Prostate Enlargement/Benign Prostatic Hyperplasia (BPH)
Benign prostatic hyperplasia is one of the most common diseases affecting men over 50 years old.
As the prostate grows makes it difficult for urine to pass out of the bladder, and then the symptoms of what is now called "lower urinary tract symptoms" begin.
What are the symptoms of the enlargement of the prostate?
The most common symptoms are difficult and slow urination, decreased urine output, dripping urine, frequent urination and need waking during the night many times to urinate. If left unmanaged, the bladder can in fact suffer long term, with loss of stretch and capacity permanently and develops other problems such as urinary tract infections, urinary stones, kidney damage, and urinary incontinence.
How the enlargement of the prostate is diagnosed?
Urologist in order to determine if the prostate is causing a blockage in the outflow of urine perform a urine flow test. This examination will show whether what the patient feels as difficult to urinate is a result of an obstruction causes from the enlargement of the prostate. Also other tests include a digital prostate examination and an ultrasound scan.
What are the treatment options for the enlargement of the prostate?
The first choice in the treatment of benign prostatic hyperplasia are medicines to relax the prostate(alpha-blockers).This medication might help initially but side effects such as dizziness or tiredness and lack of semen coming out at orgasm (retrograde ejaculation) are common
Another type of tablet is a the 5 alpha reductase inhibitor that shrinks the prostate. This medication work slowly, at least six months for effect, and can reduce libido and erections in some men.
If medications are ineffective or side effects undesirable consider seeing a Specialist to discuss options including new minimally invasive techniques which have less side effects than standard operations.
Minimally invasive techniques or Surgical treatment is decided when medications are not enough or stop being effective or when there are serious complications of the disease such as urinary incontinence, urinary tract infections, urinary stones, hydronephrosis.
The choice of the most appropriate method depends on several factors such as the size of the prostate and the general health of the patient.
Minimally invasive procedures for prostatic enlargement (UROLIFT)
The prostate is a gland surrounding the urethra that runs through the centre of the prostate, from the bladder to the penis, letting urine flow out of the body.
As men age, enlarges and causes blockage of the bladder's outflow, causing symptoms of poor flow, the need to pass urine frequently and urgently, and getting up several times at night to pass urine.
Options for the management of enlargement of the prostate are medications first, and surgery only if there is no improvement or there are side effects from the medication.
The prostate medications can cause tiredness and sexual side effects that affect the quality of men life and surgery can cause potentially long term side effects and prolonged recovery period.
Whilst traditional more invasive options do give excellent results there are now less invasive options. These are procedures which can produce great improvements in symptoms, enable men to stop prostate medications and prevent long term bladder and kidney damage. They produce less side effects, less effect on erections and ejaculation, and can usually be performed in 10-20 minutes, often under local anaesthetic
Surgical options for prostatic enlargement
These operations are performed from the urethra, without cutting the skin.
The classic transurethral resection of the prostate (TURP) is performed using an electric current during which the prostate adenoma is removed in many small pieces.
Another method of transurethral prostate surgery is Laser prostatectomy. In this method, instead of diathermy, laser beams are used either to cut the prostate. Bleeding caused by the use of Lasers is usually the results of both methods are equal and the rates of postoperative urinary incontinence or urethral strictures are small.
More recently, new techniques include putting implants into the prostate under local gel anaesthetic to hold it open (Urolift), or using steam to shrink the prostate (Rezum).
A further option being used is blocking off the blood supply to the prostate (embolisation) to treat very large prostates.
Minimally invasive techniques as Urolift, Rezum and Embolisation are usually performed without the need to stay in hospital, and generally have a faster recovery and less side effects, especially less permanent sexual side effects.
In all prostate surgeries performed for benign hyperplasia, we must remember that the entire prostate is not removed. It remains its shell (the prosthetic capsule). That's why prostate cancer can develop in a surgical patient.