Benign prostate disease
What is the prostate?
The prostate gland is a small gland (about the size of a walnut), that lies beneath the bladder, in front of the rectum and surrounds the first portion of the urethra. The prostate gland is part of the male reproductive system, with its main role is to produce fluid, which protects and nourishes sperm. The male hormone testosterone makes the prostate grow in size, therefore as men age the prostate will naturally enlarge.
The reason for this continuation of prostate growth is not fully known.
The increase in prostate size is mainly in the central portion of the gland, which, because of its close association with the urethra, can cause obstruction to the urinary flow.
What is Benign Prostatic Hyperplasia/Hypertrophy?
Benign prostatic hyperplasia or hypertrophy (BPH) is a non-cancerous enlargement of the prostate gland; it is the most common type of prostate disease in men.
Due to the proximity of the prostate to the bladder and surrounding the upper portion of the urethra, enlargement can cause what is known as lower urinary tract symptoms (LUT’s). BPH symptoms can occur slowly and progressively over a long period of time. Symptoms can vary for each individual; some men may experience very little bother while for others their symptoms can cause a great deal of bother, affecting their quality of life. Urinary symptoms related to BPH will get worse over time if left untreated.
Common urinary symptoms with BPH
Obstructive type symptoms
- Hesitancy – difficulty in beginning urination
- Weak stream – weak urinary stream or flow
- Intermittency – the urinary stream starts and stops
- Dribbling – ongoing dribbling of urine that continues after urination has finished, often as you leave the toilet.
- Incomplete emptying – a feeling that you haven’t fully emptied your bladder after urinating
- Retention – can be chronic or acute, when your bladder isn’t completely emptied after you have finished urinating (chronic) or you are unable to pass urine at all (acute)
- Frequency – the need to urinate a short time after you have been
- Urgency – the need to urinate immediately, a sensation that you may leak if you delay
- Nocturia – the need to urinate more than twice in one night
Your urologist may use the following assessments and tests to diagnose BPH and to exclude other possible conditions that may be causing your urinary symptoms.
- A full history and assessment of your symptoms including symptom score questionnaires, degree of bother of symptoms and bladder diary.
- Digital rectal examination (DRE) – a physical examination to assess the size and shape of the prostate.
- PSA blood test – measures the level of prostate specific antigen in the blood. Most commonly used to assess for prostate cancer but BPH can also cause levels of PSA to rise.
- Kidney function blood tests – for example Urea and Creatinine and eGFR to assess the functioning of your kidneys.
- Urine tests – to assess for infection
- Urinary tract Ultrasound
- Flexible cystoscopy
- Flow rate studies and Bladder scans to assess emptying
Treatments provided by our practice
There are a variety of treatment options for the treatment of BPH including the conservative management of urinary symptoms (such as deferment drills and emptying strategies), the use of medications (such as agents to relax the outflow tract or shrink the gland) and surgery aimed at removing the obstructing part of the gland.
Our Urologists are skilled in the assessment of outflow tract symptoms and will counsel you on the best treatment options.