T he prostate gland is present only in males. It lies underneath the bladder and surrounds the urethra.
It is normal for the prostate to enlarge as a man gets older. Enlargement of the prostate per sé is a natural process of ageing and becomes a concern only when it leads to problems with urination. The exact cause of prostate enlargement is unknown. An increase in age is the main reason for the increase in prostate size in the majority of men. Male hormones (testosterone) are needed for this process and also play a role.
A person with prostate enlargement may suffer from the following symptoms:
- Slow and prolonged urination. Sometimes you feel that you need to push to be able to get the urine out.
- Inability to start urinating immediately when you go to the toilet. You have to wait before urine starts to flow.
- Dribble of urine towards the end of urination. Sometime this results in wet and smelly underwear.
- A feeling of incomplete emptying of your bladder.
- Frequent desire to pass urine. It may be associated with the need to wake up several times at night to urinate.
- Urgency – when you feel that your bladder is full and you need to urinate, you have to get to the toilet very quickly and cannot postpone urination.
- Prolonged blockage of the urethra may lead to damage to the bladder and kidney, which may even result in kidney failure.
- Incomplete emptying of the bladder can result in recurrent bladder infections and even bladder stones.
- Acute retention of urine. This is the sudden inability to pass any urine and is a very painful condition. It will require bladder drainage by placement of a urinary catheter.
- Recurrent bladder infections
- Bladder stones
- Blood in the urine, sometimes with clots.
- Kidney damage / kidney failure.
Any of the following tests may be performed to assess the effects and severity of prostate enlargement:
- International Prostate Symptom Score (IPSS): You may be asked to complete a form that contains a set of questions designed to assess the severity of your urination problems.
- Urine test to check for infection
- Finger examination of your prostate (also called digital rectal examination / DRE).
- Blood tests to check your kidney function.
- PSA blood test to assess your risk of prostate cancer.
- Urine flow test to measure the exact speed of your urination.
- An ultrasound scan / sonart of the kidney is done is some cases.
Patients who have significant bother with urination as well as those who develop any of the mentioned complications of prostate enlargement, require treatment. Your doctor will discuss with you options of treatment based on the severity of your symptoms and test results.
Treatment options include:
- Medication: Your doctor may offer you medication that you will need to take every day. These tablets relax or shrink your prostate so that urination is improved.
- Surgery: Transurethral Resection of the Prostate (TURP): This method of surgery uses a special camera inserted through your urethra to the prostate. The prostate is then cut into small fragments, which are washed away with water. TURP is best done on a patient with a small prostate. TURP can be done under spinal anesthesia or general anesthesia. You need a short admission for this surgery. Most patients go home within 2 to 3 days after surgery. A bladder catheter that is inserted after the operation keeps the bladder free from blood clots in the first day after the operation. In most cases the catheter is removed before discharge from hospital.
- Surgery: Retropubic prostatectomy: During this procedure, the inner part of the prostate is removed via an incision on the lower abdomen. This method is preferred in patients with very large prostates. The duration of hospital stay is usually longer for open prostate surgery than for TURP.
- Prostate enlargement is not related to-, nor does it lead to prostate cancer; prostate cancer can occur in both small and large prostates.
- There is no strong medical proof that confirms the effectiveness of herbal remedies or special diets in relieving prostate symptoms.