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ENLARGED PROSTATE GLAND

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ENLARGED PROSTATE GLAND

An enlarged prostate gland is a non-cancerous increase in the size of the prostate, considered a natural process of aging.

  • The medical term for an enlarged prostate gland is benign prostatic hyperplasia (BPH).
  • The prostate is a small, muscular gland found in a man’s lower abdomen just below the bladder. It surrounds the urethra, the tube through which urine passes out of the body.
  • This walnut-sized gland found in men secretes the seminal fluid that nourishes and carries sperm.
  • A man’s prostate gland usually starts to increase after the age of 40.
  • The condition affects about 1.5million people globally.
  • An enlarged prostate can lead to complications such as urinary tract infections, bladder stones, bladder damage, and chronic kidney problems.
  • Having an enlarged prostate does not increase the chance of developing prostate cancer.

CAUSES

The exact cause of the condition is unknown. However, changes in the balance of sex hormone as men grow older may play a large role.

The prostate cell increases gradually, resulting in an enlargement that put pressure on the urethra – the passage for urine and semen.

In the early stage of the condition, this pressure on the urethra causes it to narrow, forcing the bladder to contract powerfully to push urine out of the body.

As the prostate grows larger and the urethra is squeezed more tightly, the bladder muscle begins to contract even with small urine, causing a frequent need to urinate.

Eventually, the bladder is no longer able to compensate for the effect of the narrowed urethra so urine is not completely emptied from the bladder.

This may result in backing up of urine, which in turn may cause recurrent urinary tract infections and other complications associated with the condition.

Risk factors may include:

  • A family history
  • Obesity
  • Type 2 diabetes
  • Erectile dysfunction
  • Aging
  • Certain medications like calcium channel blockers, anticholinergics, pseudoephedrine may worsen symptoms.

SYMPTOMS

  • Urgent or frequent need to urinate
  • Difficulty starting urination
  • Inability to completely empty the bladder
  • Increase urinating frequency at  night
  • Dribbling at the end of a urinary stream
  • Involuntary urination
  • Pain during urination
  • Abdominal pain
  • A continuous feeling of a full bladder
  • Slow urine flow
  • Straining to urinate.

Less common symptoms

  • Blood in urine
  • Inability to urinate

DIAGNOSIS

To make a diagnosis, the doctor will begin by reviewing your medical history and asking about your symptom.  Initial exams may include:

  • A rectal exam where the doctor inserts a finger into your rectum allowing him to estimate the size and shape of your prostate.
  • Urine test to rule out other medical conditions or infections that can cause similar symptoms.
  • A blood test which can indicate kidney problems
  • Prostate-specific antigen blood test. An increase in the level of PSA, a substance produced in the prostate may indicate an enlarged prostate. However, an elevated level of PSA may be due to surgery, prostate cancer, or infections.

Additional tests may be recommended to help confirm an enlarged prostate and rule out other conditions. These may include:

  • A urinary flow test to measure the strength and amount of urine flow.
  • Postvoid residual volume test to measure whether you can empty your bladder completely.
  • Transrectal ultrasound to measure the size of your prostate
  • Prostatic biopsy where a small amount of prostate tissue is removed and examined for abnormalities.
  • Cystoscopy where a tiny lighted scope is inserted into your urethra to examine the bladder and urethra
  • Urodynamic test to measure the pressure of the bladder during urination after your bladder is filled with water via a catheter.
TREATMENT

Treatment options may include medication, surgery, or laser therapy. Treatment options may depend on the size of your prostate, your age, overall health and amount of discomfort you are experiencing.

Medications such as:

  • Alpha blockers including alfuzosin, doxazosin, tamsulosin.
  • Tadalafil (Cialis) which is often used to treat erectile dysfunction, can also treat the condition
  • 5-alpha reductase inhibitors which include finasteride and dutasteride
  • Combination therapy that combines alpha blockers and a 5-alpha-reductase inhibitor.

Minimally invasive surgery which is recommended if medications are ineffective or you have a urinary tract obstruction, bladder stones, kidney problems, or blood in the urine.

This may include:

  • Transurethral resection of the prostate (TURP).
  • Transurethral incision of the prostate (TUIP)
  • Transurethral microwave thermotherapy (TUMT)
  • Transurethral needle ablation (TUNA)

Laser therapy where a laser destroys or removes prostate tissues that are overgrown.