The Enlarged Prostate
An enlarged prostate is a common term and can be used to indicate many things. Sometimes people have had an examination and were told they have an enlarged prostate, some have urinary difficulty and are told they have an enlarged prostate and some assume that everyone gets an enlarged prostate as they age. The prostate is a gland that produces part of semen and it encircles the urethra that carries urine out of the bladder and out of the body. It does not provide any hormonal or other metabolic function.
The medical condition for enlargement is referred to as BPH or benign prostatic hyperplasia and sometimes benign prostatic hypertrophy. As the name indicates, it is not cancerous. The prostate continues to grow, under the influence of testosterone, as we age. However, it grows at different rates depending on many uncontrollable variables. Symptoms also vary considerably as well. These are typically slow stream, interrupted stream, incomplete emptying, straining to urinate, urinary frequency, urgency and getting up at night to go to the bathroom. Some men have very large prostates and have no difficulties and some men have very small prostates and have great difficulty going. This has to do with the shape or the tone or “tightness”of the gland. We only treat those men that are having problems and desire treatment. If someone has a large prostate and it is not causing them problems, then no treatment is indicated.
When we are discussing voiding difficulty in men we call it “lower urinary tract symptoms” or LUTS for short. This can be from multiple factors so it gets more of a general term or diagnosis. Sometimes it’s the prostate causing the trouble and sometimes it’s the bladder or urethra. The initial evaluation includes a medical history, an examination (and sorry that means a digital rectal exam), urinalysis and a noninvasive bladder ultrasound (bladder scan). Most of the time that is all that is needed for diagnosis.
For men with LUTS from prostate enlargement there are many treatment options. We can observe and we call this “watchful waiting” and intervene if things get worse or become bothersome. In rare instances there can be serious problems from untreated BPH symptoms such as kidney failure, bladder stones and irreversible bladder damage. Evaluation is important to screen for these problems.
There are multiple medications that can help. All of the medications treat the problem and none cure the condition. Most medications work well with minimal side effects but these are rarely serious. However, most medications have a risk of sexual side effects which can discourage men from taking them.
Other treatment options include surgery and other minimally invasive procedures. The most definitive and popular surgery is transurethral resection of the prostate or TURP. Recent advances in this technology allows us to use saline irrigation solution and bipolar energy. This allows plasma vaporization which makes the procedure safer and improves recovery when compared to previous technology.
Most other minimally invasive options such as laser (PVP, HOLEP, Greenlight), steam energy (Rezum), radio frequency ablation (TUNA) and microwave therapy (TUMT) use different types of energy to ablate the obstructing prostate tissue. Each procedure has its set of advantages and disadvantages.
A newer treatment that is minimally invasive that does not cut or destroy prostate tissue is the prostatic urethral lift or Urolift. It is a unique placement of sutures and surgical clips (both of which have been used for decades in the human body) to hold open the prostate. There is rapid recovery and virtually no risk of incontinence or sexual dysfunction. It also allows most men to stop any prostate medication they are taking. Not all men are candidates and an evaluation is required prior to the procedure.
Prostate enlargement is a common problem and we have many treatments that can be custom fit to improve quality of life and minimize long term side effects.
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