Prostate Problems
The prostate is a gland present only in men. It secretes fluid that helps liquefy semen and is necessary for reproduction. It sits deep in the pelvis below the bladder and behind the pubic bone. The bladder stores urine and empties itself through a channel (urethra) that runs through the prostate gland and downstream through the penis and out (hopefully!) into the toilet.
What are prostate related symptoms?
As men age, the prostate gland will grow and may begin to block the channel through which the urine flows. It is like a tunnel whose walls gradually began to thicken and grow narrowing the roadway and causing traffic to slow down. Enlarged prostate usually occurs in men who are over 40-45 years old. It is fairly uncommon for men younger than 40 to experience symptoms of enlarged prostate. The symptoms are most common after age 50; as men age they are more likely to develop symptoms of enlarged prostate over time. The process itself is regarded as ‘benign’ because it is natural prostatic growth not as a result of cancer and therefore the condition is termed benign prostatic enlargement (BPE).
The symptoms of prostate enlargement are typically related to urination and include both storage and emptying urinary symptoms. Storage symptoms include urinary frequency, urgency, incontinence and waking up to urinate at night. Emptying symptoms include a weak stream, urinary hesitancy (an initial delay in ability to void) and double voiding (urinating twice to empty more completely). Night-time urination, called nocturia, can be caused by an enlarged prostate gland but can also be due to other causes.
In addition to bothersome symptoms, prostate enlargement can also cause other acute problems such as urinary tract infections, recurrent episodes of bleeding in the urine and inability to urinate at all (urinary retention).
A good way to see whether you have symptoms that are typical of prostate enlargement is to fill out the international prostate symptom score (IPSS) - link here. The higher your score, the more likely you are to benefit from treatment.
How is it diagnosed?
Evaluation of benign prostatic enlargement (BPE) can take several forms. First, a medical history and physical exam that focuses on the urinary tract are important. A neurological exam is performed to determine whether your symptoms are related to a problem with the nerves controlling the bladder. Other tests include a digital rectal exam to check the size and firmness of the prostate, a urine culture to evaluate for the presence of infection, and a PSA to check for prostate cancer.
If your symptoms are more severe, a postvoid residual test may be performed to evaluate the amount of urine left in the bladder after urination. A blood test assesses how well your kidneys are working. Urodynamics, or pressure-flow studies, may be used to distinguish whether your urinary symptoms are due to blockage from an enlarged prostate or to a problem with the bladder or its nerves. A transrectal ultrasound can measure the size of the prostate. Cystoscopy may also allow one to find out how much an enlarged prostate is blocking the urethra.
How is it treated?
Non-surgical
Treatment for benign prostatic enlargement (BPE) focuses on reducing the symptoms associated with prostatic enlargement. The decision on how to treat BPE depends on how bothersome your symptoms are. The International Prostate Symptom Score (IPSS) is one way to measure how affected you are by your symptoms and how well you are responding to treatment. Treatments may include the following:
Behavioural Changes – The first line treatment for BPE consists of behavioural changes, such as double voiding, timed voiding, avoidance of caffeine, alcohol and other diuretics, as well as night-time fluid restriction.
Medical Therapy – this consists of using alpha blockers, such as Tamsulosin, Alfuzosin, Terazosin of Doxazosin. These drug are adapted from drugs originally used to treat high blood pressure and work by relaxing the muscle around the prostate and bladder neck, thereby increasing urinary flow and decreasing symptoms. Five-alpha reductase inhibitors (5ARIs), such as Finasteride or Dutasteride, block the conversion of testosterone to dihydrotestosterone within cells of the prostate. This results in shrinkage of the prostate and a decrease in the associated blockage of urinary flow.
Often, these drugs are used in combination to augment therapeutic effect. Anticholinergics, medications that inhibit bladder contractions, can also be used to further improve symptom relief. Finally, Cialis has been used to also help improve BPH-related symptoms.
resection Surgery (TURP)
This represents the most reliable way to relieve urinary symptoms, although it is typically reserved for patients for whom medications are not helpful, or for those unable to tolerate, or unwilling to take, medications.
Surgery for BPE is endoscopic and carried out through the urethra – they do not require any incisions. The gold standard treatment is transurethral resection of the prostate (TURP), where the core of the prostate is cut into small pieces and then removed. TURP is performed using different types of electrosurgical or laser energy.
REZUM STEAM THERAPY
A newer technology recently introduced for BPE is the REZUM procedure. It is a minimally invasive procedure that uses steam to treat benign prostate enlargement. The procedure involves the use of a small, handheld device that delivers controlled bursts of steam to the affected tissue, shrinking the prostate and reducing urinary symptoms. On prostates which are suitable, this procedure can be carried out as a day case procedure with reduced risk of surgical complications or impact on sexual function.