It is the commonest cause of urinary symptoms also known as LUTS (lower urinary tract symptoms) after the age of 50 years. There is enlargement of prostate gland which encircles the bladder neck. By involving the urethra, an enlarged prostate can directly block the passage of urine.

 

It is also known as Benign prostatic hyperplasia (BPH)

 

BPH is present in 10% of all men by the age of 40, rising to 90% by the age of 80 years. Inspite of enlarged prostate, not every person develops symptoms.

Most men with BPH and mild symptoms do not suffer any complication related to their condition. Moderate to severe symptoms with accompanying impairment of quality of life is significant problem in around 50% of men with enlarged prostate. 

 

Symptoms

 

 A weak urinary stream 

 Need to pass urine more often, especially at night 

 Feeling that the bladder does not empty well

 Difficulty in starting urination 

 Urine Dribbling 

 Requirement to run for the bathroom and leakage of urine sometimes before reaching there.

 

Complications of disease

 

Acute retention of urine

Chronic retention of urine

Recurrent urinary tract infections

Bladder calculi (stones)

Renal failure or renal insufficiency

Bleeding in urine

 

Evaluation of patient

 

A detailed symptom assessment lies in excluding other diseases like prostate cancer and stricture of urethra. Factors like water intake, bladder volume, emotions and medications influence the final conclusion by the urologist. Nocturia is particularly troublesome symptom to treat.

DRE (Digital rectal examination - examination of prostate through back-passage using lubricated finger) is the most important investigation. The other tests include investigations like sonography, urinalysis, urodynamic study, PSA and cystoscopy  .

Many men with small prostate sizes are highly symptomatic and some men with large glands report minimal symptoms.

 

Medical Treatment

 

The patient’s perception of symptom severity and the degree to which it interferes with quality of life determines the choice of therapy. The quality of life of the partner is also taken into consideration. Frequent urination at night results in sleep deprivation and significantly impacts quality of life. For patients with bothersome symptoms, medications called alpha-blockers are prescribed by the urologist. Around 70 % respond favourably to these medicines. Addition of certain other group of medicines like alpha reductase inhibitors and anti-cholinergics may be beneficial in some patients.

 

Complications of medical treatment

 

Inspite of medications 30% all treated patients will report back to doctor with complications of prostate enlargement. Most of them will have non-responsiveness to therapy.

 

Surgical Treatment

 

Surgery for enlarged prostate is indicated and effective in patients with any of the complications due to enlargement of prostate or those in whom medicines have not worked.  

 

Types of surgery

 

• TURP- transurethral resection of prostate

• Open prostatectomy – still valid for small number of patients with very large prostates.

• Laser enucleation of prostate

• Laser vaporization of prostate

 

Complications of Surgery

 

• Bleeding

• Infection

• Strictures

• Rarely incontinence

 

Case Study 

 

Case 1 - A 75 year old married man with sedentary lifestyle developed bothersome LUTS which coincided with starting of medicines for breathing trouble diagnosed as COPD.

On examination, DRE showed prostate of more than 40 grams. His kidney functions were normal. An ultrasound revealed a well defined mass arising from prostate and extending in bladder- also called median lobe enlargement. He had high residual urine-600 ml. He was catheterised and alpha blockers were started.

The patient responded well to medicines and a trial of passing urine without catheter after 3 weeks was successful and he is on a regular follow up with us.

 

Case 2 - A 65 year old widower noticed over a period of 2 years that his urine has become more frequent and he has to pass urine urgently. Occasionally he had bed wetting especially during cold season.

On examination he had a palpable bladder and enlarged prostate. Investigations revealed benign enlargement of prostate and chronic retention of urine with kidney insufficiency.

He was catheterised for a period of 6 weeks when his kidney function became normal.

He underwent TURP (Endoscopic prostate surgery) successfully with complete recovery of kidney functions.