What is benign prostatic enlargement?
This condition is very common in men over the age of 50 years. It’s not a serious threat to health but it affects your quality of life more frequently.
The prostate gland is found only in men and it is located below the bladder and the urethra (urinary passage) runs through the prostate. It’s an important gland in the male reproductive system. It basically involves in the production of semen.
The prostate producers prosthetic fluid which is a thick white fluid. This fluid mixes with the sperm to create the semen.
It often enlarges after the age of 40 years. The enlarged prostate progressively squeezes the urethra and make urine flow difficult. This sometimes lead to weak or intermittent stream. It also leads to the bladder taking longer to empty the urine or not emptying completely. The continued growth of prostate could lead to loss of normal bladder function leading to acute urinary retention (AUR). Therefore common symptoms are difficulty starting urination, frequent need to pass urine and feeling of incomplete emptying of the bladder.
The symptoms may vary from individual to individual. Some men may require treatment but some with mild symptoms can be managed conservatively.
Enlarged prostate does not increase the risk of you developing prostate cancer.
What causes BPH?
Male testosterone hormone leads to production of dihydrotestosterone (DHT) by the enzyme 5-alpha reductase. As men grow older, there is a accumulation of DHT leading to increasing growth of prostate cells. This in turn causes prostate enlargement.
What other common symptoms?
Men present with varied symptoms from being asymptomatic (incidental finding during routine medical checkup) to coming into the emergency with acute urinary retention.
The common ones are:
- difficulty to start urination
- frequent toilet visits
- waking up at night to urinate
- urgency (unable to delay when there is and urge to pass urine)
- terminal dribbling and incontinence
- weak urine stream
Why should BPH be treated?
If untreated the enlargement could lead to:
- acute urinary retention needing catheterisation
- recurrent urinary track infection
- formation of bladder stones
- renal failure
How is BPH diagnosed?
During your visit to your urologist, there are certain test and questionnaire that might be done to confirm the diagnosis. Most often the diagnosis is confirmed by the history alone.
Your urologist might perform some urine tests and if required blood test. There might be a need to perform digital rectal examination to look for other associated pathology.
You might also need to use a uroflow meter to look at the flow rate. This results will be interpreted by your urologist. Click here to read a patient instruction sheet on uroflow in both Bahasa Malaysia and English.
Some individuals with very minimal symptoms can be managed conservatively, without any medication if your doctor feel so.
Most individuals require oral medication which is taken at night to relax the prostate and relieve the obstruction and improve symptoms. These medication has its own side-effects which will be explained to you by your urologist.
In certain individuals with enlarged glands there might be a need to start on dual medication, one to shrink the prostate and the other to relax the muscle.
Individuals who fail to respond to the medication or develop acute urinary retention, unable to tolerate the medication due to the side-effects, develop renal failure secondary to the obstruction, has recurrent urinary track infection, has a very high residual urine in the bladder require surgical intervention.
The surgical intervention basically involves enlarging the urinary passage within the prostate. The modality by which this is done varies from individual surgeons but the basic principle is the same.
Commonly done procedures are:
- TURP (transurethral resection of prostate) using monopolar or bipolar resectoscope
- laser enucleation of prostate (HoLEP)
- Greenlight laser vaporisation
Side effects of alpha-blockers
- Dizziness (especially upon standing suddenly), vertigo, lightheadedness, fainting
- Heart palpitations
- Nasal congestion, stuffiness, sinusitis, runny nose, sore throat, cough, infection
- Headache, drowsiness, fatigue, weakness
- Fluid retention, edema, swollen hands or feet
- Urinary incontinence
- Back pain
- Digestive distress, heartburn, nausea, diarrhea
- Lower libido, abnormal ejaculation (reduced semen or retrograde ejaculation into the bladder)
- Prolonged and/or painful penile erections (priapism)
- Intraoperative Floppy Iris Syndrome (IFIS) [this can cause problems during cataract surgery!], blurred vision
- Rash, itching or hives [notify your doctor immediately!]