Benign Prostatic Enlargement

Benign prostatic enlargement is a common condition in  older men. The prostate slowly grows and compresses the urethra at the outlet of the bladder.This is caused by hormonal changes. BPE may affect the way you normally urinate and may have a negative effect on your quality of life as it results in lower urinary tract symptoms (LUTS). It is the most frequently diagnosed condition in urology.

You will get treated for the symptoms caused by BPE  if they are bothersome and your quality of life has been affected by them. The main purpose of surgery is to relieve the  symptoms associated with BPE and to improve the  flow of urine. The most recommended surgical treatment for the  symptoms of BPE is transurethral resection of the prostate (TURP). The aim is to remove the part of the prostate which causes the symptoms (the adenoma). 

The procedure is done through the urethra without making an incision in your lower abdomen, which is known as minimally invasive treatment. TURP offers optimal improvement of the symptoms caused by BPE. After TURP, you may have retrograde ejaculation. 

BPE can also be treated by other types of surgery:

  • Transurethral incision of the prostate (TUIP): During  TUIP, the doctor cuts into the prostate through the bladder neck to improve the flow of urine. This procedure is rarely used for the treatment of BPE because similar results can be achieved with drug treatment. 
  • Open or Laparoscopic prostatectomy: This procedure removes the adenoma in a way similar to TURP or laser enucleation, but is done by making an incision in the abdomen or doing it laparoscopically. It is recommended for men with very large prostates. 
  • Laser treatment: The laser uses intensive light to cut (enucleate) or vaporize the prostate tissue. During the procedure, only a small amount of blood is lost.

What are the possible symptoms in men  with BPE? 

BPE can make your flow of urine very slow, it may  cause your urine flow to stop and start several times while emptying your bladder, or you may need to wait and push (strain) before you can start urinating. BPE may cause you to urinate often during the day and may wake you up at night to empty your bladder (known as nocturia). It may also cause urgency and can sometimes lead to involuntary loss of urine (known as incontinence). You may also feel that your bladder did not completely empty after urination. Your stream of urine may end with dribbling. Urine sometimes dribbles into your underwear when you leave the toilet after urinating.

The prostate is a gland which produces the fluid  which carries semen. It contains smooth muscles which help to push out the semen during ejaculation. The prostate is located directly below the bladder and around the urethra.

The symptoms associated with BPE are sometimes  called male LUTS (lower urinary tract symptoms). LUTS can be due to other conditions which affect the urinary system. 

BPE is not cancer and does not cause cancer.  However, both BPE and prostate cancer can develop as you grow older. If you have never been screened for prostate cancer, your urologist may screen for it when you come in for your prostate symptoms.

The doctor will take your medical history and do  a physical examination, including a digital rectal examination (DRE) of the prostate. During DRE the doctor uses a finger to feel the size, shape, and consistency of the prostate. Your symptoms will be carefully evaluated, blood and urine tests are done, and the speed of your flow of urine is measured during uroflowmetry. 

The level of PSA (prostate-specific antigen) in your  blood may be tested because BPE and prostate cancer can occur in the same age group. PSA can also be used to estimate your prostate volume and it can be used to estimate the risk of the BPE symptoms getting worse .

Urinalysis is used to rule out that you have a urinary  tract infection, which causes similar symptoms. If you do have an infection, urine culture is used to confirm this and to select the best antibiotic treatment for the infection. 

Uroflowmetry measures the speed of the flow of  urine. This test is done to see if the prostate obstructs the urine flow. 

The amount of urine left in the bladder after urination  is measured to see whether the bladder is able to empty completely. High PVR is a sign that the bladder is not functioning well or that there is a blockage to the urethra. This may increase the risk of urinary tract infections.

Ultrasonography of the bladder can be used to  diagnose possible other causes of the symptoms. It can also see if you have other conditions that coexist with BPE which may make the symptoms worse or have an effect on selecting the best treatment option for you. Prostate ultrasound is used to measure prostate volume. This may be important to confirm the diagnosis of prostate enlargement and to decide which treatment option is best for you.

This means that the semen will not go through the  urethra during orgasm but it will be projected into the bladder and leaves your body afterwards when you urinate. You may have retrograde ejaculation after surgery for BPE. It is also associated with some types of drug treatment. 

In most cases, surgery will not cause erectile  dysfunction. 

If urinary retention develops and you are not able to  urinate, an indwelling catheter is inserted for a few days until you can urinate on your own. Depending on how health care is organized in your country, the catheter is placed by your family doctor, the urologist, or at the emergency unit of the hospital. 

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