Part 2
By Dr Vineet Naja, MS (GSurgery); MCh(Urology) (Consulting
Urologist and Andrologist)
What is prostate enlargement, or benign prostatic hyperplasia (BPH)?
If you’re a man over 50 and have started having problems urinating, the reason could be an enlarged prostate, or BPH. As men get older, their prostate keeps growing. As it grows, it squeezes the urethra. Since urine travels from the bladder through the urethra, the pressure from the enlarged prostate may affect bladder control.
If you have BPH, you may have
one or more of these problems:
● A frequent and urgent need to urinate. You may get up several times a night to go to the bathroom
● Frequent urination at night may be a sign of an enlarged prostate
● Trouble starting a urine stream. Even though you feel you have to rush to get to the bathroom, you find it hard to start urinating
● A weak stream of urine
● A small amount of urine each time you go
● The feeling that you still have to go, even when you have just finished urinating
● Leaking or dribbling urine
● Small amounts of blood in your urine
Is BPH a sign of cancer?
No. It’s true that some men with prostate cancer also have BPH, but that doesn’t mean that the two conditions are always linked. Most men with BPH don’t develop prostate cancer. However, because the early symptoms are the same for both conditions, you should see a doctor to evaluate these symptoms.
Is BPH a serious disease?
By itself, BPH is not a serious condition, unless the symptoms are so bothersome that you can’t enjoy life. But BPH can lead to serious problems. One problem is urinary tract infections. If you can’t urinate at all, you should get medical help right away. Sometimes this happens suddenly to men after they take an over-the-counter cold or allergy medicine. In rare cases, BPH and its constant urination problems can lead to kidney damage.
What tests will my
doctor order?
Several tests help the doctor identify the problem and decide on the best treatment.
● Digital rectal exam – This exam is usually the first test done. The doctor inserts a gloved finger into the rectum and feels the prostate, which sits directly in front of the rectum. This exam gives the doctor a general idea of the size and condition of the prostate.
● Blood test – The doctor may want to test a sample of your blood to look for prostate-specific antigen (PSA). If your PSA is high, it may be a sign that you have prostate cancer. But this test isn’t perfect. Many men with high PSA scores don’t have prostate cancer.
● Imaging – The doctor may want to get a picture of your prostate using a sonogram. A rectal sonogram uses a probe, inserted into the rectum, to bounce sound waves off the prostate.
● Urine flow study – You may be asked to urinate into a special device that measures how quickly the urine is flowing. A reduced flow may mean you have BPH.
● Cystoscopy – Another way to see a problem from the inside is with a cystoscope, which is a thin tube with lenses like a microscope. The tube is inserted into the bladder through the urethra while the doctor looks through the cystoscope.
How is BPH treated?
Several treatments are available. Work with your doctor to find the one that’s best for you.
● Watchful waiting – If your symptoms don’t bother you too much, you may choose to live with them rather than take pills every day or have surgery. But you should have regular check-ups to make sure your condition isn’t getting worse. With watchful waiting, you can be ready to choose a treatment as soon as you need it.
● Medicines – In recent years, scientists have developed several medicines to shrink or relax the prostate to keep it from blocking the bladder opening.
● Surgical treatment – Surgery to remove a piece of the prostate can be done through the urethra or in open surgery, which requires cutting through the skin above the base of the penis.
Your doctor may recommend open surgery if your prostate is especially large. The most common surgery is called transurethral resection of the prostate (TURP). In TURP, the surgeon inserts a thin tube up the urethra and cuts away pieces of the prostate with a wire loop while looking through a cystoscope. TURP and open surgery both require anaesthesia and a stay in the hospital.
Is TURP the same as
removing the prostate?
A prostate removal, or radical prostatectomy, is usually done only to stop prostate cancer from spreading. If your prostate is removed completely to stop cancer, you’re more likely to have long-lasting sexual and bladder control problems, such as leaking or dribbling. TURP and open surgery for BPH remove only the adenomatous part of the prostate (which causes urine blockage). In a few cases, the prostate may continue to grow, and urinary problems may return. You should continue to have your prostate checked once a year even after surgery, to make sure that BPH or prostate cancer has not developed.
What are the side effects
of prostate treatments?
Surgery for BPH may have only a temporary effect on sexual function. Most men recover complete sexual function within a year after surgery. The exact length of time depends on how long you had symptoms before surgery was done and on the type of surgery. After TURP, some men find that semen does not go out of the penis during orgasm. Instead, it goes backwards into the bladder. In some cases, this condition can be treated with a drug that helps keep the bladder closed.
A doctor who specializes in fertility problems may be able to help if backwards ejaculation causes a problem for a couple trying to have a child.
If you have any problems after treatment for a prostate condition, talk with your doctor. Erection problems and loss of bladder control can be treated, and the chances are quite good that you can be helped.
