Enlarged prostate

Prostate enlargement is a condition that affects men above the age of fifty. It is not so common in those below forty.

The prostate is a small gland about the size of a walnut. It lies below the urinary bladder and in front of the rectum. It surrounds the urethra that takes the urine from the bladder to the outside.

The prostate produces semen that carries the sperms outside the body. As you age, the size of the prostate also grows gradually. After some time, it will reach the size of a small lemon. When it grows further, it will put pressure on the urethra and the bladder. Once this happens, you will have many symptoms.

You will have these symptoms while passing urine. The pressure on the bladder will make you feel like passing urine more often. But the flow of urine will be weak due to the pressure on the urethra.

There are many tests to detect an enlarged prostate. Ultrasound scans and cystoscopy are the most common ones. Prostate-specific antigen(PSA) tests will help to know your risk of prostate enlargement.

In some persons, medicines will help to keep the symptoms under check. If this does not, help you will need treatments to reduce the size of the prostate. Transurethral resection of the prostate(TURP) is the most common option. If the symptoms are severe, you will need surgery to remove the whole of the prostate.

Symptoms of enlarged prostate

Most of the symptoms of an enlarged prostate are related to urination. Having an enlarged prostate will  

• A weak flow of urine
• Having to strain while passing urine
• Having the feeling that the bladder is not empty after passing urine
• Getting up frequently in the night to pass urine
• Being unable to control the feeling to pass urine even for a short time
• Breaks in the flow of urine
• A drastic increase in the frequency of urination

All these symptoms occur due to the pressure on the urethra by the enlarged prostate. As a result of this, the muscles in the urinary bladder gets overactive. The urinary bladder then tries to contract with more force to push urine out of it.

Causes of enlarged prostate

The exact cause of an enlarged prostate is not very clear. Changes in the cells of the prostate and testes as you age may play a role. The hormonal changes that occur in your body as you grow old may also have a part. A fall in testosterone levels and a rise in estrogen levels is common in those with prostate enlargement.

Complications of prostate enlargement

The prostate gland is a small walnut-shaped gland that lies just under the bladder and in front of the rectum. It surrounds the urethra, the small tube that takes urine and semen out of your body. 

As you grow older, the size of the gland increases to almost the size of a lemon. Then it starts putting pressure on the bladder, making you feel like passing urine more often.

As it grows, the gland also puts pressure in the urethra. It is the reason why you will have a weak flow of urine. It also causes interruptions to the stream.

Risk factors for prostate enlargement

• Your age - Your risk goes up as you age. Almost fifty percent of those above sixty will have the problem. It increases to eighty percent in those above the age of eighty. Prostate enlargement is rare in those below 40.
• Family history- Prostate enlargement runs in families. Having a father or brothers with the condition will increase your risk.  
• Having diabetes- If you have type 2 diabetes, your risk is more. It happens because of an increase in the levels of insulin-like growth factors produced by the liver. IGF can make the prostate grow in size.
• Being obese or overweight- Those who are obese will have higher levels of estrogen in the body. It can result in the enlargement of the prostate.
• Having an inactive lifestyle- If you lead a sedentary life, your risk is more. Staying active helps to reduce risk.
• Having erection problems- Prostate enlargement is more common in those with erection problems. It could be due to a change in the levels of hormones.

Diagnosis of enlarged prostate

There are many ways to find an enlarged prostate. Tests will reveal the size of the prostate helping the doctors to plan the treatment. 

• Digital Rectal Exam.  In this, the surgeon will put a gloved finger into your rectum. The prostate lies close to the walls of the rectum. In there is an increase in size, the doctor will be able to feel it by moving the finger along the walls.
• Urinalysis- In this, a sample of your urine will go to the lab for analysis. It helps rule out other conditions like urinary infections, bladder cancer, etc. with similar symptoms.
• Prostate-Specific Antigen Test (PSA).- Prostate-specific antigen or PSA is a chemical present in the blood of all males. If there is a rise in PSA levels, it indicates a prostate enlargement. It also helps to know a person's risk of an enlarged prostate.
• Urodynamic Tests- These tests help to measure the flow and volume of urine, pressure in the bladder, etc. If the pressure is high and the flow is weak, it points to a block. It could be due to an enlarged prostate.
• Ultrasound scans- It gives an idea about the size of the prostate and residual volume of the urine in the bladder after emptying. A higher residual volume points to a severe block in the flow of urine.
• Biopsy- You will have this to rule out prostate cancer.

Treatments for enlarged prostate

In some persons, medicines will help to keep the symptoms under check. If this does not, help you will need treatments to reduce the size of the prostate. Transurethral resection of the prostate(TURP) is the most common option. If the symptoms are severe, you will need surgery to remove the whole of the prostate.

Some factors that the doctors look into while deciding the treatments are

• Your age- Some treatments can cause sexual problems. If you belong to a younger age group, you will have procedures without these side effects
• Your health- You need to be in good health to have surgery. If you are weak, the doctors may go for minimally invasive procedures with lesser side effects.
• Your symptoms- If the symptoms are mild, you will have medicines. Those with moderate to severe symptoms will need procedures to reduce the size of the prostate.

Transurethral resection of prostate or TURP

It is a minimally invasive surgery to reduce the size of the prostate. It helps to relieve the pressure on the urinary bladder and urethra.

The doctor will do a TURP, by inserting a small wire called a resectoscope through the penis and to the urethra. The doctor will then trim any excess growth to remove the pressure on the urethra and urinary bladder.

It is a safe procedure with very few risks and complications. You will have it if the symptoms are moderate or severe.

The duration of the procedure will be around an hour. You will be in hospital for a day.

Transurethral incision of the prostate or TUIP

You will have this procedure if your symptoms are moderate. The surgeon will make a few cuts in the prostate gland in the areas where it puts pressure in the urethra and bladder. For this, the surgeon will insert a resectoscope through the tip of the penis into the urethra. The surgeon will not remove any part of the prostate during this.

Prostatectomy

It is surgery to remove a part or whole of the prostate gland. If the surgeon feels that your symptoms will get better by removing a small section of the prostate, you will have a partial prostatectomy. During a radical prostatectomy, the surgeon will remove the whole of the prostate.

Laser Prostatectomy is a new mode of treatment. The advantages are less bleeding and reduced hospital stay. It is a safe procedure for patients who are on anticoagulants.