Medicosnext
I am not sure who will read this article. If doctors read it, informations may seem very superficial. At the same time, it may feel hard to understand by non-medicos. So, I will try to make it useful for both groups.
Prostate is a male sexual organ that lies just beneath the urinary bladder. Its normal weight is 15-20 g, and it surrounds the urethra just after leaving the urinary bladder. We do not know the real function of prostate gland. What we know is, it helps in nourishment of spermatozoa and increases semen volume. By the age of 45, many hormonal changes do occur in men’s bodies that lead to enlargement of the prostate gland. Benign prostatic enlargement (BPH) is not cancerous. It does only enlarge in size, but does not metastasise (spreads) in other organs, as it does in prostate cancer. But, in early stage, all symptoms of benign or cancerous prostate may be similar.
As you see in the picture, enlarged prostate squeezes the urethra from all around, so urine does not flow out easily. Thus, mainly two groups of symptoms can be present with enlarged prostate. One is voiding, and another is storage symptom.
Voiding symptoms
1. Straining: To overcome the resistance in urethra caused by prostatic compression, the patient needs to use abdominal pressure to pass urine.
2. Incomplete voiding: Even after urination, the patient does not feel that his urinary bladder is empty, he still feels some residual urine in bladder.
3. Hesitancy: Initiation of urination is delayed even after the patient wants to pee.
4. Retention: At the end, the patient cannot void the urine at all.
Storage symptoms
1. Increased frequency: During urination, the patient cannot empty his urinary bladder. So, again after a short while, he feels the urge to urinate.
2. Nocturia: It is similar to increased frequency, but the patient needs to wake up at night to pee.
3. Urgency: Once the patient feels the urge to urinate, he cannot hold urine and immediately needs to go to bathroom. In some cases, he wets his undergarment.
Symptoms of benign enlargement of prostate do not correlate with its size. Even small prostate can give severe symptoms, and large prostate may be asymptomatic.
The above-mentioned symptoms are common in men with enlarged prostate, but all symptoms may not be present. Once disease progresses and is not treated in time, it may develop complications. Urinary tract infection, urinary bladder stone formation, inguinal hernia, blood in urine, and ultimately, kidney failure, are some complications of benign enlargement of prostate.
Investigations
Similar symptoms may be seen in other conditions like urethral strictures, neurogenic urinary bladders, prostate cancer, urinary tract infections, urinary bladder stones, urinary bladder cancers, and many others. So, to rule out those diseases and confirm the diagnosis of benign enlargement of prostate, a few investigations are mandatory. Urine test, kidney function test, haematological test, uroflowmetry test, and ultrasound are basic investigations that are done in patients suspected with benign enlargement of prostate. In some cases, blood PSA test and urodynamic study also may be required.
Treatments
Some patients with benign enlargement of prostate may not require any treatment, and some may require surgery. So, depending upon the symptoms, treatment is divided into watchful waiting, medical therapy, and surgery.
Watchful waiting: If the patient has enlarged prostate, but its symptoms are mild and do not bother him much, such patients can be kept in watchful waiting only. He does not require any treatment.
Medical therapy: If patient has moderate symptoms that bother his daily activities, then he needs medicines. The medicines that are prescribed to patients with benign enlargement of prostate act for 24 hours only. They relax the muscle fibers in the prostate gland and eases the passing of urine. These drugs may lower blood pressure, so giddiness is the main side effect of the drug. In some patients, visual problems also may arise.
Surgery: If the patient does not feel better with medicines or develops complications like urinary bladder stones, blood in urine, hernia, or kidney failure, then he needs surgery.
Nowadays, minimal invasive prostate surgery is available. In such a procedure, only the patient’s lower half of the body is anaesthetised, and without any incision a working instrument is passed through the urethra, and the prostate gland is removed. The patient can watch the entire operative procedure without any pain.
Main complications of prostate surgery are bleeding, which may occur up to six weeks after surgery. Urethral stricture, which is late complication of surgery, may be encountered in less than 5% of the cases. Retrograde ejaculation, or dry ejaculation, is the consequence, and not a complication of the surgery. If patient is still willing to have children, surgery is not advisable. Erectile dysfunction may be seen in a very small number of cases. Urinary incontinence (inability to hold urine) after surgery is a rare entity nowadays. It is mostly due to incorrectly selected patient or technical error.
Many patients ask, “Does prostate gland re-grow after surgery?” The answer is yes. In the prostate, there are three zones. In case of benign enlargement of prostate, we remove only its innermost part, which compresses the urethra. Not like in prostate cancer, when we remove the entire prostate gland. So, definitely, prostate does re-grow, but to reach its previous size, it takes about 10-12 years, but that does not mean he will need surgery again.
Key Points
1. Symptoms of benign enlargement of prostate do not depend on its size.
2. Similar symptoms may be seen in other diseases also.
3. Not all cases of benign enlargement of prostate require treatment, but when the prescribed medicines are not tolerated, or they do not improve symptoms, or complications of enlarged prostate are noticed, then surgery is the only answer.
4. Surgery is minimally invasive and performed without incision.
5. Surgical complications are encountered in less than 5% cases.
