Benign Prostate Enlargement (BPH)
Above: Cross-section of urinary bladder and prostate, comparing normal prostate with enlarged prostate.
The prostate is a walnut-sized gland which is situated at the opening of the urinary bladder. It is exclusively a male reproductive organ. The prostate produces a specific fluid which nourishes sperm, and therefore this gland is important during reproductive age.
The prostate gland grows larger due to an increase in the number of cells (hyperplasia). However, the precise reason for this increase is unknown. A variety of factors may be involved, including androgens (male hormones), estrogens, growth factors and other cell signaling pathways.
As the prostate grows larger and the urethra is squeezed more tightly, the bladder might not be able to fully compensate for the problem and completely empty.
Often it is difficult to explain the exact role of the prostate gland in causing urinary blockage. So as to understand things more clearly, I like to imagine the prostate as a donut. The mouth or opening of the urinary bladder is connected to the “central hole” of the donut. The prostate gland has tendency to grow outwards as well as inwards. So the donut can swell outside and inside making the “central hole” occluded. This creates a physical blockage to the urine flow resulting in various symptoms such as urinary frequency, urgency, slow stream, dribbling and sense of inadequate emptying of the bladder.
There are a number of treatment options available to manage this problem.
Medical treatment
The medical treatment comprises “Prostate relaxing medications” (alfa blockers) and or “Prostate shrinking medications” (5 alfa reductase inhibitors). There are specific indications for prescribing these medications and not all patients suffering with prostate problems would qualify for medical treatment. More so, they do carry some side effects as well. However, it is an effective way of treating prostate symptoms in some patients.
Surgical procedures
Various surgical procedures have been performed to physically reduce the volume of the occluding prostate and so far TURP (Transurethral Resection of Prostate) has been the gold standard. Of course, the new GreenLight laser prostate vaporisation system has shown equivalent results compared with TURP, with greatly reduced side effects.
To enumerate other surgical options:
- TUVP (Transurethral Vaporization of Prostate)
- TUNA (Transurethral Needle Ablation)
- HoLAP (Holmium Laser Ablation of Prostate)
- HoLEP (Holmium Laser Enucleation of Prostate)
- TUMT (Transurethral Microwave Thermotherapy)
- Open prostatectomy
