Enlarged Prostate

An enlarged Prostate is about as inevitable as grey hair.
By the time we are in our middle ages 1 in 3 of us will have an enlarged Prostate.
But dont worry. It ain’t that serious.

Prostate enlargement or Benign Prostatic Hyperplasia is a natural part of the ageing process which starts at about age 25 but rarely becomes noticeable until middle age when the enlargement produces symptoms.


But first things first…

What is it?
Your Prostate is a gland about the size of a walnut and it is situated at the neck of your bladder. It is wrapped around the junction of the urethra which is the tube that carries urine from the bladder down the penis and the Vas Deferens Which carry sperm from the testicles, and join the urethra just below the neck of the bladder.

What does it do?…
Not much is known about the function of the Prostate apart from the fact that it helps in the production of seminal fluid (The white fluid which carries sperm that you ejaculate when you ‘come’)

Watch a short video on the anatomy of the prostate

Why does it get bigger?
Your prostate goes through two main stages of growth.
Early in puberty it almost doubles in size, then in your mid twenties it starts to grow again although much more slowly.
By the time we are in our fifties, about a third of us will start to notice prostatic symptoms.
This is because the tissue that surrounds the prostate stops it from expanding, so the effect of growth is to act like a clamp on the urethra.

Enlarged Prostate symptoms can include
  • Poor flow, taking longer to empty your bladder
  • Having to wait for flow to start
  • Unable to fully empty your bladder
  • Dribbling afterwards

If You have an enlarged Prostate you may also feel the need to pee more often, and possibly experience a feeling of increased urgency.

This doesn’t happen at once, the symptoms come on gradually maybe over years and it doesn’t happen to everyone.
The symptoms depend on how much ‘squeeze’ the prostate is putting on the urethra. Some people with BPH don’t experience any symptoms.

What you should do if you have any of these symptoms is go to a doctor…
He will probably start by giving you a Digital Rectal Examination (DRE)br>< This, (‘you guessed it’.)
Involves him inserting a gloved finger into your rectum and feeling your prostate.

For a description of the process by a doctor

Your Doctor will also probably take some blood, which he will have tested for a substance known as Prostate Specific Antigen or PSA.
The levels of PSA in the blood increase with prostate size, also people with Prostate Cancer have high levels of PSA.

So a PSA test serves two purposes one to eliminate Cancer as a diagnosis, and two to provide a ‘benchmark’ to compare future PSA tests against.

Depending on the severity of the symptoms the doctor might send you to a specialist called a urologist, who might carry out some more detailed tests these may include…

  • Urine flow study
    In which the doctor gets you to pee into a special device that measures your flow rate.
  • Cystoscopy
    Where a small camera is inserted down the penis (Don’t worry they numb you first) enabling the urologist to see any narrowing or other obstructions also this camera can go on to look inside your bladder to check it out. Cyscoscopy Video
  • Bladder ultrasound.
    This is a hand held device which measures by sound waves how much urine is left in your bladder after you have emptied it.
These will tell him what treatment (If any) is required.

What are the treatments for enlarged Prostate?
An enlarged prostate on its own normally doesn’t cause health problems, so treatments usually depend on the severity of the symptoms and may be as simple as adopting a ‘wait and see’ strategy which can be reviewed periodically or if symptoms get worse.
One study of men with mild symptoms who had no treatment, after five years shows that…

  • 45% had no change
  • 40% had an improvement
  • 15% got worse.

Should treatment be required there are several options available depending on severity…

Drugs
There are two types of drug currently being used to treat Benign Prostatic Hyperplasia. They are…

  • Alpha blockers
  • 5-alpha reductase inhibitors

Alpha blockers are more common and work by relaxing the muscle around the opening of the bladder and usually give a good result soon after starting them.
But they can have some side effects…
Alpha Blockers reduce blood pressure, and can cause dizziness, especially in the early days of use.
There are also risks of impotence.

5-Alpha reductase inhibitors Work in a different way.
They prevent the production in the body of a hormone called Dihydrotestosterone which is partly responsible for prostate enlargement.
Reducing the amount of Dihydrotestosterone can actually reduce it!
As with Alpha Blockers. Side effects can also include erectile dysfunction, and impotence.
The good news is that these side effects are reversible upon stopping the medication.

For more information on prescribed drugs.
Uk licensed Drugs US Licensed Drugs

For more serious cases of enlarged Prostate there are the surgical options These are...

  • Transurethral surgery
  • Open surgery
  • Non Invasive Surgery

Transurethral surgery
Involves the placing of instruments down the penis to carry out the surgery
There are two procedures...

The first is called
Transurethral resection of the prostate or TURP
In which an instrument is used to cut away the prostate tissue around the urethra enabling better flow.
There are downsides to this procedure…

  • It may not help with urgency problems
  • There is a 10% risk of becoming impotent
  • There is a 1% chance of incontinence
  • 50% of men suffer from ‘Retrograde ejaculation’
  • In which due to the removal of tissue semen flows into the bladder rather than down the penis. This is harmless as the semen is expelled with urine but it’s no good if you want to become a father.

Turp Video

The second operation is called

Transurethral Incision of the Prostate (TUIP)
Similar to TURP but in this case small cuts are made into the bladder neck and the prostate allowing a slackening of the pressure.The advantage of this is that it gives the same relief from symptoms and there are no side effects as in TURP. But the long term effectiveness isn’t known.

Open surgery
This is only done in really serious cases and for removal of the prostate which we will look at elsewhere

‘Non-invasive’ surgical options.
These all basically do the same thing as TURP, widen the obstruction caused by enlargement of the prostate and consist of putting some sort of instrument down the penis.

The more common ones are…

  • Transurethral Microwave Thermotherapy
  • This involves inserting a device about the size of a pencil down the urethra which uses microwaves to burn away tissue to enable better flow. But it doesn’t help with incomplete bladder emptying
  • Water-induced thermotherapy
  • Again an instrument is placed into the penis and hot water is used to open up the constriction
  • Transurethral needle ablation (TUNA)
  • In this treatment the instrument has two needles which deliver low level radiofrequency to burn away tissue.

At the moment there is some doubt about the effectiveness of these techniques compared with TURP

Living with an enlarged prostate
As you can see from the above living with an enlarged prostate shouldn’t be that difficult.
If a wait and see policy is advised you can help yourself by...

  • Taking care when you drink. Such as before going to bed, try not to drink for a couple of hours before retiring.
  • Avoid drinking caffeine and alcohol as both of these will increase your need to pee.
  • After you have finished peeing wait a while and go back and try again this should help to ensure your bladder empties fully
  • Try to train your bladder by holding on for say half an hour after you first get thr feeling you want to pee after a weel extend it to an hour and so on until you can hold it for four to six hours in between
All the above should of course be discussed with your doctor first.

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