Conditions & Treatments

Prostate Enlargement

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OVERVIEW

The prostate gland is a male sexual gland located deep in the pelvis. The prostate creates fluid for semen. It is approximately the size of a walnut and includes a portion of the urethra.

As men age, the prostate gland may enlarge over time. This enlargement can block the flow of urine through the urethra. Enlargement of the prostate does not always need treatment, but if symptoms are bothersome to the patient, treatment may help relieve these symptoms.

At the University of Kansas Department of Urology, we are committed to providing our patients with the highest quality care and the most advanced treatments available. We work closely with each patient to develop a personalized treatment plan that takes into account their unique needs and goals.

SYMPTOMS & CAUSES

Blockage of urine from an enlarged prostate can cause a weak urinary stream and difficulty urinating. The urinary stream can start and stop, and men may feel they are unable to fully empty the bladder without straining. Other symptoms include sudden urges, frequent urination, and waking at night to urinate.

DIAGNOSIS & SCREENING

This diagnosis is often made based on the symptoms of a physical examination. We may recommend a scan to ensure the bladder is empty. Basic urine testing (urinalysis) is done to rule out other problems.

In addition, a cystoscope may be used to look inside the bladder. A PSA test may also be done to screen for prostate cancer, and imaging may be used to determine the size of the prostate gland.

TREATMENTS

There are several types of treatments to address prostate enlargement:

Medications:

  • Alpha blockers: tamsulosin, alfuzosin, doxazosin, and silodosin
  • 5-alpha reductase inhibitors: finasteride and dutasteride
  • Phosphodiesterase-5 inhibitors: tadalafil

Minimally invasive procedures:

  • Urolift
  • Aquablation

Surgical procedures:

  • Transurethral resection of the prostate
  • Laser ablation/vaporization of the prostate
  • Laser enucleation of the prostate
  • Simple prostatectomy

Medications:

Alpha blockers: tamsulosin, alfuzosin, doxazosin, silodosin, and terazosin

These medications can relax the prostate, resulting in a more open urinary channel and reduced obstruction, and often work fast. Side effects may include lightheadedness, dizziness, fatigue, and lack of ejaculation.

5-alpha reductase inhibitors: finasteride and dutasteride

These medications shrink the prostate by blocking the effect of testosterone within the prostate gland. These medications take several months to be effective but are effective in larger glands and can reduce the need for surgery. Side effects may include lower sex drive and erectile dysfunction.

Phosphodiesterase-5 inhibitors: tadalafil

This medication relaxes the prostate gland to improve urinary flow. Side effects include facial flushing, heartburn, nasal congestion, and headache.

Minimally invasive procedures:

Urolift

A small needle places an implant within the prostate that compresses the prostatic tissue to widen the urethral channel, reducing the obstruction. This is done through the urethra without cuts or sutures. This procedure has fewer sexual side effects compared to other surgeries but may be less effective at reducing symptoms over the long term and may require a second procedure.

Aquablation

This procedure uses a very thin jet of water to remove prostate tissue and widen the urethral channel. This procedure has fewer sexual side effects than more traditional procedures and provides good control of urinary symptoms. However, longer-term studies are still pending.

Surgical procedures:

Transurethral resection of the prostate

This is considered the “gold standard” prostate procedure. A cystoscope is placed through the urethra, and a hot wire loop is used to remove the prostate tissue to widen the urinary channel.
This procedure improves the urine flow through the prostate and reduces urinary symptoms. The tissue is sent in for a pathological examination. Transurethral resection surgery has high long-term success rates and reduces the need for a second procedure.

Laser ablation/vaporization of the prostate

This procedure is similar to transurethral resection of the prostate, but instead of a hot wire loop, a high-powered laser is used to vaporize the prostate tissue from within the urethra to widen the urinary channel. No tissue is available to send for analysis. This method has very low blood loss and is useful for men with a higher risk of bleeding or blood thinners. Like TURP, this procedure has very good long-term success rates.

Laser enucleation of the prostate

Using a cystoscope through the urethra, a laser cuts a large portion of the prostate tissue, similar to removing an egg from a shell. A second instrument cuts the prostate tissue into small pieces that are removed through the cystoscope.
This procedure removes more prostate tissue than other transurethral procedures, which are sent for analysis. This procedure is particularly effective for large prostate glands.

Simple prostatectomy

This procedure can be done through an open incision or with the surgical robot and is used for large prostate glands.

OUTLOOK & PROGNOSIS

For most men, urinary symptoms improve after the treatment of BPH. It can take time for sexual function to fully recover, and rates of erectile dysfunction are very low. The ability to orgasm is not expected to change, however, many men will experience difficulty with ejaculation after the surgery. This is not harmful but can be bothersome.
Other risks of prostate treatment procedures include infection, bleeding, and leakage of urine (incontinence). Scar tissue can form that may need to be treated. Some men may need additional treatment if initial treatments are not effective.

CONCLUSION

Understanding prostate enlargement is crucial for accurate diagnosis and personalized care. Early detection, regular check-ups, and a healthy lifestyle play a vital role in reducing risks and improving outcomes. Consulting with experienced medical professionals is essential for informed decisions regarding prevention and treatment options tailored to your needs.

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