinary symptoms, including frequent urination, especially at night (nocturia), difficulty starting urination, weak urine flow, and the sensation of incomplete bladder emptying. Understanding the symptoms, treatment options, and potential side effects is crucial for managing this condition effectively.

Symptoms of BPH
The symptoms of BPH can vary in severity and may include:
1. Frequent Urination: An increased need to urinate, particularly at night.

2. Urgency: A sudden, strong urge to urinate.

3. Weak Urine Stream: A decrease in the force of the urine stream.

4. Difficulty Starting Urination: Trouble initiating urination.

5. Incomplete Emptying: The feeling that the bladder is not fully empty after urination.

In your case, the ultrasound measurements of 41 x 33 x 47 mm indicate a moderate to severe enlargement of the prostate. Generally, a normal prostate size is about 20-30 grams, and anything above this can be considered enlarged. However, the degree of enlargement does not always correlate directly with the severity of symptoms, as some men with significantly enlarged prostates may experience mild symptoms, while others with smaller prostates may have severe symptoms.

Treatment Options
Treatment for BPH can range from lifestyle changes and medications to surgical interventions, depending on the severity of symptoms and the impact on quality of life.
1. Medications:
- Alpha-blockers (like your current medication, 活路利淨OCAS): These relax the muscles of the bladder neck and prostate, improving urine flow and reducing symptoms.
- 5-alpha-reductase inhibitors: These medications can shrink the prostate over time but may take several months to show effects.

- Combination Therapy: Sometimes, a combination of both types of medications is used for better symptom control.

2. Surgical Options: If medications are ineffective or if there are complications, surgical options such as Transurethral Resection of the Prostate (TURP) or laser therapy may be considered.

Side Effects of Medications
While medications can significantly improve symptoms, they can also have side effects. The sensation of discomfort during ejaculation that you mentioned could indeed be a side effect of the medication. Common side effects of alpha-blockers include:
- Dizziness or lightheadedness
- Fatigue
- Retrograde ejaculation (where semen enters the bladder instead of exiting through the penis)
If the side effects are bothersome, it is essential to discuss this with your healthcare provider. They may consider adjusting the dosage or switching to a different medication.

Conclusion
In summary, BPH is a common condition that can significantly impact quality of life. Your current treatment with 活路利淨OCAS seems to be providing some relief, but if side effects persist, it is crucial to communicate this with your doctor. Regular follow-up is essential to monitor your symptoms and adjust treatment as necessary. If you experience any new or worsening symptoms, such as fever or signs of infection, it is important to seek medical attention promptly. Your healthcare provider can help you navigate the best course of action based on your individual circumstances.

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