Usually, the male prostate gland enlarges after 40 years; this is known as benign prostatic hyperplasia or benign prostatic hypertrophy (BPH). This increase can cause a number of urinary symptoms. More momentous bladder and kidney problems can also develop.
There are various effective treatment options for BPH, including medical and surgical options. Usually, transurethral resection of the prostate (TURP) is the most common prostate surgery.
Causes of an enlarged prostate
The prostate is a nut-shaped gland located just after the bladder neck. It is commonly used to produce fluid that protects and enriches sperm.
As a man ages, the prostate gland gradually enlarges. It usually starts after age 40 and is thought to be caused by hormonal changes. This increase can cause difficulty urinating and can lead to problems with the bladder and kidneys. The increase occurs as a result of hyperplasia (increase in the number of cells) and hypertrophy (increase in cell size).
An enlarged prostate does not cause prostate cancer. However, prostate cancer can occur in men with an enlarged prostate.
As the prostate gland enlarges, it narrows the urethra (the tube that drains urine from the bladder) and can obstruct the flow of urine. This can lead to urinary problems such as:
Increased urge to urinate
Uncontrollable urge to urinate
Nocturia - the need to get up often at night to urinate
Difficulty starting the flow of urine (indecision)
Poor urine flow - poor flow or stopping/starting flow
Dribbling urine - especially at the end of urination
Incomplete emptying of the bladder.
The term LUTS (lower urinary tract symptoms) is commonly used to refer to a number of urinary symptoms associated with BPH.
Some men may have no symptoms at all, while others may have very severe symptoms. An enlarged prostate, if the severe case, can also lead to:
Chronic renal failure
Enlargement and thickening of the bladder wall
Urinary tract infection (UTI)
Bleeding from the urethra
Acute urinary retention.
Any of these situations can damage the bladder, urethra, and kidneys. If you experience burning, bleeding, or pain while urinating, seek immediate medical attention. Lack of urination is generally a medical emergency.
If you have symptoms of an enlarged prostate, you should see your doctor for an accurate diagnosis and recommend treatment. It is important to rule out other possible causes of symptoms such as prostatitis (inflammation of the prostate gland) or prostate cancer. To diagnose this condition, your doctor will do the following:
During the exam, your doctor will feel for signs of an enlarged bladder in your abdomen and will do a digital rectal exam to check for an enlarged prostate.
They will be done to test kidney function and to test PSA (prostate-specific antigen). PSA is a protein secreted into the bloodstream by the prostate gland. Higher than normal levels may indicate an enlarged prostate, inflammation of the prostate (prostatitis), or prostate cancer. PSA levels are usually significantly elevated in prostate cancer, but not always.
This may indicate an infection or blood in the urine. Other urine tests can measure the force and volume of the flow and determine if the bladder can be emptied completely.
If blood tests indicate an elevated PSA level and a digital rectal examination indicates an enlarged prostate, a prostate biopsy may be recommended to rule out prostate cancer. Ultrasound scans of the prostate and urinary tract are also needed in men over 40.
Doctor Treatment is Necessary if an enlarged prostate is causing symptoms. Traditionally, three main treatment approaches have been used: wait and watch medical treatment, and surgical treatment.
“Wait and see” (ie: no treatment).
This approach may be advised if symptoms are mild and do not adversely affect the quality of life. The condition is monitored regularly and treatment will be recommended if symptoms worsen.
There are a number of medications that can be used to treat an enlarged prostate. Some medications work by relaxing the muscles within the prostate gland, making it easier for the urethra to open, while others have the effect of reducing the glandular component of the prostate. Medications commonly used in Russia to treat an enlarged prostate include tamsulosin, terazosin, doxazosin, and finasteride.
Up to 25% of men with enlarged prostate require surgery, usually because they are experiencing severe symptoms that negatively impact their quality of life. Some less invasive procedures have been developed recently, but since the long-term results of these new therapies are not yet known, transurethral resection of the prostate remains the most commonly performed procedure.
Transurethral Resection of the Prostate (TUIP)
TURP is performed by a specialist urologist (a specialist in the urinary system) and is usually performed under general anesthesia.
The specialist inserts a resectoscope (a thin tube telescope with light at the end) through the urethra and up into the prostate gland. The specialist can view the prostate and bladder either through a resectoscope or on a television monitor.
A special loop is used to remove the glandular component in fragments, then the bleeding vessels are coagulated with a ball.
After TURP, a hospital stay of one to five days may be required. The specialist will recommend recovery instructions and exercise before going home, so it's important to follow them carefully.
A variation of the TURP method is laser resection of the prostate. This is done in a similar way to TURP, except that the laser beam is used to cut the prostate tissue rather than the heated loop wire. This method tends to cause less bleeding than TURP, and recovery times tend to be shorter.
Transurethral Prostate Incision (TUIP)
TUIP is similar to TURP except that the prostate tissue is not removed. Instead, one to three incisions or incisions are made into the prostate gland near the bladder neck. This releases a “ring” of enlarged tissue, creating a larger opening around the urinary tract and therefore allowing urine to flow more freely.
This surgery involves removing part or all of the prostate gland through an incision in the lower abdomen or perineum (the area between the scrotum and the anus). It is also performed by a specialist urologist and may be recommended in cases where the prostate gland is significantly enlarged. It is usually performed under general anesthesia. Hospital stays for up to five days are common after open prostatectomy. Again, the specialist will recommend instructions for recovery and activity.