Enlarged prostate

Overview

The prostate is a gland around the uppermost part of urethra in men. It tends to grow in size with age because of hormonal changes. Typically, it is a non-cancerous (benign) growth that is technically called benign prostatic hyperplasia (BPH). BPH is a very common condition estimated to be present in more than 50 percent of men over the age of 60 and 90 percent of men over the age of 70.

Symptoms of BPH

BPH causes several symptoms related to urination because it squeezes the urethra or irritates the lower part of urinary bladder. Patients with BPH often experience the following symptoms:

 

  • Blood in the urine (hematuria)
  • Frequent urination
  • Sudden or urgent need to urinate
  • Difficulty in starting urination
  • Weak or interrupted urination
  • Dribbling urinary stream
  • Urine leakage
  • Incomplete emptying of the bladder
  • Sudden inability to pass urine

Diagnosis of BPH

Doctors diagnose BPH through physical examination, symptoms and tests measuring the extent of blockage to urine flow.

  • Digital Rectal Examination: A doctor palpates the prostate gland through the rectum to determine its size, shape and consistency.
  • AUA Symptom Index: A questionnaire based index that assesses urinary problems to diagnose BPH.
  • Urodynamic Tests: Office based tests to evaluate urine flow and measure the volume and pressure of urine.
  • Uroflowmetry: A test to measure urine flow rate. A reduced flow rate suggests BPH.
  • Pressure Flow Study: A precise test to assess urine blockage. A catheter is inserted into the bladder through the urethra and pressure in the bladder during urination is measured.
  • Post-void Residual (PVR). The amount of urine left in the bladder following urination, measured by ultrasound or catheterization.
  • PSA (prostate specific antigen) Testing: PSA is a protein produced by prostate cells, which can be detected in the blood. A simple blood test can indicate if further evaluation for prostate cancer is necessary. Elevated PSA levels can also be associated with BPH.

Treatment of BPH

Treatment of BPH depends on the extent of the problem that it is causing.

Observation: Men with minimal symptoms may not require any treatment except an annual check up.

Medicines: Some medicines reduce prostate size by blocking the conversion of testosterone to dihydrotestosterone. Drugs called alpha blockers relieve symptoms by relaxing the bladder and prostate.

Stents: Some patients benefit from prostatic stents that push back surrounding tissue and widen the opening.

Minimally invasive procedures: Minimally invasive therapies using laser or microwave treatment can reduce or eliminate symptoms.

Surgery: Surgery is needed in cases that do not respond to the above measures. The options are:

  • Transurethral Microwave Therapy (TUMT): A catheter with a microwave unit is inserted through the urethra to heat up the prostate and relieve blockage. It is typically an outpatient procedure done under local anesthesia.
  • Transurethral Resection of the Prostate (TURP): It involves the removal of obstructive prostate tissue with a special tool inserted via the urethra. Complications of TURP may include blood in the urine, scar tissue formation, discomfort or difficulty in  urination or sexual problems.
  • Transurethral Incision of the Prostate (TUIP):
    If the prostate is not too enlarged making a nick in the lower part of bladder through the urethra can reduce pressure on the prostate and make urination easier.
  • Prostatectomy: A very enlarged prostate may
    have to be surgically removed. Complications may include incontinence or impotence. The da Vinci procedure is a robotic prostatectomy procedure used in selected cases. It causes less blood loss, pain and has a shorter recovery time.
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