Benign Prostate Enlargement
An enlarged prostate compressing the urethra and bladder.
What is Benign Prostate Enlargement?
The prostate is a gland about the size of a large walnut located in men in the lower urinary tract. It produces the fluid which carries semen. Benign prostatic enlargement (BPE) is a common condition. It is related to hormonal changes which happen as men grow older. BPE is not prostate cancer, however, both benign prostatic enlargement and prostate cancer may develop with age and some people may have both diseases.
What symptoms will I experience?
BPE can affect the way you normally urinate by putting pressure on the urethra at the outlet of the bladder (Fig. 1). The symptoms, which are often called lower urinary tract symptoms (LUTS) may range from mild to very bothersome and can have a negative effect on your quality of life. These symptoms may include
The need to urinate more often than usual
The need to wake up at night to urinate
The sudden need to urinate and having trouble holding it in
Any involuntary loss of urine (incontinence)
A weak stream of urine
The flow of urine starts and stops (intermittency)
Straining when urinating
The feeling that the bladder is not completely empty
The severity of symptoms is important in deciding if you will benefit from treatment.
How will the diagnosis be made?
The symptoms listed in the previous section can point to many diseases and not only BPE. Thus the doctor will do a series of tests to understand the cause of your symptoms.
This will include a medical history (including a questionnaire to understand the nature and severity of your symptoms, and how much they affect your quality of life) and a physical examination including a digital rectal examination (DRE) .
You may be asked you to keep a bladder diary to note down how much you drink and urinate. In the clinic your doctor may conduct a test called uroflowmetry to record your flow of urine.
Other urine and blood tests, and imaging of your bladder and prostate (ultrasound and/or CT scan) may be needed. In certain cases, more invasive tests such as urodynamic evaluation and / or cystoscopy may be required.
What are the treatment options for benign prostate enlargement?
Treatment options for Benign Prostate Enlargement include:
Watchful waiting and life-style changes – for mild symptoms
Drink enough water to keep your urine clear or a light yellow colour
Drink less in the evening to avoid getting up at night to urinate
Avoid alcohol and caffeine
Maintain a healthy diet, exercise and weight-loss.
Medical treatment with drugs – for bothersome symptoms which affect quality of life. Several options are available depending on severity of symptoms, size of your prostate, your past medical history, medication and allergies and personal preference
Surgical treatment for Benign Prostate Enlargement
Indicated if medications are not preferred, not tolerated or don’t give relief of symptoms.
If you develop complications of BPE (eg. kidney problems, inability to urinate, recurrent infections, blood in urine, bladder stones)
Factors which influence the type of surgery indicated include severity of symptoms, size of your prostate, your past medical history, current medications and allergies and personal preference including need for preservation of erectile and ejaculatory function.
Types of surgery include:
Open / Robotic Surgery
BPE can affect quality of life of patients significantly including significant effects on your social and personal life and sexual relationships. You should seek help and together with your partner and your urologist you can identify what is important in your personal and sex life and choose the best treatment option. There are many ways to relieve your symptoms and maintain your sex life, which will make it easier to live with BPE.