Prostate Enlargement

Introduction

Prostate enlargement, also known as benign prostatic hyperplasia or BPH, is the most common prostate problem in men. Almost all men develop some degree of prostate enlargement as they age.  The prostate gland encircles the urethra, so when the gland enlarges, it presses against the urethra, restricting urine flow through the tube and causing problems with urination and other associated symptoms.

Anatomy

The prostate gland is a small, walnut-sized gland situated between the bladder and the penis, just in front of the rectum. It forms part of the male reproductive system and releases a fluid that protects and nourishes sperm.  This fluid is secreted into the urethra and is discharged along with sperm as semen during ejaculation. The prostate is divided into 4 anatomical zones and enlargement typically occurs in the central and transitional zones of the prostate.

Causes

The exact cause of prostate enlargement is unknown. However, it is believed that factors connected to aging and changes in the cells of the testes may play a part in the growth of the gland, in addition to testosterone levels.  Also family history of prostate issues or any abnormalities with your testes may increase your risk of prostate enlargement.

Signs and Symptoms

Less than half of all men with prostate enlargement exhibit symptoms of the condition, which may include:

• Frequent urination
• Straining to urinate
• Weak urine flow
• Inability to urinate
• Blood in the urine
• Pain with urination
• Loss of bladder control
• Incomplete bladder emptying
• Dribbling at the end of urination
• Delayed or slowed start to urination

Diagnosis

In order to diagnose prostate enlargement, your doctor may conduct the following tests and examinations, including:

• A review of your medical history and symptoms
• A digital rectal examination or DRE
• A prostate specific antigen blood test or PSA test
• Urinalysis to look for infection or blood
• Urine flow study
• Bladder scans
• Post-void residual urine test
• Ultrasound
• Cystoscopy

Treatment

Conservative measures are always the first line of treatment for an enlarged prostate. These measures may include the following:

• Watchful Waiting: If you do not experience any symptoms of an enlarged prostate, your doctor may decide to wait-and-watch for the progression of the condition with regular monitoring and imaging studies, usually once a year.
• Medications: Medication is the most common treatment method for controlling symptoms of an enlarged prostate. There are a number of medications, some prevent growth of the prostate while others actually shrink the prostate gland. Other drugs may be prescribed to improve urine flow and reduce bladder outlet obstruction.

Surgical Treatment

The main objective of surgical treatment is to reduce the size of the prostate gland and enlarge the urethra to make voiding easier. Treatment may include the following:

• Transurethral resection of the prostate or TURP: Removal of the part of the prostate causing obstruction with the help of surgical instruments passed through the urethra.
• Transurethral incision of the prostate or TUIP: Making incisions on the prostate with instruments introduced through the urethra to decrease the pressure on the urethra.
• Laser therapy: Using a laser to make cuts or destroy the obstructive part of the prostate.
• Transurethral needle ablation or TUNA: Destroying part of the prostate with a heated needle.
• Transurethral microwave therapy or TUMT: Using heat from microwave energy to destroy part of the prostate.
• UroLift: A new system which uses implants to lift and hold the enlarged prostate tissue away from the urethra.
• Open prostatectomy: This involves making an incision on the skin to access and remove the prostate. This is rarely used and mostly recommended for very large prostates.

Risks and Complications of Surgery

Some of the risks and complications of prostate surgery include:

• Urinary tract infections
• Blood in the urine
• Erectile dysfunction
• Retrograde ejaculation
• Urinary incontinence
• Sudden inability to urinate
• Damage to surrounding tissues or organs
• Recurrence of prostate enlargement

Summary

It is common for the prostate gland to become enlarged as a man ages. It is important to discuss your symptoms of enlarged prostate with your physician, no matter how minor you feel they may be.  Your physician will work with you to develop a treatment plan that helps you manage your symptoms and lead a healthy life.