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What is an enlarged prostate?
An enlarged prostate, sometimes called benign prostatic hypertrophy, or BPH, is an enlargement of the gland that produces seminal fluid
which, mixed with sperm from the testes, is ejaculated during male orgasm. It is not cancer. The prostate gland is located just below the bladder in front of the rectum. It surrounds the upper end of the urethra, the
tube that carries urine from the bladder to the end of the penis. The gland grows slowly during childhood, then undergoes a rapid growth spurt at puberty. By 20 base to 25 years, it is fully developed and is normally
about the size of a walnut. Many men experience a second period of prostate growth when they reach their mid- 40s.
What are the causes of an enlarged prostate and who is at risk?
This very common condition is usually found in men aged over 50 years. It is uncertain what causes it, but it may be linked to changes in hormone levels caused by the ageing
process. The cells that make up the prostate grow and multiply. This compresses the urethra, making it more difficult both to pass urine and to empty the bladder completely. It also puts strain on the bladder muscles,
which must work harder to expel urine. What are the common symptoms of an enlarged prostate?
These symptoms develop over time:
- difficulty in starting to pass urine
- frequent urination
- a strong urge to urinate but only a weak flow
- a burning sensation or pain while urinating, and
- waking up at night to urinate
As the condition worsens, the bladder cannot expel urine and it becomes distended. This can cause swelling and pain in the abdomen. If the pain is severe or if only a few drops of urine can be passed, this is called
acute urinary retention and needs immediate medical treatment. If the bladder muscles begin to fail, incontinence may result, usually as small dribbles of urine. In most men, damaged bladder muscles require surgical
repair. How do doctors recognise an enlarged prostate?
Your doctor will feel your abdomen for signs of bladder distension, and feel your prostate
through the rectum. Your urine will be tested for infections and a blood test may be needed to check the function of your kidneys. You will be asked about your symptoms and may be asked to pass urine in the clinic so
the flow and volume can be measured. Sometimes the doctor will send you for an ultrasound scan, which is a simple and painless way to view the prostate and urinary system. What is the treatment for BPH?
Non-surgical management
Sometimes no treatment is needed. Often the symptoms are mild and not especially troubling, and they may improve with time. You might want to discuss
this with your doctor.
To lessen the symptoms, drink less fluids, particularly in the late afternoon or evenings, but not so little that you dehydrate. Your doctor will probably advise you on what is realistic. You
should also try to avoid medications that increase the amount of urine that the body produces.Your doctor may give you alpha- blockers or finasteride. Alpha blockers relax the bladder muscles and increase urinary flow
within just one or two days. You may experience side effects such as headaches, dizziness, or tiredness. For this reason it is best to take the medication before bedtime. Finasteride prevents the male hormone
testosterone from being converted into its active form, and this reduces the size of the prostate. However you may need to take it for 6 months before your symptoms improve, and it has the greatest effect in men with
the largest prostates. A small percentage of men who take finasteride experience sexual problems.
Cystoscopy
Cystoscopy uses an instrument called a cystoscope to view the inside of the urethra and bladder. The cystoscope is effectively a tiny telescope in
a tube, which is inserted into the urethra. It is used to help diagnose conditions affecting the prostate gland, the urethra and the bladder. It is also used in operations to remove or reduce the size of the prostate
gland, and to obtain samples to test for infection or the presence of cancer cells. Special dyes can also be injected into the bladder through a cystoscope so that X- rays may be taken. Some cystoscopy procedures need
only a local anaesthetic, whereas others are performed under a general anaesthetic. They can usually be performed as a day case, so you will be able to go home the same day, although you will need someone to take you
home and stay with you for 24 hours. There is little risk that it will damage the genital organs or urethra. You will usually feel some discomfort when passing urine for a few days but drinking extra water will help.
There may be a little bleeding from the urethra, especially if a tissue specimen has been taken. If you have a temperature, pain, a persistent burning sensation or persistent bleeding after a cystoscopy, it is important
that you see your doctor.A
cystoscopy is a routine procedure that can be performed as a day case, so you will be able to go home the same day, although you will need someone to take you home. There is little risk that it will damage the genital organs or urethra. You will usually feel some discomfort when passing urine for the first few days afterwards but drinking extra water will help. After a cystoscopy, a little bleeding from the urethra is not uncommon, especially if a biopsy specimen has been taken. If you have a temperature, pain, a persistent burning sensation or persistent bleeding after a cystoscopy, it is important that you see your doctor.
