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What is the prostate?

It is a fleshy walnut like organ around the neck of the bladder in males, the urethra (tube connecting the bladder to the outside) passes through it. It is a combination of glands and muscles. It is a part of the male reproductive system.

What is Benign Prostatic Hypertrophy (BPH)?

It implies a non cancerous swelling of the prostate gland. This could cause pressure on the bladder outlet and hence cause difficulty in passing water or urination by decreasing the diamet. Hence a person might need to pass water more often and with difficulty.

Why do men get BPH?

The reasons for the prostate enlargement are not clearly understood as yet. It is usually seen in older men. Most of the times it is an entirely benign process which is so common that it can be almost considered a normal part of getting older. However a very small percentage of men can have cancerous growth n the prostate.

What are the symptoms of BPH?

The symptoms could start by difficulty in passing water. There might be trouble in starting urination or an unusually slow flow with dribbling at the end. You might need to wait for a few minutes before the flow starts. Straining might actually hinder the stream. It can get worse at night. You might want to pass water more often as well. You might feel lack of control on your bladder occasionally causing ‘spills’ or ‘leaks’. All these might disturb your sleep and you might feel more comfortable always being in close proximity of the toilet. A full bladder with incomplete emptying may cause bed wetting or back pain. A complete blockage may cause urinary retention and you may need urgent treatment.

What other conditions can mimic BPH?

Your doctor will ensure that you do not suffer from any other disease of the prostate like cancer or inflammation. It is best to discuss your concern with your doctor in case you are worried.

Will it get worse?

If left untreated symptoms can occasionally get worse? Your doctor will consider the various complications that can arise out of this condition and decide the best treatment plan for you which could be medical therapy or surgery. Usually surgery is not necessary and drug therapy can be used to treat BPH unless your symptoms are very bad. You might need to see a ‘Urologist’, a surgeon who specialises in waterworks treatment.

What medical treatments are available?

Two main types of medications are available. Your doctor will decide what type of drug is suitable for you after discussing with you.

Both drugs act in different ways.

First one acts on your bladder to relieve symptoms by relaxing the muscles surrounding the urethra, bladder and prostate whereas the second shrinks your enlarged prostate hence relieving symptoms. Both allow urine to flow more freely by widening the urethra( the tube like bladder outlet) It will take a couple of months to find out which medicine suits you best.

Which treatment is right for me?

Your doctor will decide the best treatment options for you after due consideration to all the relevant factors. Some important considerations are:

•The size of the prostate.

•How severe the symptoms are

•Is the condition affecting your life style

•Will you need surgery in the future

•Are there any impending complications like acute urinary retention(inability to pass water)

What will the urologist advice?

The urologist may want to find out the extent of the problem. He might perform a physical examination from your back passage and some routine tests. These could include a urine test (to rule out a water infection), an ultrasound (to evaluate your kidneys and your bladder), blood tests and urine flow test to see the rate at which you pass water.

The results of these tests will decide further management.

Occasionally more complicated test might be needed to rule out cancer of the prostate.

Will I need an operation?

If you have severe symptoms then your urologist may recommend you to have an operation. It involves removing part of the enlarged prostate gland. It can be done by different methods and your urologist will discuss with you the method best for you depending on the size of the prostate. One of the popular methods is the Trans Urethral Resection of the Prostate (TURP) which is suitable for most except very large prostate. It involves passing tiny telescopes through the penis after a suitable anaesthetic. Your urologist will usually inform you of the details of the most suitable procedure for you.

What happens after a TURP operation?

There might be a little bleeding after surgery and you might need to stay in hospital for a few days till it stops. It may take a few days for full recovery from surgery. It can take longer if you are older. Occasional complications are infection and bleeding. You will need to inform your doctor if you develop temperature, pain on passing water or sudden blood in your water. Your doctor might advise some antibiotics and plenty to drink.

Surgery may cure bladder obstruction symptoms but it make take longer for all the symptoms to settle. Sometimes symptoms may get worse for a few days before they become better. It can take up to six months for the benefits of surgery to appear.

When can I have sex again?

Usually men who have normal erections before surgery continue having them after surgery. In some men after surgery sperms and seminal fluid may start going back into the bladder instead of coming out of the penis (Retrograde Ejaculation). It is a harmless side effect, but it can cause difficulty in having children after TURP. This could be the case if no semen comes out after an orgasm.

Also read about Prostatitis

Also read about Prostate Cancer and PSA