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    Benign Prostatic Enlargement

    Overview
    Causes
    Risk Factors
    Symptoms
    Diagnosis
    Treatment
    Where to Seek Treatment
    Singapore General Hospital
    Contributed by SGH Urology Centre

    Overview

    prostateThe prostate is a plum-sized gland located in front of the rectum and just below your bladder, where urine is stored. The prostate gland surrounds the urethra, which is the canal through which urine passes out of your body. The urethra also secretes fluid that forms part of semen.

    The prostate gland often enlarges with age. This condition is known as benign prostatic enlargement (BPE), benign prostatic hyperplasia (BPH) or benign prostatic hypertrophy. As the prostate enlarges, its capsule (layer of tissue surrounding it) stops it from expanding outwards. This causes the prostate gland to press inwards against the urethra like a clamp on a garden hose.

    As a result, the bladder wall thickens and the bladder contracts even with small amounts of urine, causing more frequent urination. Eventually, the bladder weakens and loses the ability to empty itself, resulting in residual urine left in the bladder.


    Causes

    BPE occurs because of a complex interaction between the male hormone dihydroxytestosterone (DHT - active component of testosterone), small amounts of oestrogen (female hormone), and other growth factors. This results in an imbalance of cell growth and death, and subsequent prostate growth and enlargement.


    Risk Factors

    Increasing age is a risk factor for BPE. There is no convincing evidence that your diet or lifestyle are risk factors for the condition.


    Symptoms

    male genitourinary tractIf you have BPE, you may experience symptoms that include :

    • a hesitant, interrupted, weak urine stream
    • urgency and leaking or dribbling of urine
    • more frequent urination, especially at night

    Some men with greatly enlarged glands have little obstruction and few symptoms. Others, whose glands are less enlarged, may have more blockage and greater problems. Sometimes you may not know you have any obstruction until you suddenly find yourself unable to urinate at all. This condition, called acute urinary retention, may be triggered by taking certain cold medications that prevent the bladder opening from relaxing and allowing urine to empty.

    Severe BPE can, over time, cause serious problems such as urinary tract infections, bladder or kidney damage, bladder stones, and incontinence. If your bladder is permanently damaged, treatment for BPE may be ineffective. If BPE is found in its earlier stages, your risk of developing such complications is lower.


    Diagnosis

    Some of the common tests to diagnose BPE include :

    • Digital rectal examination (DRE). Your doctor inserts a gloved finger into the rectum and feels the prostate next to the rectum. This gives him a general idea of the size and condition of the gland.
    • Urine flow study. A special device you urinate into measures how quickly the urine is flowing. A reduced flow often suggests BPE.
    • Cystoscopy. A small tube, a cystoscope, is passed through the opening of the urethra in the penis. It contains a lens and light system that helps your doctor see the inside of the urethra, prostate and the bladder to identify the location and degree of the obstruction.

    Treatment

    Treatment may not be needed in mild cases. In moderate to severe cases, the following treatment options are available :

    Drug Treatment
    Drugs that relax the smooth muscle of the prostate and bladder neck are Transurethral resection of the prostate (TURP) is the most common technique used to treat BPE. used to improve urine flow and reduce bladder outlet obstruction. Drugs that inhibit production of the male hormone DHT, which is involved with prostate enlargement, are used to prevent progression of growth of the prostate or actually shrink the prostate in some men.

    Surgical Treatment
    Most urologists recommend removal of the enlarged part of the prostate as the best long-term solution for someone with BPE. With surgery for BPE, only the enlarged tissue that is pressing against the urethra is removed; the rest of the inside tissue and the outside capsule are left intact. Surgery may be performed by the following methods :

    transurethral resection TURP• Transurethral resection of the prostate (TURP). This is the most common technique used in 90 percent of all prostate surgeries for BPE. Under anaesthesia, a resectoscope is inserted through the penis. The surgeon uses the resectoscope with a special wire loop or laser fibre to remove the obstructing tissue one piece at a time. The pieces of tissue are carried by the fluid into the bladder and then flushed out at the end of the operation.

    • Open surgery. In some cases when a transurethral procedure cannot be used or if the gland is extremely large, open surgery may be needed. Under anaesthesia, the surgeon makes an incision in order to reach the prostate capsule to scoop out the enlarged tissue from inside the gland.

    • Laser vaporisation. A laser fibre is passed through the urethra into the prostate using a cystoscope and bursts of laser energy are delivered to destroy the prostate tissue. As with TURP, laser surgery requires anaesthesia and a hospital stay. This technique is often used for selected people with smaller glands. At the end of surgery, a urinary catheter is inserted through the opening of the penis to drain urine from the bladder into a collection bag for a few days.

    Sexual Function After Surgery

    Most men are able to continue to have erections after surgery. After prostate surgery, the neck of the bladder is widened, so the semen takes the path of least resistance and enters the wider opening to the bladder rather than be expelled through the penis. Later, it is harmlessly flushed out with the urine. The main impact of prostate surgery is that you will not be able to father children in the normal way as you have a dry ejaculate. However, most men fi nd little or no difference in the sensation of orgasm or sexual climax after surgery.

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