Enlarged prostate: Symptoms, Diagnosis, and Treatment

Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is also known as benign prostatic hypertrophy is a condition characterized by an enlarged prostate gland. An enlarged prostate gland is associated with a thin stream of urine flow. In some cases, patients may fail to urinate completely. BPH can also lead to urinary infections, kidney stones and reduced kidney function.

BPH is most prevalent in elderly men over the age of 80. About 8% of men between the ages of 31 and 40 years may also suffer from the condition. 

Symptoms of Benign Prostatic Hyperplasia

The symptoms of an enlarged prostate usually begin after the age of 50.  The most common symptoms include:

  • Frequent urination especially at night

  • Difficulty in passing urine

  • Leaking or dribbling of urine

  • A hesitant or weak stream of urine

  • A strong urge to urinate (urinary urgency)

  • Difficulty in starting to urinate (straining)

  • Urinary incontinence - difficulty in controlling bladder

  • Uncommon symptoms may include blood in the urine, urinary tract infection and inability to pass urine completely.

Diagnosis of Benign Prostatic Hyperplasia

Your doctor will obtain a medical history and perform a physical examination.

 A physical examination involves a rectal exam to check for prostate enlargement.

Your healthcare provider will request some tests such as:

  • Urinalysis to rule out infections and other conditions 

  • Urinary flow test and postvoid residual volume test

  • Blood tests such as a prostate-specific antigen (PSA) test. A high PSA is associated with BPH.

Depending on the test results, your doctor may recommend further testing such as:

  • Cystoscopy

  • Transrectal ultrasound

  • A biopsy of the prostate (transrectal ultrasound-guided biopsy)

  • A urodynamic assessment to check the bladder and urethra 

  • Flow rate and residual ultrasound- a test to check the flow rate of the urine followed by an ultrasound 

Treatment of Benign Prostatic Hyperplasia

Mildly enlarged prostate usually requires no treatment - only observation is recommended. 

Moderate and severe benign prostatic hyperplasia requires treatment. 

The treatment for enlarged prostate includes both conservative and surgical treatment.

Non-surgical Treatment

Lifestyle changes include:

  • Limiting fluid intake hours before sleeping or before going out

  • Avoiding drinks that make you urinate more often such as caffeine or alcohol

  • Avoiding medicines that exacerbate urinary symptoms such as antihistamines, antidepressants, decongestants, and diuretics. 

  • Doing pelvic floor exercises (e.g. Kegel exercises) for strengthening the pelvic floor muscles

Medications

Your doctor may prescribe medications to relax your bladder and prostate muscles to aid urine passage.

Surgical Treatment

Transurethral resection of the prostate (TURP): A most common type of surgery used for enlarged prostate. In this surgical procedure, prostate tissue is removed through the urethra using a resectoscope. 

Other surgical procedures include:

  • Laser prostatectomy: A procedure that kills the prostate tissue using laser and cystoscope. 

  • Prostatectomy: It is the removal of the prostate and it is used in rare cases only. It is used in circumstances such as failed procedures, a very enlarged prostate, and a completely blocked urethra.

  • Transurethral incision of the prostate: Small incisions are made in the prostate that helps to ease pressure on the urethra. 

  • Transurethral electrovaporization: An electrode attached to a resectoscope is used to heat prostate tissue until the tissue is destroyed. 

  • Prostatic urethral lifts: These are implants that are inserted in the prostate to keep it away from the urethra. 

  • Radiofrequency ablation: This technique involves applying heat to specific areas of the prostate. 

  • Microwave thermotherapy: It involves applying heat to kill excess prostate tissue. 

  • Suprapubic catheter: It is a temporary solution to control bladder outlet obstruction before surgery. 

Life after Surgery

Post-surgery, it will take a few weeks to recover. 

Usually, after surgery, you will remain in the hospital for one or two days.

The recovery time depends individually. Most patients recover within 6-8 weeks. 

Your doctor may recommend the following for a quick recovery such as

  • Drinking plenty of water

  • Including fibres in the diet to prevent constipation

  • Avoiding sex for 4-6 weeks

  • Avoid strenuous exercise

Consult your doctor immediately if you have any of the following symptoms:

  • Fever

  • Redness or swelling at the surgical site

  • Pain or burning sensation while urinating (if more than a few days)

  • Blood in urine

  • Nausea or vomiting 

Your doctor will obtain a medical history and perform a physical examination including a rectal examination. Tests such as urine tests and blood tests including a prostate-specific antigen (PSA) test are required. Additionally, some other tests such as cystoscopy and imaging tests may be recommended in some patients. 

 

 

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