Prostate enlargement - MITR

Prostate enlargement

Benign Enlargement of Prostate

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