What is the prostate gland?
This is a walnut-sized gland located underneath the bladder and through it passes the waterpipe (urethra). The prostate's main function is to produce a fluid (prostatic fluid) that nourishes the sperm.
As men age, the prostate cells multiply; hence, the prostate grows in size. This is not a cancer. Medically, this is known as benign prostatic hyperplasia (BPH).
50% of men between the ages of 50 and 59 have enlargement of the prostate. This increases with age; around 80% of men over 70 years have this issue.
Some men do not experience any bothersome symptoms, but many suffer from a myriad of urinary troubles ranging from increased urinary frequency, urgency, poor or intermittent flow, inability to completely empty the bladder and waking up to pee.
What is considered an enlarged prostate?
This can range from minor (under 30 to 40 g), large (above 80g) and extra large (more than 150g).
What are the risk factors for benign enlargement of the prostate?
- Age.
- Family history.
- Metabolic Syndrome
- Obesity.
How are BPH symptoms diagnosed?
The doctor/urologist will enquire about your urinary voiding habits and review your medical history, social habits, and fluid intake.
The physical examination includes an abdominal, genital and back passage exam
A blood panel check that includes prostate-specific antigen (PSA) and kidney function test are commonly ordered.
A urinalysis plus minus urine for cultures is typically ordered.
A flow test and post-void residual to measure the rate of urine flow and the amount of urine that remains in the bladder after urination form part of the initial investigations.
A camera test called flexible cystoscopy can be ordered to assess the lower part of the urinary tract system to delineate any mechanical constraints possibly leading to your water work issues.
How is benign prostatic hyperplasia treated?
First step is Lifestyle changes, which include the following:
- Reducing daily consumption of fluids, especially before bed
- Reducing or avoiding consumption of diuretics like caffeine and alcohol, which can increase urine production and excretion
- Avoiding the use of decongestants and antihistamines, which may increase the retention of urine in the bladder
- Avoid juices, fizzy drinks and spices as they are all irritants to the bladder's inner lining.
- Address any constipation (increase fluid and fibre intake/exercise/use laxatives)
Medication options alone or in combination
- Alpha-blockers (tamsulosin/alfuzocin/silodosin). These medications relax the muscles in the prostate and lower part of the bladder, which results in improved urine flow.
- 5-Alpha reductase inhibitors (finasteride/dutasteride). By suppressing hormones that contribute to the enlargement of the prostate, these medications reduce the size of the prostate by around 20 to 30 per cent.
- Phosphodiesterase inhibitors (Cialis). These drugs, typically prescribed for erectile issues, relax muscles in the lower urinary tract, which increases urinary flow.
- Anticholinergics. For storage lower urinary tract symptoms (frequency and/or urgency) without signs of urinary retention. These medications relax the muscles in the bladder, calming its firing.
Enlarged prostate surgical treatment
When lifestyle changes and medications fail to achieve an improvement, surgery is the next step to be explored. Nowadays, there are various surgical approaches.
Eligibility depends on various factors, including your health status, prostate size and side effect profiles.
ENERGY INTERVENTIONS
Transurethral Resection of the Prostate (TURP). The gold standard to compare each treatment modality with as it has been done over several decades. The surgeon removes prostate tissue using a special loop of wire through which an electric current passes.
Bladder Neck Incision (BNI). When the entry to the bladder (known as bladder neck) is tight and positioned high without major prostatic enlargement the surgeon makes two small incisions from the bladder to the prostate widening the bladder neck this improved flow of urine. Most men can go home the day of surgery.
Laser Surgery. The surgeon uses a laser to remove or destroy prostatic tissue. The main ones employed are
Holmium Laser Enucleation of the Prostate (HoLEP). This is indicated for prostates that are 80g and more. It cores the prostate leaving the capsule
REZUM. Steam is injected through a special needle and destroys the prostate issue.
NON ENERGY INTERVENTIONS
Prostatic Urethral Lift (UroLift)
Prostatic Arterial Embolization (PAE)
iTIND
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