Enlarged prostate is an age related problem in males. I have not used the terms disease or disorder as it is a natural corollary of aging. It’s like wrinkling of skin, greying of hair, balding etc. There is no male who will not have enlargement of prostate with aging. However when it is associated with urinary problems, a urologist consult is needed.
What are the symptoms of enlarged prostate?
The male is usually above the age of 55 years even though in some men the onset could be earlier. The common symptoms are:
Poor urine stream
Interrupted urine stream
A feeling of residual urine even after urination
Increased urinary frequency
Urgency in urination
Getting up frequently in the night to urinate
Some men will have more significant symptoms like:
Hematuria, i.e. blood in urine
Repeated urinary infections
Blockage of urine.
Of these symptoms blockage to the flow of urine is an emergency and brings the patient to the emergency room of the hospital.
Evaluation:
If the patient has any of these symptoms he is evaluated by a urologist. He does a physical exam which includes prostate evaluation by inserting a finger in the anus. He will also order urine examination to rule out infection, ultrasound examination of abdomen to assess prostate size and other organs. An important test which is usually asked for is serum PSA test. This is a blood test which will detect prostate cancer. It is advisable to do this test in men above the age of 55 years. In case it is abnormal, further tests are done to confirm prostate cancer.
Urine Flow Rate is another test which is sometimes done. It measures the strength of urine stream. The patient is asked to urinate in a reservoir and the flow is assessed.
Treatment:
The treatment of enlarged prostate is either by medicine or by surgery. In the last many years medical management has become the mainstay of treatment. Surgery is reserved for those patients who do not respond to medical management.
Medical management:
These are a group of drugs called alpha blockers. They relax the smooth muscle of the prostate and improve the urine flow. They are very effective and help about 80% of the patients. As the new generation drugs have minimum side effects, they can be used long term. Occasional side effects like hypotension and nasal congestion may force some to discontinue the tablets but it is rare.
Surgeries for BPH:
Surgeries for enlarged prostate or BPH are done in the following conditions:
If the patient has unsatisfactory outcome with tablets.
If the tablets are not available easily. This can happen if the patient resides in rural or far flung areas.
Cost factors. The patient may find the recurring expenditure more than the amount spent on surgery. This is because the tablets have to be taken lifelong.
Side effects: Side effects like dizziness and nose blocks may force some patients to discontinue the tablets.
Blockage of urine: Some patients may have repeated urine blockage which does not respond to tablets. Such people need to undergo prostate surgery.
Repeated Urinary Infections: Tablets are not effective in treating recurrent urinary tract infections. Surgery is the only option in such patients.
Hematuria or blood in urine: Repeated hematuria despite treatment necessitates surgery.
Renal failure: If the patient develops kidney failure due to infections or blockage of urine, then surgery is needed.
Stones in the urinary bladder: If high urine residue in bladder leads to urinary bladder stones formation then surgery is indicated.
What surgeries are done for enlarged prostate?
Prostate surgeries are done endoscopically. An endoscope is inserted through the penis and the obstructing prostate is resected from within using electric current or laser. The surgery takes about one hour to perform. No cuts or stitches are needed. The surgery is done under either spinal or general anesthesia and the hospital stay is 48 hours. Surgeries provide long term relief from obstruction and are very effective and safe. When an electric current is used to resect the prostate, it is called TURP. When laser is used, it is called laser prostatectomy. There are many different lasers like Holmium, Green Light, Diode, Thulium etc. They have minor variations in technology and technique.