Benign prostate enlargement (BPE)
The commonest reason for BPE is Benign Prostatic Hyperplasia (BPH) which is a non-cancerous enlargement of the prostate. It is very common and enlargement typically starts in men in their 30’s and continues throughout life, but may slow after the age of 70.
Enlargement of the prostate can squeeze or restrict the urethra, the tube that leads from the bladder, causing symptoms. Approximately 40% of men in their 50’s have ‘prostate symptoms’ caused by BPH, previously termed ‘prostatism’ but now called LUTS – lower urinary tract symptoms. These can consist of difficulty starting the urine stream, weakening of the stream, a need to strain and a feeling of incomplete emptying after passing urine. Symptoms of bladder irritability can also occur along with getting up to pass urine at night - called nocturia.
Occasionally BPH can cause severe symptoms and complications such as urinary retention or the inability to pass urine, bladder infections and bladder stones. The obstruction caused by BPH in severe cases can affect the functioning of the kidneys.
The commonest reason for LUTS is benign enlargement of the prostate causing obstruction to the urinary tract. The other causes could be stone in the water passage, a stricture (scar) in the water passage, or in some cases a cancer of the prostate can also cause these symptoms.
A careful medical history is important to assess the presenting symptoms, and to look for complications of BPH. A physical examination will be performed to examine the abdomen and also a rectal examination (finger in the back passage) to assess the prostate. You will be asked to fill out a validated questionnaire that gives an idea of the extent that your symptoms are affecting your life which may help influence the decision for treatment.
Investigations for BPH/LUTS can include:
• A urine test is performed
• Usual blood tests include kidney function tests and may include a PSA test.
• A urine flow test (passing urine into a special machine) measures the urine flow and can tell if there is any significant reduction in the urine flow.
• An ultrasound of the kidneys and bladder may be requested.
• A cameral inspection of the urethra (tube coming from the bladder) and the bladder is required in some patients.
Treatment in the initial stages of symptoms is medical. Medications that relax the smooth muscle in the prostate (alpha blockers) help in alleviating the symptoms. Medication can also be given to decrease the size of the prostate. These alter the testosterone supply (5α reductase inhibitors) to the prostate and shrink the size over a period of time. If the symptoms are severe or unresponsive to medication the patient can be advised to undergo a surgery which is called as Trans-urethral resection of prostate) TURP. This procedure can also be done using a bipolar diathermy machine or laser beam.
The TURP procedure involves using a special instrument to ‘re-bore’ the channel through the prostate, which relieves the obstruction caused by the enlarged prostate. This is done either under a general or a spinal anaesthetic. After the procedure a tube or catheter is left inside the bladder for a few days and is usually taken out before going home.