Prostate enlargement

Overview

Prostate enlargement affects almost all men to some extent. The prostate gland increases in size as men get older. In some men, the enlargement causes symptoms due to obstruction of urine flow. Up to 50% of men above 50 years of age will have symptoms due to prostate enlargement.

Symptoms

Prostate enlargement may cause the following symptoms:

  • Difficulty in initiating urination
  • Weak urine stream
  • Urine stream stops and starts
  • Unable to empty bladder completely
  • Frequent urination
  • Urgent need to urinate
  • Leakage of urine

When the problem is untreated, it can cause serious problems such as:

  • Sudden and complete inability to pass urine resulting in severe pain
  • Blood in the urine
  • Bladder stones
  • Kidney failure

Diagnosis

Tests that can be done to confirm the diagnosis include:

  • Rectal examination to check prostate size and to feel for nodules
  • Urine test to check for blood in the urine
  • PSA blood test to check for prostate cancer
  • Ultrasound of the prostate to check prostate size and shape
  • Ultrasound of the bladder and kidneys to check for stones and obstruction
  • Uroflow test to assess the urinary flow rate

Treatments

Medication
Patients with mild symptoms of BPH are initially treated with medication. There are two main types of medication, one that relaxes the prostate and gives quick relief of symptoms, the other to shrink the prostate and prevent further worsening of the condition.

Surgery
Patients with severe symptoms of BPH may require surgery. Nowadays, the surgery is minimally invasive and no incision is needed.

Transurethral resection of prostate (TURP)
TURP is the most established minimally invasive treatment for BPH. The prostate gland is cut from within by a special cystoscope with a loop attachment. A urinary catheter is inserted afterwards to allow recovery and is removed after one or two days. As it is minimally invasive, there is minimal pain and the recovery is quick.

Greenlight laser prostatectomy
Greenlight laser prostatectomy is a newer surgical procedure for BPH. The prostate gland is vaporised from within using laser.

What is the difference between TURP and Greenlight laser?
TURP is suitable for treatment of prostate glands of all sizes. Greenlight laser prostatectomy is suitable only for smaller prostates. The advantage of Greenlight laser is that postoperative bleeding is less.