Men’s Health Month: Urologist Dr. Rowe Explains What You Should Know about Prostate Enlargement

What is the prostate and what is prostate enlargement?

The prostate is a gland beneath the bladder in the pelvis. The urethra (urine channel) goes through the middle of the prostate just like the hole in a doughnut. As men age, the prostate enlarges. As it enlarges, it can cause obstruction or blockage to urine flow. This can occur at younger ages but is most common in men over50. The enlargement of the prostate is referred to as BPH (Benign Prostatic Hyperplasia). About 8% of men age 30-39 will have symptoms from BPH and as many as 80% of men over the age of 70 will have symptoms. The enlargement of the prostate is determined mainly by genetics as well as some hormonal influence.

What are the symptoms of prostate enlargement?

There are 2 types of symptoms related to prostate enlargement.  The obstructive symptoms are due to the blockage to urine flow.  These are typically: slowing of the urine stream, a delay in the urine stream starting, the stream starting and stopping, and the feeling that the bladder is not emptying completely.  The irritating symptoms are due to the bladder’s response to the obstruction.  These typically include more frequent urination, getting up during the night to urinate, or needing to get to the bathroom more quickly than usual.  While these symptoms can be signs of an enlargement, they can also be caused by other conditions.

What treatments are available?

If there are severe complications such as complete inability to urinate, recurrent urinary infections, or kidney failure, potentially aggressive treatment is required.  The majority of men with prostate enlargement will not experience any of these complications and will just have urinary symptoms.  If symptoms are present and not bothersome, no treatment is needed.  However, evaluation by a physician is highly recommended to be sure that there isn’t some other cause of the symptoms, such as an infection.

If symptoms are bothersome, initial treatment is typically with medications.  There are 3 classes of medications that are approved to treat prostate enlargement.  In general medications can improve symptoms but they don’t relieve the obstruction. If the medications work, they need to be taken continuously. Some work relatively quickly and others can take several months to have an effect.

There are surgical therapies as well. A prostatic urethral lift is a minimally invasive outpatient procedure that involves inserting small implants in the prostate that open the urethra. This is typically done with mild sedation and local anesthesia. This procedure most often achieves better results than medication and usually has a quick recovery time and low risk of complications.

More formal surgeries physically remove the inner part of the prostate that is causing the blockage. This can be done using electricity or lasers through a scope. Physically removing the tissue has the best long term success rates and although most patients tolerate them very well, there are more potential complications from these procedures.

What is the best treatment for an individual patient?

When it comes to treatment, there is no ‘one size fits all’ solution that is right for everybody.  That’s why it’s important to have an evaluation by your primary care provider (PCP)  if symptoms are present.  . If your PCP does not find an infection or anything worrisome like blood in the urine, often a trial of medications will be given.  If this doesn’t help, it is best to see an urologist who can go over the different options and help determine the best approach to treatment.

Steven J. Rowe, MD earned his Medical Degree from University of Illinois College or Medicine and completed his Residency in Urology at Cleveland Clinic Foundation in Cleveland, OH. He is Board Certified in Urology and serves as the Division Leader of Urology at Crystal Run Healthcare. Dr. Rowe’s clinical interests include robotic and minimally invasive surgery, kidney stone disease, incontinence, and urologic oncology. He is seeing patients at Crystal Run’s Middletown, Warwick, and Rock Hill Locations.