The prostate gland lies underneath the bladder and surrounds the urethra.
Enlargement of the prostate is a natural process as men get older. An enlarged prostate only becomes a concern when it leads to problems with urination. The exact cause of prostate enlargement is unknown: male hormones (testosterone) are needed for this process and may play a role and there may also be a familial tendency.
An enlarged prostate does not put you at a higher risk of developing prostate cancer.
What are the symptoms of prostate enlargement? (BPH)
A person with prostate enlargement may suffer from the following symptoms:
- Slow flow and prolonged urination. Sometimes you feel that you need to push to be able to get the urine out.
- Inability to start urinating immediately when you go to the toilet (hesitancy). You have to wait before urine starts to flow.
- Dribbling of urine towards the end of urination. Sometimes this results in wet and smelly underwear.
- A feeling of incomplete emptying of your bladder.
- Frequent desire to pass urine. It may be associated with the need to wake up several times at night to urinate.
- Urgency – when you feel that your bladder is full and you need to urinate, you have to get to the toilet very quickly and cannot postpone urination.
- Prolonged and severe blockage to urine flow from the bladder may in later stages lead to damage to the bladder and kidneys (kidney failure).
- Incomplete emptying of the bladder can result in recurrent bladder infections and even bladder stones.
An enlarged prostate can restrict urine flow from the bladder
As a Urologist, I feel passionate about the importance of having prostate enlargement (BPH) properly assessed.
If left untreated, an enlarged prostate can lead to potentially serious problems like:
- Acute retention of urine. This is the total inability to pass any urine resulting in an over-filled and very painful bladder. It will require urgent bladder drainage by placement of a urinary catheter.
- Recurrent bladder infections.
- Bladder stones.
- Blood in the urine, sometimes with clots.
- Kidney damage / kidney failure.
In my practice, I see men with enlarged prostates (BPH) and urinary symptoms every week.
During the consultation, I will assess the effects and severity of prostate enlargement as this will determine our treatment strategies. The following tests may be done at the time of your consultation:
- International Prostate Symptom Score (IPSS): You may be asked to complete a form that contains a set of questions designed to assess the severity of your urination symptoms.
- Urine test to check for infection.
- Finger examination of your prostate (also called digital rectal examination / DRE).
- Blood tests to check your kidney function.
- PSA blood test to assess your risk of prostate cancer.
- Urine flow test to measure the strength of urine flow.
- An ultrasound scan to check for adequate bladder emptying.
The treatment options for prostate enlargement / BPH:
This is usually the first line of treatment and consist of tablets which are taken once a day. Depending on the tablet prescribed, it can either relax the prostate or actually decrease the size of the prostate so that urination and symptoms are improved. Some men respond well to medication but in others it may not be effective.
TURP refers to "trans-urethral resection of the prostate". This is a minimally invasive surgical procedure ("key-hole") where a camera is inserted through the urethra (bladder pipe) and into the prostate. The enlarged prostate tissue is then cut away using special instruments passed through the camera. TURP can be done under spinal anesthesia or general anesthesia. The operation itself lasts about 60 minutes and most patients spend 2 nights in hospital afterwards. A bladder catheter is placed immediately following the operation and is then removed before your discharge from the hospital. Over the years, numerous other surgical techniques have been described to treat large prostates / BPH (eg laser prostatectomy, water vapour treatment, stents, clips, sutures etc). TURP is still considered the Gold Standard of treatment - the only exception is probably men with very large prostates where laser prostatectomy is preferable.