PROSTATE GLAND ENLARGEMENT
What is Prostate Gland Enlargement ?
The prostate gland is only present in men. It produces fluid which is added to the semen at the time of ejaculation. The normal prostate in young men is about the size of a small plum. Urine passes from the bladder to the end of the penis through a tube called the urethra. The urethra passes throught the centre of the prostate, and is surrounded by it. Behind the prostate is the rectum, or back passage. This is why the prostate gland can be examined by rectal examination. From the age of 40, some enlargement of the prostate occurs in all men. Only in about 1 in 10 will the enlargement cause significant symptoms or require any treatment. The degree of enlargement does not relate to the amount of difficulty in passing urine. This is because the prostate may enlarge « outwards » without squashing the urethra which passes through its centre. Although the enlargement may start at about the age of 40, symptoms only tend to occur later: it is unusual to have prostate trouble before the age of 55. The symptoms which occur are loosely termed « prostatism ». This consists of poor urinary flow and an inability to fully empty the bladder. This is turn is called bladder outflow obstruction. One may have to wait for the urinary flow to commence. Because the bladder does not fully empty, urine may need to be passed quite frequently. This can interfere with a good night’s rest. Sometimes there is an increasingly strong desire to pass urine, and rarely leakage of urine occurs (incontinence). Occasionally, an enlarged prostate will cause blood to appear in the urine. Sometimes, when the bladder cannot fully empty, this predisposes to an infection in the urine. This causes the desire to pass urine even more frequently and may also result in a burning sensation in the penis on passing urine. Prostate enlargement can cause a complete blockage to urine flow. This then requires emergency treatment. Why does Prostate Gland Enlargement occur ?
The cause for prostate enlargement is unknown. However, male hormones (androgens) influence the enlargement of the prostate. It is rare to see enlargement of the prostate in men whose male hormone levels are very low. There is little difference between races, and environmental factors do not seem to be significant. Treatment Involved for Prostate Gland Enlargement
The surgeon (urologist) must first prove that the prostatic enlargement is the cause of the symptoms. He may find it helpful to measure the urinary flow rate. This is a simple test: you pass urine into a large funnel and the time taken for a particular volume of urine to pass is calculated electronically. The urologist will also arrange an x-ray or ultrasound scan to make a picture of the bladder after an attempt at emptying. This will reveal whether the prostate is causing obstruction to the urethra. The ultrasound scan will also check that the kidneys are normal. In some hospitals, the size and the shape of the prostate can also be measured by ultrasound. An ultrasound probe, a little larger than an index finger, can be inserted into the rectum to make a more accurate picture of the prostate. This technique can also be used for taking specimens (biopsies) of the prostate, if there is any suspicion of cancer. The first method of treatment is usually tablets. One type of tablet allows the muscles in the prostate to relax, and this alone can lead to a significant improvement in symptoms. Another group of tablets reduce the size of the prostate by stopping the action of male hormone levels on this gland (so-called anti-androgens, such as finasteride). These are useful if the gland is quite large. Recent research has shown that the use of these drugs may reduce the likelihood of needing surgery. A herbal preparation (senenoa repens) has also been shown to have some benefits with minimal side effects. Finally, an operation can be performed called a transurethral prostatectomy, which can provide great relief from troublesome symptoms. Recently, a few hospitals have been testing a microwave heat treatment to shrink the prostate. Such treatment is not very successful, and it is difficult to predict which patients are most likely to benefit. Laser treatment for the prostate has also been developed. The use of the laser is attractive because there is very little bleeding and the hospital stay is reduced. At present the results of laser treatment are variable, and more research will be required before laser treatment can be recommended for more than a few cases. In most cases, a transurethral prostate operation (TURP) will be recommended. If symptoms get worse, or if bleeding occurs, consult your doctor. If Left Untreated
In about one out of three patients, the symptoms remain unchanged for quite long periods. Often the symptoms gradually or suddenly worsen. The bladder may hardly empty at all or may cause back pressure on the kidneys, causing kidney failure. Such a complication may produce general unwellness and sickness, but may occur to quite an advanced degree without giving you any symptoms at all. If the bladder cannot empty properly, the urine may become infected, causing pain and fever. It is possible that you may be unable to pass any urine at all. This is usually painful and emergency hospital admission is required to drain the urine with a tube called a urethral catheter. If this happens, prostate operation will often be needed. Occasionally the bladder distends more slowly and without pain. Eventually the urine begins to leak. This is called chronic urinary retention and also requires treatment by bladder catheter and often an operation.
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ULTRASOUND
CANCER
OF THE PROSTATE
CHRONIC
RENAL FAILURE
PROSTATECTOMY
: TURP OPERATION |
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