By Dr. Sudhir Khanna, Urology
The prostate is a small, muscular gland located in the perineum region, which is the opening of the urinary system into the outside environment. The prostate also produces fluid which forms the semen. As a natural process of aging, the prostate enlarges and this puts pressure on the urethra. Therefore, there is a constant urge to urinate along with groin pain.
In most men, the enlargement is benign. The cells multiply as a normal process of aging and the gland just grows bigger. This puts pressure on the urethra, and so the person is never able to completely empty the bladder. There is a constant urge to urinate, which worsens at night and the person loses sleep. The bladder tries to compensate by becoming thicker and stronger, which only makes the condition further worse.
The person also can have a problem in starting a urine stream, the urine can start and stop with continued dribbling. The bladder is never fully emptied, leading to conditions like recurrent infections and bladder stones.
This condition, medically known as benign prostatic hypertrophy (BHP) or benign prostatic enlargement (BPE) is often ignored by men as just having to visit the bathroom too often. Most reach out for help when the sleep is disturbed.
In the initial days, doctors also prefer to go with “watchful waiting.” The patient is asked to come for regular checkups where symptoms are monitored and testing is done if required. With BPH, there is also a BPH index based on symptoms and clinical testing. When the index increases beyond 8, then treatment is considered. The index is measured using symptoms including:
- Severity of symptoms
- Effect on the overall quality of life
- Progression of symptoms from the last checkup date
- Patient’s willingness for surgery
- Medications: These either stop the further enlargement of the prostate or shrink the already enlarged prostate. Some also help in relaxing the bladder muscles so urine flows easily. Alpha blockers and 5-alpha reductase inhibitors are generally used. Men who are younger are often treated with medications.
- In older men, where the symptoms are more severe, minimally invasive surgery would be done. Either heat or laser is used at low frequencies to destroy a part of the prostate so that the pressure on the urethra is reduced. Stents may also be used to keep the urethra open to allow for easy passage of urine. These are outpatient, one-day procedures, and provide immediate relief.
- Surgery: Severely enlarged prostates are best removed surgically for complete relief of symptoms. Transurethral resection of the prostate (TURP) or transurethral incision of the prostate (TUIP) are the most definitive treatments for enlarged prostate.