Prostate Enlargement-Benign Prostatic Hyperplasia :What Are Your Treatment Options?

Gentlemen, if trips to the restroom require sudden dashes or are marked by difficulty urinating, your prostate may be enlarged. You’re not alone—an estimated 50 percent of men in their 50s have an enlarged prostate.  The prostate, the gland that produces the fluid that carries sperm, grows larger with age. An enlarged prostate, or benign prostatic hyperplasia (BPH), can block the urethra from transporting urine from the bladder and out of the penis.

Don’t resign yourself to living with BPH. Addressing your symptoms now can help avoid problems later. Untreated BPH may lead to urinary tract infections, acute urinary retention (you can’t go at all), kidney and bladder stones and, in severe cases, kidney damage. Treatment options include medications and surgery. When you evaluate these choices, you and your doctor will consider how much your symptoms interfere with your life, the size of your prostate, your age, overall health, and other medical conditions you have.

Symptoms

An enlarged prostate can make it more difficult to urinate. Not all men who have an enlarged prostate experience symptoms. However, about one-fourth of all men in the United States report some trouble urinating.

At first, symptoms may be mild because the bladder muscle is able to compensate for the pressure from the enlarged prostate on the urethra.

The pressure of the prostate on the urethra causes an interrupted or weak stream of urine. Other symptoms include:

·         Difficulty starting to urinate

·         Continuing to dribble after urination

·         A feeling that you have not completely emptied your bladder

The severity of these problems depends on how much pressure the prostate is putting on the urethra.

Another set of symptoms happens when the urine that collects in the bladder causes irritation. These symptoms include:

·         Painful urination

·         A frequent need to empty the bladder, especially at night

·         A feeling of urgency that accompanies the sensation to urinate

·         Loss of bladder control (incontinence)

Potentially serious complications can occur if the bladder does not empty completely. Urine that does not exit the bladder can lead to the growth of bacteria, which can cause frequent urinary tract infections. Also, urinary stones can form in the bladder lining due to an accumulation of debris and chemicals. Broken blood vessels can cause blood in the urine, often because of torn or enlarged veins on the inner surface of the prostate. Blood in the urine also can be caused by the sudden stretching of the bladder wall. If left untreated, urine retained in the bladder can back up into the kidneys, which can cause kidney failure over time.

Diagnosis

Your doctor will ask questions to rate the severity of your urinary symptoms. The doctor will do a digital rectal exam to feel the size, shape and consistency of the prostate gland. Usually, a sample of your urine will be examined for blood or evidence of infection.

Occasionally, your doctor may order tests, such as an ultrasound, to measure the amount of urine in your bladder, or a cytoscopy, in which a lighted tube is inserted through the penis into the bladder. Special tests also can be done to evaluate the muscles and nerves in the bladder, especially if you are having trouble with leakage of urine.

Invasive surgery for BPH includes transurethral surgery, which does not require an external incision, or open surgery, which does. In 90 percent of all surgeries for BPH, the surgeon performs transurethral resection of the prostate, or TURP. Using a resectoscope inserted through the penis, the surgeon removes prostate tissue obstructing the urethra. With TUIP, transurethral incision of the prostate, the surgeon makes incisions in the neck of the bladder and in the prostate. This serves to widen the urethra and increase urine flow.

Laser Surgery

Laser surgery for BPH involves inserting a scope through the penis tip into the urethra. A laser passed through the scope removes prostate tissue by ablation (melting) or enucleation (cutting). In photoselective vaporization of the prostate (PVP), the laser melts excess prostate tissue.

Holmium laser ablation of the prostate (HoLAP) is similar, but a different type of laser is used. The surgeon uses two instruments for Holmium laser enucleation of the prostate (HoLEP): a laser to cut and remove excess tissue and a morcellator to slice extra tissue into small segments that are removed.

Open Simple Prostatectomy

In complicated cases of a very enlarged prostate, bladder damage, or other problems, open surgery may be required. In open simple prostatectomy, the surgeon makes an incision below the navel or, in laparoscopic surgery, several small incisions in the abdomen. Unlike prostatectomy for prostate cancer when the entire prostate gland is removed, in open simple prostatectomy the surgeon removes only the portion of the prostate blocking urine flow.