Routine tests show that the prostate increases to a greater or lesser extent in nearly every male over the age of 45; the harmless spread of normal prostate tissue is a natural consequence of the aging process. Specifically, nodes are progressively developed in the prostate, so the gland itself becomes bigger by their accumulation. The change does not have to cause the problems, although the prostate may considerably swell. In some men, the prostate – which is usually relaxed to allow free flow of urine from the bladder through the urethra – becomes hard and non-elastic, but this ”hard” prostate may not cause any problems.
As the gland becomes harder, narrowing the urethra which it surrounds, the bladder muscles usually compensate for the discomfort and become more powerful. This additional muscle strength is often enough to open the urethra. Serious illnesses occur only after the bladder muscles can no longer compensate for the discomfort, which leads to a serious interruption in the urinary flow.
Symptoms of enlarged prostate enlargement vary greatly, but one of them is common in all cases: difficult urination, or weak urination. The patient will feels that he needs to urinate more often (and the urge for urination can be so strong that he wakes up at night), but he wlill drop small amounts of urine. In addition, even if the urge for urination is powerful, the patient will often have to wait for urine to start going, which is particularly evident in the morning. The pains are very rare and there are no visible swellings or bumps as the prostate is deep in the abdominal cavity. However, blood can sometimes be found in the urine (hematuria).
Although it is very common in men who have passed the age of 45, enlarged prostate rarely causes problems before the age of 55. Severe urinary tract problems affect 10% of older men.
Although the condition itself is not dangerous, enlarged prostate can cause problems for three main reasons. First, if the bladder is never completely depleted, the urine that stays in it may be infected (see cystitis in men article). Secondly, since the muscular wall of the bladder becomes stronger in order to ”push” the urine through the narrowed urethra, it can be so thick that it will constrain the ureter (a tube that leads the urine from the kidney to the bladder), which can cause acute pyelonephritis. Finally, if the seriously enlarged prostate is not treated, the urinary bladder muscles will no longer be able to overcome the problem (i.e. urinary retention), and they can gradually or suddenly stop functioning. Sudden stopping occurs when bladder suddenly stops ejecting the urine; this condition is called acute urinary retention. Acute retention is rare, but very painful, and requires urgent medical intervention. Gradual stopping is more common and occurs when the bladder gradually ejects smaller amounts of urine. If the condition is not treated, the amount of residual urine (in the bladder) will cause the stomach to increase (as if the patient is pregnant). In many cases, the accumulated urine will ”leak” out from the bladder whenever the patient coughs, sneezes, or strains himself. If no appropriate measures are taken, the condition will eventually lead to acute retention, and possibly renal insufficiency.
What to do?
If you feel the symptoms of enlarged prostate, contact a doctor who will examine the gland by inserting a finger in the rubber gland in your rectum, and then send you to a urologist for the examination. The urologist will observe urine leakage, and perhaps measure it with the urine flow meter. Intravenous pyelogram (IVP) may also be needed to check whether the symptoms are the result of a problem with an urinary tract or a result of an enlarged prostate, and to determine the degree of possible damage to the bladder, urinary tract or kidneys due to prostate enlargement.
If you have symptoms of acute retention, immediately go to your doctor or to hospital. Before the diagnosis (and, of cours,e the treatment) you will need to empty the bladder with the catheter.
If the symptoms are mild, and diagnostic tests indicate that no emergency intervention is needed, the doctor will probably not take any action. At least 30% of the cases with mild symptoms of the disorder disappear without treatment, so it is advisable to wait some time. However, if the problems do not disappear or if they become worse, or if the tests indicate a severe urinary flow stoppage, it will be required to remove the tissue that caused prostate enlargement.
This operation, prostatectomy, can be performed by a classical surgical method or by a modern method known as transurethral resection (TUR). Surgical removal of excess tissue is performed through the opening in the lower part of the abdomen.
In transurethral resection, a thin tube (resectoscope) is inserted through the urethra into the prostate. At the top of the tube there is a wire loop, which can be heated by electric current; the surgeon will, with the help of a miniature telescopic device, manipulate the loop and cut the problematic nodes. After the procedure, the patient remains in the hospital for a 4 or 5 days at max (in comparison, the hospital stay after a classic surgery is usually 10 to 14 days), and the postoperative pains are weaker. However, in some cases, TUR can not be performed.
Regardless of the method, most prostatectomy is successful. The operation alleviates the problems with urination, and the prostate rarely ”causes” problems after the procedure. However, especially in the classical method, a damage to the nerve that leads to penis is possible. Because of this, some patients become impotent after the surgery, while others remain potent but become sterile (infertile) because the seed is thrown back, into the bladder, not out. Fortunately, since the enlarged prostate is a problem that affects older men, most men in need of prostatectomy do not have to worry about losing fertility. A seed that is thrown into the bladder is not dangerous as the fluid (seed) is released along with urine.