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Q: When a long course of medications failed to help my older brother, he underwent a prostate operation that solved the problem. Now just a few years later, I am following in his footsteps.

However, now that I face the surgery, I find myself with a lot more questions, seeking many more answers than he did. Could you explain just what is accomplished by these procedures?

A: You must be referring to a common problem of older men, called benign prostatic hyperplasia. It certainly is of interest to many readers. While the condition is rarely seen before age 40, it is seen with increasing frequency in men over the age of 50. By age 80, 75 percent of all men are affected. About a third of the affected men will require some type of treatment.

The prostate is located at the neck of the bladder. The urethra, the tube that carries urine from the bladder through the penis, runs through the gland. In benign hyperplasia, the tissues of the gland begin to grow larger and start to compress the urethra. It is thought that certain male hormones (androgens) play a role in this growth.

As the urethra becomes compressed, the symptoms of BPH become more pronounced. They include: a reduction in the force of the urinary stream, hesitancy in starting urination, post voiding dribbling and nocturia (excessive urination at night).

A doctor can make this diagnosis with the infamous, but most important, rectal examination, during which the enlarged gland can be palpated. A variety of other laboratory tests and analysis, including a tissue needle biopsy, are sometimes performed to clinch the diagnosis.

In many cases no treatment is necessary except for close and regular observation. Prescription medications that help voiding, such as terazosin, prazosin and finasteride, are useful in some cases.

A number of surgical techniques have been developed to correct the problem, including the insertion of a balloon catheter through the urethra to dilate the channel and push back the overgrowth of prostatic tissue. Other techniques cut through the urethra and remove a portion of the gland (trans-urethral prostatectomy). Open surgery through the abdomen that removes the growth may also be employed. The results of all these procedures are generally good.

Dr. Allan Bruckheim welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to him in care of Tribune Media Services, 435 N. Michigan Avenue, Suite 1400, Chicago, IL 60611.

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