What is a Prostate? Where is it?
Only males have a prostate. It is a gland in the male reproductive system, located just below the urinary bladder. As shown in the diagram, it surrounds a part of the urethra, (the tube that carries urine from the bladder, out through the penis).
What does the prostate do?
The prostate contributes to the milky fluid that carries the sperm produced by the testis. The prostatic fluid is also thought to supply nourishment for the sperm. Since the prostate contributes a portion of the semen volume throughout the better part of a man’s life, many men are able to father children well into their 70’s and 80’s.
What is benign prostatic hyperplasia (BPH)?
BPH is the non-cancerous enlargement of the prostate gland in males. Throughout childhood the prostate is very small. It begins to enlarge during puberty and approximately doubles in size; then the growth slows. At about age 45, the prostate often starts growing again and continues to enlarge for the rest of man’s life. This is considered to be due to hormonal changes. The degree of this enlargement varies in each person.
The enlargement itself is not the problem. As it continues to enlarge, it can frequently start to squeeze the urethra (like pinching a straw). This can interfere with the normal flow of urine and cause uncomfortable symptoms.
An enlarged prostate generally does not interfere with sexual functioning. But severe urinary symptoms however can be embarrassing and inhibit a man’s sexual activity.
Do all males suffer from symptoms of an enlarged prostate?
Not so. 4 out of every 10 men over age 55, 7 out of 10 men in their 70’s, and by age 80, an even larger number, suffer from symptoms of an enlarged prostate.
What are the urinary symptoms of an enlarged prostate?
One or more of the following:
- Frequent urination, especially at night
- Sudden, uncontrollable urge to urinate
- A poor urine stream
- A sense of incomplete bladder emptying
- Difficulty in starting urination
- Incontinence of urine
- Total blockage of urine
- Bleeding in the urine
- Urine infection
How is BPH diagnosed?
- Your doctor will take a detailed medical history, including past and present medical problems
- He will examine the prostate gland by inserting a gloved, lubricated, finger into the rectum
- Check for any other medical problem that may be causing similar symptoms
- Check your urine for presence of infection
- Do a urine flow test to measure the force of your urine stream, and the degree of block
- Do an ultrasound scan to get details of the prostate gland, its effects on the kidneys if any, and the amount of urine in the bladder after urinating
- Do an urodynamic study, if needed, to check bladder pressure
- Other tests such as x-rays, biopsy, cystoscopy etc., if indicated
Are all enlarged prostates treated?
Just because the prostate is enlarged, it does not need to be treated. If your symptoms are mild you may not need any treatment at all. If your symptoms are severe, or if the result of the tests shows that the urinary tract is significantly affected, you must undergo early therapy.
What are the management options?
Depending upon the severity of your symptoms, several management options are available. Your
Urologist will discuss these options with you before deciding on any one method.
- MEDICAL MANAGEMENT
These are suitable only for mild symptoms and when the degree of obstruction is not severe. These medications have to be taken on a long-term basis, and have a proven benefit in well selected patients. Depending upon the drug used, you may experience minor side effects.
Drugs such as 5 alpha-reductase inhibitors are supposed to act by reducing the size of the enlarged prostate over a long period of time. These however are not suitable for all types of prostates, and give relief for prostate sizes of over 30 gm.
Other drugs such as alpha-blockers, relax the smooth muscle component in the region of the prostate and partially open up the passage. These give only symptomatic relief.
- SURGICAL MANAGEMENT
Currently the best method of treatment. The gold standard among various surgical options is the transurethral resection of the prostate (TURP). This is done by passing an endoscope through the urinary passage (urethra) and the inner core of the gland is removed, widening the passage.
What are the post operative effects of this surgery that I must know?
About 25 to 95% of patients have failure to ejaculate after intercourse, as the semen is pushed backwards into the bladder instead of the outside. Very rarely, less than 1% of people have leaking of urine either on straining or continuously. Decreased erectile function is known to occur with aging. However erectile impotence attributable to TURP itself is less than 30%. Post-op stricture incidence is common to all forms of endoscopic intervention and is around 7%. Less than 10% of patients may have recurrence of BPH over 5-10 years requiring re-resection.
All tissue removed at the time of surgery will be sent for examination to confirm the benign nature of the gland. Very occasionally the presence of malignancy may be a surprise report.
Treatment for BPH does not eliminate future incidence of prostate cancer, as this originates in an entirely different portion of the gland. Therefore annual evaluation may still be considered important for men who have undergone surgery for benign prostate gland enlargement.