Enlargement of Prostate - Symptoms, Treatment and Side Effects

Friday 9 March 2012

The prostate gland is a walnut-sized gland that is located below the bladder and in front of the rectum, and surrounded by the urethra (urinary passage). The prostate gland produces fluid which forms part of the semen that carries the sperm on ejaculation. The gland starts to increase in size from puberty onwards, and there is a greater rate of increase from 40 years of age onwards.

Symptoms of Enlarged Prostate Gland

The reason for the enlargement of the prostate gland (benign prostatic hyperplasia (BPH)) is not very clear. Symptoms of enlarged prostate glands (generally classified as lower urinary tract symptoms), include:
  • slowing down of the urinary stream
  • straining to pass urine
  • delayed start of the urinary stream
  • dribbling at the end of micturition
  • feeling of incomplete emptying of bladder
  • inability to pass urine (urinary retention)
  • incontinence of urine
  • passing urine more frequently
  • waking up at night to pass urine, usually more than twice a night
  • strong and sudden urges to pass urine
  • pain during urination
  • blood in the urine
These symptoms can be assessed using the International Prostate Symptom Score (IPSS), consisting of questions grading the severity of each symptom. The IPSS score is from 0-35, wherein 0-7 is mild, 8-19 is moderate and 20-35 is severe.

Other Conditions that give rise to these symptoms include:
  • urinary tract infection
  • bladder stones, bladder tumours
  • narrowing of the urethra (urethral stricture)
  • patients with neurological (related to nerves) problems
  • post-micturition dribble (the few drops of urine still remaining in the urethra (after passing urine) that will trickle out)

Diagnosing Benign Enlargement of Prostate

Some of the tests carried out to help diagnose the benign enlargement of prostate (BPH) include:

1) Urine analysis to look for evidence of possible infection and presence of blood.
2) Blood test to assess kidney function to ensure that the enlarged gland has not resulted in obstruction that could lead to impairment of kidney function.
3) Urine flow test to measure the speed of the urinary flow.
4) Blood test for prostate specific antigen (PSA). PSA is a protein produced by the prostate cells. The PSA Test measures the level of PSA in the blood and is a marker for prostate cancer. However, PSA alone cannot be used to determine if a patient has prostate cancer.
5) Measurement of residual urine in the bladder by performing an ultrasound.

Treating Benign Enlargement of Prostate

1) Watchful Waiting
BPH needs treatment only if the symptoms are bothersome or if the enlargement is giving rise to life-threatening complications.

2) Medical Treatment
  • Alpha blockers help makes the flow of urine faster.
  • 5-Alpha Reductase Inhibitors helps reduce the size of the prostate gland.
3) Surgical Treatment
  • Transurethal resection of the prostate gland operation. It doesn't result in any external scar.
  • Laser prostatectomy is used to vapourise, resect or enucleate the prostate gland.
  • Open prostatectomy operation, for very large glands.
  • Other minimally invasive procedures such Needle Ablation (TUNA), Microwave Therapy (TUMT), High Intensity Focused Ultrasound (HIFU) or urethral stent.
Risks associated with surgical treatment include:

Alternative treatments, especially saw palmetto and pumpkin seeds are very popular worldwide, used by men with lower urinary tract symptoms. However, the evidence for the efficacy of these products is lacking.

Generally, patients with mild symptoms and minimal impact on their quality of life is advised to stick to watchful waiting. Patients who have failed medical treatment or those with certain complications (impaired kidney function, bladder stone, recurrent bleeding from the enlarged prostate gland) may need to consider surgical treatment.

(Source: StarFit4Life, Obstruction Ahead! by Prof Dr Azad Hassan Abdul Razack, 12 February 2012)

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