Benign Prostatic Enlargement :: Erectile Dysfunction :: Urinary Incontinence

Benign Prostatic Enlargement

Benign prostatic enlargement (BPE) refers to non-cancerous enlargement of the prostate gland. It is common for the prostate gland to become enlarged as a man ages. Though the prostate continues to grow during most of a man’s life, the enlargement does not usually cause problems until later in life. The prostate gland encircles the urethra, so problems with urination can occur if the gland restricts urine flow through the tube. As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the gland to press against the urethra like a clamp on a garden hose. BPE rarely causes symptoms before age 40, but more than half of men in their 60’s and as many as 90% in their 70’s and 80’s have symptoms of an enlarged prostate which blocks the flow of urine from the bladder. Benign Prostatic Hyerplasia (BPH) is a diagnosis made by a pathologist when they examine the prostate tissue under a microscope when part of the prostate has been removed by surgery.

The following bladder changes can occur over a period of time secondary to blockage by an enlarged prostate:

• The bladder wall becomes thicker (Trabeculation)
• The bladder becomes overactive. Urgency (defined as a strong desire to pass urine which is difficult to defer) can result even when the bladder contains only small amounts of urine, causing more frequent urination. Nocturia can also occur and refers to getting up more than once at night to pass urine.
• The bladder muscle can weaken over time and lose the ability to empty itself (bladder underactivity). Incomplete bladder emptying can occur.

Symptoms which can be caused by an enlarged prostate are

• Urinating more often during the day
• Need to urinate frequently during the night
• Urinary urgency, which means the urge to urinate is so strong and sudden, you may not make it to the toilet in time
• Urine stream is slow to start
• Urine dribbling some time after finishing urination
• A sensation that the bladder is not fully emptied after urination
• Lack of force to the urine flow, which makes aiming more difficult
• The sensation of needing to go again a few minutes after urinating

Diagnosis

You may first notice symptoms of an enlarged prostate yourself, or your doctor may find that your prostate is enlarged during a routine check-up. The doctor may do a physical examination to assess the condition of the prostate.

The tests vary from patient to patient, but the following are the most common.

Urine Microscopy and Culture

A urine sample is taken to look for signs of blood and infection.

Digital Rectal Examination (DRE)

Your doctor inserts a gloved finger into the rectum to feel the surface of the prostate that lies close to the rectal wall. If your doctor feels something suspicious such as a lump or bump, further tests will be carried out. Other tests are needed to enable a more accurate diagnosis.

Prostate Specific Antigen (PSA) Test

A blood sample is taken by your doctor to check for prostate specific antigen (PSA), which is produced by the prostate and is increased by cellular abnormalities within the prostate.

As men get older the prostate gland grows and so the PSA is likely to rise. A high PSA may indicate some type of prostate disease. The level can be raised due to inflammation of the prostate (Prostatitis) and enlargement of the prostate gland (Benign Prostatic Enlargement).

PSA is a useful tool for diagnosing and monitoring prostate diseases, but further tests are required to confirm which condition is present.

Flow Test

Sometimes the doctor will ask a patient to urinate into a special device that measures how quickly the urine is flowing. A reduced flow often suggests a blockage by the enlarged prostate.

Cystoscopy

In this exam, the doctor inserts a telescope through the opening of the urethra in the penis. This procedure can be done under local anaesthetic or general anaesthetic. The tube, called a cystoscope, contains a lens and a light system, which help the doctor see the inside of the urethra and the bladder. This test allows the doctor to determine the size of the gland and identify the location and degree of the obstruction.

Urodynamic Study

This test is designed to assess the function of your bladder to store and expel urine. Two small tubes are inserted through the urethra into the bladder and a small balloon catheter is placed in the back passage. They help to measure pressure in the bladder during storage and emptying. The bladder is then filled with water to see how much it can hold. You may be asked to cough and bear down during the test to assess the presence of incontinence. Once the bladder is full, you can then pass urine while we measure the pressure your bladder muscle generates and how quickly you can expel fluid from your bladder.

Treatment

Conservative Treatment

If the person has an enlarged prostate but is not bothered by the symptoms, the patient and the doctor may decide to simply wait and monitor the condition regularly. This option requires regular check-ups with the doctor – usually once a year – to see if the condition is getting any worse.

Pharmacotherapy

Your doctor may advise treatment with medications which either relax the muscle in the prostate or shrink an enlarged prostate by decreasing the active male hormone level withint the prostate. The doctor will select the medication that best suits the condition, keeping in mind the person’s general health condition, medical history, medications taken for other conditions and quality of life considerations.

Surgery

Surgery is another option for the treatment of blockage caused by an enlarged prostate. The most common type of surgery is TURP (TransUrethral Resection of the Prostate). A TURP is effective at relieving symptoms quickly. TURP is discussed elsewhere in this website click here to go that section. Prostate tissue can also be removed using laser technology. Click here to read more about Greenlight Prostatectomy.