The Care and Feeding of the Enlarged Prostate Gland

If you are a man, then you have a prostate gland.  If you have a prostate gland, then you are likely to be one of the 14 million American men who experience bothersome symptoms beginning around age 50.  This article will discuss the diagnosis of the enlarged prostate gland and what are some of the available treatment options that can reduce the symptoms associated with this common condition.  It is a walnut sized organ at the base of the bladder and surrounds the urethra or tube that is in the penis and transports urine from the bladder to the outside of the body.  It is common and even normal for the prostate gland to become enlarged as a man ages. Though the prostate continues to grow during most of a man’s life, the enlargement doesn’t usually cause problems until middle age or around 50. BPH rarely causes symptoms before age 40, but more than half of men in their sixties and as many as 90 percent in their seventies and eighties have symptoms of BPH.

The prostate gland encircles the urethra like a donut, so problems with urination can occur if the gland restricts urine flow through the urethra. As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the gland to press against the urethra like a clamp on a garden hose.

The following changes occur over a period of time.

  • The bladder wall becomes thicker and will contract without the owner’s permission causing urgency of urination.
  • The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination.
  • Eventually, the bladder weakens and loses the ability to empty itself. Urine remains in the bladder.

The narrowing of the urethra and partial emptying of the bladder cause many of the problems associated with BPH.

Some problems associated with BPH are

  • Urinating more often during the day
  • Need to urinate frequently during the night
  • Urinary urgency, which means the urge to urinate is so strong and sudden, you may not make it to the toilet in time and soil your clothing-very embarrassing!
  • The urine stream is slow to start
  • Dribbling after urination
  • A sensation that the bladder isn’t emptied after urination
  • Lack of force to the urine flow, which makes aiming more difficult
  • The sensation of needing to go again a few minutes after urinating

Diagnoses

You may first notice symptoms of BPH yourself, or your doctor may find that your prostate is enlarged during a routine check-up. The doctor can determine the size of the prostate gland during a physical examination.

The diagnosis is made with several of the following tests:

Symptom Score

This is a brief questionnaire that provides a numerical value to the symptoms associated with urination.  The higher the score (maximum is 25), the more symptoms a man has and the more likely he will want to have treatment for relief of his symptoms.

Urinalysis

A urine sample is taken to look for signs of blood and infection.

Digital Rectal Examination (DRE)

Your doctor inserts a gloved finger into the rectum to feel the condition of the prostate that lies close to the rectal wall. If your doctor feels something suspicious such as a lump or bump, further tests will be carried out. Other tests are needed to enable a more accurate diagnosis. 

Prostate Specific Antigen (PSA) Test

A blood sample is taken by your doctor to check for prostate specific antigen (PSA), which is produced by the prostate and is increased by cellular abnormalities within the prostate.

As men get older the prostate gland grows and so the PSA is likely to rise. A high PSA may indicate some type of prostate disease. The level can be raised due to inflammation of the prostate (Prostatitis) and enlargement of the prostate gland (Benign Prostatic Hyperplasia or BPH).

Urine flow rate

This test consists of a man urinating in private over a funnel which measures the volume of urine and the time that it takes to empty the bladder.  The urine flow rate is expressed in milliliters per second.  Normal is greater than 15 ml\second.

Urodynamics

Sometimes the doctor will ask a patient to urinate into a special device that measures how quickly the urine is flowing. A reduced flow often suggests BPH.

Imaging studies

The ultrasound examination evaluates the size of the prostate gland which often determines the treatment option which is best for your situation.  It is a painless examination consisting of the insertion of a small pencil-size probe into the rectum and uses sound waves to determine the appropriate treatment for prostate gland enlargement.

Cystoscopy

In this exam, the doctor inserts a small tube through the opening of the urethra in the penis. This procedure is done after a solution numbs the inside of the penis so all sensation is lost. The tube, called a cystoscope, contains a lens and a light system, which help the doctor see the inside of the urethra and the bladder. This test allows the doctor to determine the size of the gland and identify the location and degree of the obstruction.

Treatment options

  1. Watchful waiting-If the person has BPH but is not bothered by the symptoms, the patient and the doctor may decide to simply wait and monitor the condition regularly. This option requires regular check-ups with the doctor – usually once a year – to see if the condition is getting any worse.
  1. Drug therapyYour doctor may advise drug therapy which aims at shrinking the enlarged prostate. The doctor will select the medication that best suits the condition, keeping in mind the person’s general health condition, medical history, medications taken for other conditions and quality of life considerations.
  1. Minimally invasive treatments-The prostatic urethral lift or UroLift is an implant of several polyester sutures connected by two small metallic tabs that opens the prostate gland located in the urethra and improves the flow of urine thus decreasing the symptoms of the enlarged prostate gland. UroLift has been approved by the FDA to relieve the symptoms of the enlarged prostate gland. There have been nearly xx thousand of men who have had the treatment which reports favorable results up to 4 years. Most insurance companies will now pay for the UroLift procedure 
  1. Surgery-Surgery is another option for the treatment of BPH. The most common type of surgery for BPH is TURP (Trans Urethral Resection of the Prostate). This procedure requires an admission to the hospital, a general anesthesia, a urinary catheter for several days, and the risk of sexual problems afterwards.

Bottom Line:  Nearly all men will experience the problems associated with the enlarged prostate gland.  The enlarged prostate gland impacts a man’s quality of life.  Help is available and nearly all men can be helped.  If you have symptoms associated with urination, speak to your doctor.

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