Prostate enlargement
Benign Prostatic Hyperplasia (BPH)
Overview
Prostate enlargement is a condition that occurs in men, primarily men over 40 years old. Benign prostatic hyperplasia is the term for the enlargement of the prostate gland. This condition can cause various urinary symptoms, including bladder, kidney, and urinary tract issues. In some cases, an enlarged prostate can block the flow of urine from the bladder.
As the prostate gland is underneath the bladder, the urethra passes through the prostate. When the prostate becomes enlarged, pressure can close the urethra, blocking the flow of urine. Prostate growth throughout a man’s life is normal. It is only where the prostate enlarges to the point of causing symptoms that there is a concern.
The primary factor that causes prostate enlargement is believed to be the gradual change in sex hormone balance as men age. In general, prostate enlargement symptoms are rare in men under 40 years old. By age 80, roughly half of men are affected.
Symptoms
The severity of symptoms varies widely, and they generally become worse over time after first appearing. Typical symptoms include:
- A frequent need to urinate
- Frequent urination at night
- Difficulty beginning urination
- A urine stream that stops and starts
- Inability to empty the bladder
- Weak Urinary Stream
- Urgency of Urination
Prostate enlargement can also lead to urinary tract infections in some cases.
Diagnosis
A physician will ask the patient questions about the extent and severity of their symptoms, their medical history, and their urination habits. They will also likely order a urine test to check for urinary tract infections that can cause many of the same symptoms as prostate enlargement.
A digital rectal exam, in which the physician inserts a finger into the rectum to physically check the prostate for enlargement, is the most direct course for verifying prostate enlargement. Further testing can include a blood test to check for kidney problems.
A prostate-specific antigen blood test is another method for diagnosing prostate enlargement. The blood is denser with these antigens when the prostate is enlarged, so they are easy to identify with a blood test. Similar increases can be seen after recent surgeries or in cases of prostate cancer.
Treatment
Many different types of treatment are available for prostate enlargement. A physician can recommend medication or either minimally invasive or more involved surgery. Many factors go into choosing the best course of treatment, including general health, age, the extent of symptoms, and degree of enlargement.Medication
For mild to moderate symptoms, medication is often the most common treatment. Several different types of medication are effective, including alpha-blockers that relax muscles around the bladder and prostate, medications that shrink the prostate, or a combination of the two.Minimally Invasive Surgery
When medication doesn’t provide results, minimally invasive surgery is often the next choice. Several procedures involve inserting a scope and small tools through the urethra to reduce the prostate through resectioning, incisions, microwaves, or needle ablation.Laser Treatment
In some cases, the removal of excess prostate tissue using a high-energy laser is appropriate. This method can relieve symptoms while also reducing the risk of side effects. It is a standard method in cases with other complications, such as patients on blood-thinning medications.UroLift System
The UroLift procedure was FDA approved in 2013 as a minimally invasive treatment to alleviate the symptoms of BPH by holding the enlarged prostate tissue out of the way. It works in a similar manner to tie-backs used to hold open window curtains. There is no heating, vaporizing or cutting of any prostate tissue. It can be used for men who are considering a more invasive procedure, such as a TURP or a PVP, or it can be used by men who are doing well on medication, but simply want to get off their meds. It allows improvement in urinary symptoms while preserving sexual function.
Your urologist will evaluate you in the office with a cytoscopy and an exam to make sure your anatomy will allow use of the Urolift. You will then be scheduled for an outpatient procedure during which the urolift is placed. After the procedure you will need to void, then you wll be discharged. In the rare event that you are unable to void a small catheter wll be placed for several days, then removed in the office.
It is common to have a small amount of bleeding and urgency for the first several weeks after the procedure, after which you should note improvement in your voing symptoms.
For more information visit:
http://urolift.com/
Transurethral Resection of the Prostate (TURP)
Transurethral Resection of the Prostate (TURP)
Benign prostatic hyperplasia (BPH) is very common. It will affect 50% of men between the ages of 51-60 and up to 90% of men over the age of 80. Common symptoms include frequent urination, urgency, difficulty emptying the bladder or starting urination. This procedure is particularly important in men when have kidney failure due to poor bladder emptying or trouble with urinary infections and/or bladder stones. Transurethral resection of the prostate (TURP) is considered the gold standard for the surgical management of BPH. Approximately 150,000 men have this procedure each year.
It is performed under spinal or general anesthesia. The urologist inserts an instrument called a resectoscope through the penis into the urethra. This instrument uses fluid and a light source to visualize the prostate, as well as an electrical loop that is used to shave out the obstructing prostate tissue. This loop is then used to cauterize and seal any bleeding blood vessels. The resected tissue is irrigated into the bladder and then removed and sent to a pathologist to examine under a microscope. You can think of the prostate as an orange and the obstructing tissue is the inner substance of the orange. The goal is to “shave out” the substance of the orange without injuring the “orange peel” or capsule of the prostate. At the end of the procedure, a catheter is placed into the bladder and is used to continuously irrigate the bladder with fluid. It is typical for a patient to go home the following day or two. It is possible to sometimes go home the same day in some circumstances when a bipolar TURP is performed. There is no surgical incision, and the entire procedure is performed through the penis. The catheter often stays in for a few days and may be removed either at home or in the urologist’s office. When a patient goes home with a catheter, the catheter is attached to a leg bag for convenience. Instructions will be given before one leaves the hospital.
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FAQ's
The various types of minimally invasive and open prostate surgeries all carry a risk of side effects. Among these is retrograde ejaculation, where semen flows to the bladder instead of the penis, urinary tract infections, erectile dysfunction, and bleeding. In very rare cases, loss of bladder control can be a side effect.
In some cases, a prostatectomy, the partial or total removal of the prostate, could be necessary. That is typically only in cases of extreme enlargement or damage to the bladder. The procedure entails an incision in the lower abdomen to remove tissue. This procedure generally requires a brief hospital stay and could require blood transfusions.
There are several simple changes that patients can make to control some symptoms of prostate enlargement. These are generally the same changes advised with other urinary issues. Limiting fluid intake during the evening, avoiding caffeine and alcohol, and scheduling bathroom visits can all help.
In more complex cases, physicians can opt to call for several more advanced tests to understand that patient’s condition more fully. These tests may include a transrectal ultrasound, where an ultrasound probe is used to more closely evaluate the prostate. A prostate biopsy involves taking a tissue sample with a needle to rule out cancer or other conditions.