Noncancerous enlargement of the prostate gland, causing difficulty in passing urine
- Rare before the age of 40; increasingly common after the age of 50
- Genetics and lifestyle are not significant factors
In most men over the age of 50, the prostate gland has become enlarged to some degree. Such prostate enlargement is known as benign prostatic hyperplasia. The condition is noncancerous and is not associated with prostate cancer. Minor prostate enlargement is considered a natural part of the aging process. The cause of the condition is unknown.
What are the symptoms?
As the prostate gland grows larger, it constricts and distorts the urethra (the tube from the bladder to the outside of the body). At first, this enlargement does not cause any symptoms. However, if the prostate gland continues to enlarge, it may cause difficulty in passing urine, resulting in the following symptoms:
Frequent need to pass urine, during the day and night.
Delay in starting to pass urine, especially at night or if the bladder is full.
Weak, intermittent flow of urine.
Dribbling at the end of urine flow.
Feeling that the bladder has not completely emptied.
These symptoms may be worsened by cold weather; drinking large volumes of fluids (especially alcohol); taking drugs that increase urine production, such as diuretics; or taking drugs that may cause urinary retention, such as antispasmodics (see Antispasmodics and motility stimulants).
If the bladder does not empty completely, it may enlarge and make the abdomen swell visibly. Urine may collect in the bladder and stagnate. If the condition is left untreated, the urinary tract may become infected (see Cystitis) and there is an increased risk of bladder stones. Rarely, retained urine can produce a build-up of backward pressure from the bladder to the kidneys, leading to kidney damage (see Hydronephrosis), and kidney failure may occur. Occasionally, an enlarged prostate gland may suddenly block the outflow of urine completely (see Urinary retention), causing rapidly increasing pain. This problem requires emergency treatment.
How is it diagnosed?
Your doctor will perform a digital rectal examination, in which a finger is inserted into the rectum to feel the prostate. The doctor may also arrange for blood tests to assess kidney function and rule out prostate cancer and urine tests to look for evidence of infection. Urine flow may also be assessed (see Urodynamic studies). Ultrasound scanning may be carried out to measure the amount of urine left in your bladder after passing urine and check that your kidneys are not abnormally enlarged.
What is the treatment?
The choice of treatment depends on factors such as age, general health, the degree of the prostate enlargement, and whether the obstruction of urine flow is having harmful effects on the bladder and kidneys. Treatment may affect sexual function, and you should discuss the available treatments with your doctor.
If your symptoms are mild, your doctor may simply advise you not to drink fluids in the evening so that urinary frequency is decreased at night. If the symptoms persist, drugs, surgery, or catheterization may be necessary.
Alpha blockers are commonly used to treat prostate enlargement and can relieve the symptoms in some cases (see Drugs for prostate disorders). If your symptoms are more severe, your doctor may suggest prostate surgery to remove part of the gland through the urethra (see Partial prostatectomy). Only tissue that is obstructing urine flow is removed. If the prostate is considered to be too large for a partial prostatectomy, the prostate may be removed through an abdominal incision. This procedure may result in infertility. It may also cause erectile dysfunction. Laser surgery and shrinkage of the prostate using microwaves are alternative treatments that are now becoming available.
If surgery is not advisable due to old age or poor health, a catheter or urethral stent (a tube inside the urethra) may be left in permanently to drain the urine (see Bladder catheterization).
What is the prognosis?
The outlook varies greatly. Mild cases may be improved with drug treatment, but surgery is more effective for severe cases. About 1 in 7 men needs a second partial prostatectomy after 8–10 years.
From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.
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