Overview
A common part of aging in men is the enlargement of the prostate gland, frequently referred to as benign prostatic hyperplasia (BPH), or benign prostatic hypertrophy. The prostate naturally grows as the man matures, however, the enlargement does not typically cause discomfort until later in life.
The prostate is located right below the bladder (as depicted below) while partially wrapping around the urethra. As the prostate enlarges, it applies pressure onto the bladder while constricting or narrowing the urethra, causing an obstruction of urine flow from the bladder through the urethra. Naturally, when any passageway is hindered, we apply more strength or force to push our object through. As we continue to use this energy, we begin to lose the strength we initially occupied and eventually require the same level of energy to apply on now much smaller objects.
Gradually, the bladder becomes stronger and thicker, though making it less flexible and elastic; resulting in an over sensitive bladder that will contract when it contains just small amounts of urine causing you to urinate more frequently. The bladder is now working more often than it used to; in time, it is unable to overcome the effect of the restricted urethra becoming incapable of emptying out entirely (incomplete bladder emptying) and leaving behind urine (residual urine). The remaining urine leaves you at great risk for developing urinary tract infections, amongst other urological conditions.
Symptoms:
- Weak or slow urinary stream
- Urinary Retention
- Incomplete Bladder Emptying
- Urinary Incontinence
- Urinary Frequency
- Urgency to urinate (strong and sudden)
- Nocturia (needing to urinate at night)
- Pain/burn with urination
- Hematuria (blood in the urine)
- Delayed start of urination
Diagnosis
Your doctor will ask you a variety of questions to obtain a thorough medical history. One or more of the following exams and tests are performed for diagnosis:
- Digital Rectal Exam (DRE) – to feel the prostate gland
- Uroflow – checks the urine flow rate
- Urocuff – measures internal bladder pressure as you urinate
- Bladder Scan – measures post-void residual (PVR) or how much urine is left in the bladder after urinating
- Transrectal Ultrasound of the Prostate (TRUS) – small, lubricated probe placed into the rectum to capture video and pictures of the prostate
- Urinalysis – checks for blood and screens for bacteria (infection) in the urine.
- Urine Culture – indicates the type of bacteria growth and lists the antibiotics sensitive to it.
- Prostate-Specific Antigen (PSA) – blood test to screen for Prostate Cancer (see below for more information regarding correlation to Prostate Cancer)
- Cystoscopy – flexible catheter with a camera inserted through the urethra into the bladder to check for any abnormalities within the bladder
- Urodynamic Study (UDS) – study that measures bladder capacity, flow rate and bladder muscles (essentially measures how your bladder functions or works)
Treatment
Once diagnosed, the choice of treatment is relative to the severity of symptoms and any contraindication of other medical conditions.
Medications
A natural product called Saw Palmetto can be taken as a dietary supplement for urinary symptoms associated with an enlarged prostate. It is derived from a species of palm tree and is recommended as an alternative to medication for symptom relief.
Your doctor may also recommend medications. Alpha 1-blockers are used to relax the bladder neck muscle and prostate, allowing for easier urination. Antibiotics are primarily used for chronic prostatitis (a prostatic infection causing inflammation) which may not be linked to BPH, however, they have been noted to aid in short term relief of BPH symptoms.
Surgery
Transurethral Microwave Thermotherapy (TUMT)
A catheter is inserted through the urethra where an antenna is extended to the prostate emitting microwaves. The microwave energy heats up and destroys excess prostate tissue blocking urine flow. Essentially, this procedure shrinks the prostate and increases the passageway allowing for easier urination.
Greenlight Laser of the Prostate
A minimally invasive therapy that vaporizes prostate tissue which is blocking the flow of urine from the bladder. It uses a unique high power laser energy which is selectively absorbed by the blood within the prostate tissue which leads to vaporization and removal of the tissue, leading to an open channel for the passage of urine.
Transurethral Resection of the Prostate (TURP)
A surgical telescope is used to core out the inside of the prostate (surrounding the urethra) creating a larger channel making the passage of urine easier.
Transurethral Needle Ablation (TUNA)
Using a cystoscope, tiny needles are placed into your prostate where radio waves are then passed through the needles creating scar tissue. This tissue then shrinks the prostate tissue to create a larger urinary channel so the passage of urine is easier.
