Enlarged prostate can cause urination problems in men
By Andrea K. Walker and The Baltimore Sun
May 01, 2013 | 2:28 PM
Many men will experience prostate enlargement as they get older, some to the point that it will cause urination problems. Dr. Michael Naslund, director of the Maryland Prostate Center at the University Maryland Medical Center, said there are many options for treatment, including surgery, drugs and lifestyle changes.
What is the prostate and how does it function in the body?
The prostate gland sits beneath the bladder in men. The primary function of the prostate in a young man is to produce some of the fluid in the ejaculate and to transport urine and sperm out of the body through the urethra.
Why is an enlarged prostate a health risk?
As men age, the prostate enlarges and in some men enlarges to the point where there is partial or complete blockage of urine flow from the bladder. In this situation a man can develop difficulty passing urine.
The bladder is a muscle and like any muscle, it will thicken if it has to squeeze harder to push urine through a partially obstructed prostate gland. The increased thickness leads to a decrease in bladder capacity and reduced ability of the bladder to expel urine. This process results in frequent urination, a weak urinary stream, sudden urges to urinate, the need to strain to get urine to pass and urinating more than once during the night. In some cases, the obstruction is such that the bladder does not empty completely or sometimes is unable to empty at all. If the bladder cannot empty, the man develops urinary retention and has to be catheterized.
Who is most likely to suffer from an enlarged prostate?
Prostate enlargement begins microscopically when a man is in his 40s, but usually men over 50 are the ones bothered by prostate enlargement. Just because a man's prostate is enlarged does not mean he needs treatment. Many men have enlarged glands and are never bothered with urine flow.
The exact molecular cause of prostate enlargement is not known. What is known is that advancing age and male hormones are the main risk factors for prostate enlargement.
Which tests are done to evaluate an enlarged prostate?
The evaluation of a man with an enlarged prostate is usually an evaluation of his urinary symptoms. If he is not bothered by his symptoms, the residual urine left over in the bladder after urination can be checked with an ultrasound, and if that volume is acceptable, no treatment is needed. If the bladder is not emptying adequately or if the man is bothered by his urinary symptoms, there are both medical and surgical treatment options available.
How is an enlarged prostate treated?
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For most men, medication is usually the first treatment considered. There are two classes of medicines: alpha-blockers and 5-alpha reductase inhibitors. Which medicine is used depends on the specifics of a man's situation. In some instances, both medicines are used simultaneously. As long as bladder function is good, approximately 75 percent of men can be managed, at least initially, with medications in a satisfactory manner. There are side effects, which occur in 5 percent to 8 percent of men from these medicines, but, in general, they are well tolerated.
Medical management does not work for all men. In addition, there is a subset of men who, for various reasons, do not want to take medications. In these settings, there are some minimally invasive procedures as well as surgical procedures that can be done to alleviate the obstruction. The "standard" operation is transurethral resection of the prostate (TURP). In this procedure, the obstructing tissue is surgically removed from the inside of the prostate. To visualize how this is done, the prostate could be considered as an orange. During the surgery, the fruit is resected and peel is left behind leaving a wider opening for urine to pass through. This is a very effective procedure at relieving obstruction. The downside to TURP is that there are some side effects that can occur which are undesirable.
In recent years, minimally invasive surgical procedures have been developed. The advantage of these procedures is that the side effect and complication risk is decreased, but a potential disadvantage is that in many men the results are not as consistent as those with a TURP. There are options that heat the prostate either with radio frequency energy or microwave energy. The heat to the tissue shrinks the prostate and interrupts the nerve supply, which can improve symptoms in many men. In addition, many urologists now use a laser to perform vaporization of the prostate as a substitute for the standard TURP.
Men who have bothersome urinary symptoms should discuss this issue with a urologist. Some men are concerned about bringing this to the doctor's attention for fear that they may require treatment. Many older men today remember either their father or another male relative 20 or 30 years ago who received prostate surgery and was "never the same afterward." With modern techniques, the complications and risks of surgery are much less than in previous eras. Treatment is not something a man should fear if he is having difficulties urinating.