Surgery
Surgery is the most effective treatment but may cause troublesome side effects, and not everyone is suitable for surgery. The most common procedure is to 'core out'
the prostate gland, an operation that is known as trans- urethral resection of the prostate (TURP). Another operation that is performed with a cystoscope is a trans-urethral incision of the prostate (TUIP), in which a
cut is made in the bladder neck or along the length of the prostate to relieve the pressure on the urethra. A TUIP is usually performed only if the prostate gland is not very enlarged. Heat therapy
You are more likely to have heat therapy than surgery unless you have severe symptoms or complications. Heat therapy delivers heat energy through the urethra to destroy excess
prostate tissue. It is more effective than medication for moderate to severe symptoms, and it doesn't produce as many troublesome side effects as surgery. It is often performed on an outpatient basis and you will
usually only need a few days to recover. There are several different types of heat energy that may be used. Transurethral microwave therapy (TUMT) delivers safe amounts of microwave energy under local anaesthetic, but
you may still feel some heat and have bladder muscle spasms or a strong desire to urinate. Most people find these effects are quite bearable and they disappear after the treatment is finished. You can go home when you
can urinate satisfactorily — usually the same day. It may take several weeks for you to see a noticeable improvement in your symptoms. Symptoms may return after a few years, especially if they were severe when first
treated. With transurethral needle ablation (TUNA) radio waves are delivered through needles which are placed in the prostate gland using a special catheter inserted into your urethra. TUNA works best in men with
smaller prostates. With transurethral electrovaporisation of the prostate (TVP), a special instrument uses an electrical current to cut and vaporise excess tissue, while sealing off the tissue to prevent bleeding. This
procedure is especially useful for men at higher risk of complications from invasive surgery, including those taking blood- thinning medication.
Laser therapy includes transurethral evaporation of the prostate
(TUEP), noncontact visual laser ablation (VLAP) and interstitial laser therapy. TUEP is generally safe, with little bleeding and works quickly. With VLAP, the laser energy dries up and destroys excess prostate tissue,
which your body eliminates over several weeks. Interstitial laser therapy directs laser energy from inside the prostate. It is safe and works well on larger prostates, which are often the hardest to treat.
Complications of surgery and heat therapy
Possible complications of any general anaesthetic include nausea, a chest infection and thrombosis (blood clot), but these are more likely if you
smoke or are very overweight. After a TURP or a TUIP, it is usual to have some pain or discomfort. This can generally be relieved with simple analgesic tablets and gets better in the few days after the operation.
Bleeding from the urethra is also common after a TURP and usually stops after a day or two. Sometimes there is bleeding again about a week later, when the scab on the prostate (where the tissue was removed) falls off.
This is nothing to worry about and usually stops of its own accord. Many men have retrograde ejaculation after a TURP. This means that during ejaculation some or all the fluid passes backwards into the bladder. This
reduces fertility and it may alter the sensation of orgasm. Impotence is also a risk following TURP. You should discuss these possible complications with your doctor, particularly if you plan to have children. Heat
therapy is safe and only causes temporary discomfort. It may be necessary to wear a urinary catheter for a few days, and for the first few weeks, it is normal to have urgent, frequent or painful urination and small
amounts of blood in your urine. You may also ejaculate less semen with TUMT. With TUNA there is a small risk of retrograde ejaculation. Interstitial laser therapy causes substantial tissue inflammation, and urinary
tract infections are common. What is the outcome of an enlarged prostate?
An enlarged prostate is very common in men aged over 50 years. It is not cancer and there is
no proof that it can lead to cancer. An enlarged prostate may not need treatment, but if symptoms are severe there are several options, which you should discuss with your doctor. Medications for Enlarged Prostate
Hytrin (Terazosin HCL)
Proscar (Finasteride)
Transurethral resection of the prostate has been the accepted surgical treatment for symptoms of urinary obstruction in men with benign prostatic
hyperplasia; however,there are some serious potential complications,and improvement may not be permanent. Hytrin (terazosin: alpha one-selective adrenergic antagonists) have efficacy in benign prostatic hyperplasia
owing to relaxation of smooth muscles in the bladder neck,prostate capsule,and prostatic urethra.This drug rapidly improve urinary flow.
In men with prostatic hyperplasia, Proscar (finasteride) causes a consistent
decrease in prostate size and , in the third of men treated with this agent,improvement in urine flow and symptomatology; it thus provides an alternative to surgery in men with moderate disease manifestations. |
