Enlarged Prostate

The prostate is a gland located in the male pelvis, underneath the bladder and surrounding the urethra (water-tube) as it exits from the bladder. The seminal vesicles are two small sacks that attach to the prostate and produce material that mixes with the prostatic fluid to form semen. The tubes from the testicles (vasa) carry sperm to the prostate where the sperm are mixed with the prostate and the seminal vesicle fluid. The fluid is then ejaculated during orgasm by a connection to the urethra called the ejaculatory ducts.

PROSTATE DISEASE

Prostate disease is a term used to describeany medical problems involving the prostate gland.

Common prostate problems experienced by men include:

  • Prostatitis which is inflammation and swelling of the prostate gland
  • Benign prostatic hyperplasia (BPH), which is a non-cancerous (benign) enlargement of the prostate gland, and occurs in virtually all men as they get older.
  • Prostate cancer

BENIGN PROSTATIC HYPERPLASIA (BPH)

This normal, gradual and inevitable part of ageing in men, whereby the prostate enlarges, commonly leads to a variety of changes in the way the bladder works, which are called lower urinary tract symptoms (LUTS).

LUTS includes:

  • Delay in getting urine flow started
  • Weaker or slower flow of urine
  • Dribbling at the finish of passing urine
  • Going more often
  • Getting up at night to pass urine
  • Needing to rush to get to the toilet (urgency)
  • Not emptying the bladder possibly leading to urinary infections or bladder stones
  • Loss of control of the bladder
  • Blood in the urine

BPH is one of the most common diseases affecting the prostate and is the most common benign tumour in men as they get older. This condition is present in 50% of men over 50 years.

The prostate size can be assessed by a digital rectal examination where a gloved and lubricated finger is inserted into the anus, or by ultrasound.

The size of the prostate is less important than the urinary symptoms it causes. This digital examination may also feel a cancerous lump though not all prostate cancers can be felt in this manner.

The International Prostate Symptom Score questionnaire (download from this website) is a useful way of assessing how severe your symptoms are. PSA blood test, ultrasound of kidneys and bladder, urine tests and urine flow tests, as well as measurements of retained urine, are also usually done as part of the assessment.

Treatments for BPH; These range from watchful waiting, to medication, through to surgery.

Medications derived from plants have shown some benefit, for example, Saw Palmetto, but generally prescription medications such as Flomaxtra® or Duodart® are much better able to reduce the symptoms of prostatic obstruction. Often this is only a temporary relief and eventually surgery is required and most medications have some side-effects.

There have been a number of so-called “minimally-invasive” surgical treatments for BPH over the years, and Dr. Love has had experience with all of them. Many have proved unsatisfactory in the medium to long term, and the only ones that have been shown to be really useful for patients are the Rezum® steam technique ,and the UroLift® device, which is achieving good results with follow-up beyond 5 years,done as day case procedures, with no side-effects, particularly no sexual side-effects.

Transurethral surgery of the prostate (TURP) is actually also a reasonably minimally invasive way of treating prostatic obstruction, and has been the “gold standard” treatment for many years, giving excellent results usually requiring just a two-day visit to hospital. However, laser surgery, especially GreenLight® laser, has proved to be an alternative to TURP, because there is virtually no bleeding and sometimes men are in hospital for as little as 12 - 18 hours after this form of prostate surgery. There can be some sexual side-effects from both TURP and GreenLight®.

Dr. Love has extensive experience in all forms of treating BPH, and is an active user of TURP, GreenLight® , Rezum® and UroLift® technology. Some patients are more suitable for one, rather than one of the other, treatments, and must be assessed individually.