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Treatment of an enlarged prostate gland

About the size of a walnut, the prostate gland is located under the bladder and surrounds the urethra (the tube through which urine passes out of the body). The gland is only present in men, producing seminal fluid which is mixed with sperm to make semen.

This article on enlarged prostate is written by Jackie Griffiths, a freelance journalist who writes health, medical, biological, and pharmaceutical articles for national and international journals, newsletters and web sites.


The prostate gland can start to enlarge when a man reaches middle age. This condition is known as benign prostatic hyperplasia (BPH) and affects about a third of all men over 50 years.

As the prostate grows larger, it may press on the urethra and cause problems urinating.

Although it is not prostate cancer, the symptoms of BPH are very similar, so you should see a doctor if you start to have trouble passing urine.

Causes

While it is not fully understood why some men develop an enlarged prostate, it is clear that advancing age is the main risk factor. If symptoms of BPH are present it’s wise to see the doctor promptly as early treatment is often simpler.

Symptoms

An enlarged prostate gland can cause the following symptoms:

  • difficulty in starting to pass urine
  • a weak stream
  • straining when urinating
  • the feeling that the bladder isn’t empty after urination
  • the need to pass urine urgently
  • frequent trips to the toilet, including several times in the night
  • a burning sensation or pain when urinating

Diagnosis

The doctor will ask about the severity of your symptoms and then perform a digital rectal examination (DRE) to examine the size of your prostate. This simple procedure involves inserting a finger into the rectum and may be uncomfortable, but not painful.

The doctor will also feel your abdomen to determine if the bladder is distended, indicating chronic urinary retention, which means that the bladder does not empty properly. A urine test will be performed to check for infection or blood.

A blood test may also be carried out to check for a prostate specific antigen (PSA). This measures the amount of enzyme produced by the prostate and will reveal prostate cancer if present. Other blood tests check kidney function and blood sugar levels, to eliminate diabetes, as both of these conditions can cause urinary symptoms.

Less common tests include: urine flow tests; ultrasound to check the contents of the bladder; measurements using a catheter inserted into the bladder; and transrectal ultrasonography (TRUS) where an ultrasound probe is passed into the rectum to view the prostate. A sample of the prostate (known as a biopsy) may be collecting using a needle to check for cancerous cells.

Treatment

If the enlarged prostate symptoms are mild, some men opt for “watchful waiting” - where no treatment is undertaken. However if symptoms deteriorate, there are two main treatment routes available.

Drugs

Alpha-blockers (such as Xatral, Cardura and Doralese) relax the muscles at the neck of the bladder and in the prostate. This reduces pressure on the urethra and improves the flow of urine. They do not cure BPH but alleviate the symptoms.

5-alpha-reductade inhibitors (such as Proscar) inhibit the production of the hormone DHT, which contributes to prostate enlargement. These drugs do reverse BPH to some extent and may therefore delay the need for surgery.

Plant extracts (such as Serenoa repens) are commonly used to alleviate BPH, although formal evidence of their effectiveness is limited.

Surgery

TURP (transurethral resection of the prostate) is the most common operation for BPH and is done under a general anaesthetic. A long thin camera with a light source and lens attached (known as a resectoscope) is passed into the urethra to give the surgeon a clear view of the prostate. A controlled electric current is then applied to shave off sections of the enlarged prostate.

TUIP (transurethral incision of the prostate) is a quicker operation than TURP and involves removing less tissue, under a general or spinal anaesthetic. Instead of removing a portion of the prostate, small cuts are made in the neck of the bladder and prostate to improve the flow of urine.

Open prostatectomy is only used on men whose prostate is very large. It is a major operation in which an incision is made in the lower abdomen to remove the central part of the prostate.

There are other alternative enlarged prostate treatments coming into more use today. Laser therapy (where a laser cuts away prostate tissue) and transurethral microwave thermotherapy (where heat removes prostate tissue via a probe) are becoming more common.

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