Benign Prostatic Hypertrophy

The prostate gland is located in the midline at the junction of the urinary bladder and urinary passage in the penis. It is present only in men and is about 20 gms in weight at 20 yrs of age, but increases in size to about 50 gms by the age of 80 yrs.

It surrounds the urinary passage on all sides just below the bladder and this part of the urinary passage is called prostatic urethra. The prostate gland is a chemical factory. It produces secretions which act as lubricants, produces chemicals which can increase or decrease blood pressure. It also produces a substance called prostacyclin which reduces blood clotting by stopping platelets from adhering to each other.

As the prostate enlarges over the age, in about 20% of men, it can produce symptoms or obstruction. The incidence of obstruction rises with advancing age. The symptoms of prostatic enlargement are often referred as LUTS (men) or lower urinary tract symptoms.

Symptoms

  • Urgency or inability to hold urine for adequately long time
  • Precipitancy or voiding rapidly at times soiling undergarments
  • Frequency or repeatedly passing urine more often
  • Hesitancy or difficulty in starting urination
  • Feeling of incomplete evacuation of urine
  • Incontinence or passing urine at times in clothes
  • Nocturia frequent getting up at night to pass urine

Later on a person may develop retention or a full bladder, urge to pass urine but the inability to do so.

The symptoms do not always progress and may even improve spontaneously in many. In some cases, if the passage of urine is obstructed, the bladder wall becomes thick and pressure generated for passing urine may damage the kidneys leading to renal failure.

Investigations for prostate disease.

The symptoms are investigated by

Rectal examination to look for prostate cancer.

Ultrasound examination of bladder, prostate, amount of retained urine after voiding, nodules in the prostate etc

Uroflowmetry or the time and volume study as urine is passed. Normally a person should pass urine at a rate of > 20 ml/sec.

Urine routine examination.

Prostate surface antigen Or PSA which increases with kidney size but is an important marker of cancer of the prostate.

Treatment

Treatment is both by drugs (in early cases) and by surgery in advanced cases. The drugs used are Alfa blockers which decrease the resistance to urine flow in prostate and finasteride (inhibits enzyme converting testosterone to DHT a more active form). Finasteride, dutasteride and similar drugs reduce prostate size over months.

Surgical treatment consists of the removal of partial or total of the prostate gland. It can also be done via laser (TURP) and more refined means.