Prostate Enlargement

The prostate gland is only found in men and its purpose is to produce fluid to protect and nourish sperm. A normal prostate is the size of a chestnut and is located below the bladder.  The urethra (tube that carries urine out) passes through the middle.

The prostate begins to get bigger around age 50 and by age 90 most men have an enlarged prostate also known as benign-prostatic-hyperplasia. This enlargement makes it difficult to pass urine. Symptoms are usually mild but if they become distressing medical management includes medicines or surgery.

 

The cause is not known but, there are other conditions that can cause an enlarged prostate. These include:

  • Prostate cancer
  • acute prostatitis
  • chronic prostatitis

 

Risk factors for prostate gland enlargement include:

  • age
  • family history
  • diabetes and heart disease
  • lifestyle

 

Symptoms are called lower urinary tract symptoms (LUTS) and can also have other causes. As the prostate enlarges the urethra begins to narrow. This can partially obstruct urine discharge. These symptoms include:

  • weak flow or stopping and starting
  • longer to empty the bladder
  • difficulty initiating urine flow
  • slow dribble at the end of voiding
  • poor emptying
  • frequency
  • nocturia -going to the bathroom many times at night
  • urgency

 

 

When having symptoms it should be discussed with the doctor

Complications of an enlarged prostate can include:

  • Sudden inability to urinate (urinary retention)
  • Urinary tract infections (UTIs)
  • Bladder stones – may cause infection, bladder irritation, blood in the urine or obstruction of urine flow.
  • Bladder damage
  • Kidney damage

Enlarged prostate does not mean an individual will develop complications but, urinary retention and kidney damage can be serious complications and require attention.

An enlarged prostate may have no symptoms. Symptom severity is not always caused by the size of the prostate. Passing blood, incontinence, or pain may also be caused by bladder or kidney issues, or other prostate problems.

Serious complications may occur but are unlikely and include:

  • Total blockage of the urethra
  • Chronic retention ( the bladder does not empty completely) This can lead to infections and incontinence (dribbling).

 

Enlarged prostate generally does not cause any damage or complications. Treatment depends on the severity of symptoms. When symptoms are mild the best option is monitoring symptoms.

When having symptoms it should be discussed with the doctor. Even if symptoms are not bothersome, it is important to identify and rule out any underlying causes.

Benign prostatic enlargement is normally diagnosed based on symptoms. Tests are generally not needed unless there are complications. Testing would be done to rule out causes and give the doctor an idea of prostate size.

Testing includes:

  • physical exam of the prostate
  • urine and blood tests
  • cystoscopy and ultrasound
  • maintaining a voiding journal
  • PSA (prostate specific antigen)

A high PSA can be found with prostate cancer. However, most men with elevated PSA do not have prostate cancer.

Medicines may be used to treat symptoms. They are not a cure and do not make symptoms totally go away. Medication includes:

  • Alpha-blocker – relax the smooth muscle of the prostate and bladder neck
  • 5-alpha reductase inhibitors – block the conversion of testosterone

In some cases,  a combination of medicines may be used. The combination may provide quicker and better relief of symptoms.

Surgery may be an option to treat symptoms. Partial removal of the prostate may be an option for symptoms or if medications are ineffective. Some of these interventions include:

  • Transurethral resection of the prostate (TURP)
  • Transurethral incision of the prostate (TUIP)
  • Open prostatectomy
  • Laser prostatectomy
  • UroLift

 

Overall, enlarged prostate does not always cause symptoms and treatment depend on symptom severity and tolerance of minor symptoms.

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