Prostate Enlargement(BPH)

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Prostate Enlargement(BPH)

Introduction

The prostate gland enlarges with age in men. Enlargement of the prostate per se is a natural process of aging and becomes a concern only when it leads to problems of urination. 

What causes prostate enlargement?

The exact cause of prostate enlargement is unknown.  Advancement of age is the main reason for increase in size of the prostate. Male hormones are needed for this process.

What are the symptoms of prostate enlargement?

A person with prostate enlargement may suffer from the following symptoms:

  • Slow and prolonged urination. Sometimes you feel that you need to push to be able to urinate.
  • Inability to start urinating immediately when you go to the toilet. You have to wait before urine starts to flow
  • Dribble of urine towards the end of urination. Sometime this results in wet and smelly underwear.
  • A feeling of incomplete emptying of your bladder
  • Frequent desire to pass water.  It may be associated with need to wake up several times at night to urinate.
  • Desire to hurry to urinate with the fear that you can urinate on your clothes.
  • Prolonged blockage of the urethra may lead to damage of the bladder and kidney.
  • Incomplete emptying of the bladder can result in recurrent bladder infections and even bladder stones.

What are the options of treatment for prostatic enlargement?

Treatment of prostate enlargement is only necessary in individuals who suffer severe problems with urination. Those who have mild symptoms do not need treatment as long as they can cope with the symptoms. In fact, the symptoms improve for some people without any medication or surgery.

What to expect during  a visit your doctor?

Your doctor will perform the following test to assess the severity and effect of prostate enlargement: 

  • Prostate score: Your doctor will ask you to fill a form which contains a set of questions designed to assess your urination problems.
  • Urine tests for infections
  • Finger examination of the prostate via the anus.
  • Blood tests to check how your kidney is functioning
  • PSA test to check for the risk of prostate cancer.
  • Urine flow test to measure the exact speed of your urination
  • A look inside your urinary bladder with a cystoscope(special camera) to assess for any bladder damage or other possible causes of urination problems.
  • Sonar of the kidney is done is some cases.

What are the options of treatment for prostate enlargement?

Your doctor will discuss with you options of treatment based on the severity of your symptoms and the results of the tests above.  In general, the less severe your problem, the less aggressive is the treatment.

Treatment options include: 

Watchful waiting:  Patients with mild symptoms are often observed without any medication or surgery. Majority do not require any treatment even after follow up.

Medications: Your doctor will offer you medications that you will need to take every day.  These medications relax or shrink your prostate so that you can urinate more easily.

  Your doctor may offer you surgical removal of the part of the prostate which is blocking your urethra based on the results of the test above or in case medications do not work for you.

What to expect with prostate surgery?

The most commonly performed surgeries for prostate enlargement include:

Transurethral Resection of the Prostate (TURP):   This method of surgery uses a special camera inserted via your urethra to the prostate. The prostate is then cut into small fragment, which are washed away with water. TURP is best done on a patient with a small prostate.  TURP can be done under spinal anesthesia or general anesthesia.  You need a short admission for this surgery. Most patients go home within 1 to 2 days after surgery.  A catheter inserted to wash the bladder after surgery is removed before you are discharged.

Open prostate surgery: is done to remove the inner part of the prostate via an incision in the lower abdomen. This method is preferred in those with large prostates. Admission for open surgery is usually longer than TURP. You may be discharged after 5-7 days after the surgery with a catheter for one extra week. This catheter allows the wounds in the prostate to heal before it can be removed.

What are the risks of prostate surgery?

The main risks of prostate surgery include:

  • Bleeding which may occur during the operation. Occasionally, some individual bleed after surgery. 
  • Infections
  • Loss of forward ejaculation 
  • Urine leakage 
  • Urethral blockade

Common concerns about prostate enlargement

  • Prostate enlargement is not related to prostate cancer. Prostate cancer can occur in both small and large prostate.
  • There is no strong medical proof which confirms the effectiveness of herbal medication or special diets in relieving prostate symptoms.