What is prostate?
Prostate is a gland related to male sexual organ. It’s job is to produce semen. It’s size and shape is like an almond. It is situated just distal to urinary bladder neck and encircle urinary passage or urethra. Innumerable fine ducts of prostate open in this part of urethra and release its secretion during sexual stimulation and orgasm. This secretion gives nourishment and protection to sperm in ejaculate.
What is the normal size of prostate?
Normal prostate in adult is usually less than20 cc but it starts enlarging with age after 40 year. This enlargement happens due to male hormone testosterone. As male keep on producing testosterone throughout life, prostate gland keeps on enlarging with age. It may grow around 60 to 80 gm. up to age of 60 years. In certain males, it may be exceptionally large(150 cc to 300 cc). This normal age related enlargement of prostate is called as benign Prostate hyperplasia ( BPH, benign: relatively harmless; Hyperplasia: increases in size due to multiplication of cells).
What happens with enlargement of prostate?
Gradual enlargement of prostate compresses urethra and creates resistance to urinary flow. Urinary bladder need to apply more and more pressure to overcome this resistance during urination. Initially, as long as bladder is able to compensate this increased resistance, patient may not feet any urinary symptoms, but as bladder get fatigued various urinary symptoms start arising.
Individual patient may feel different types and pattern of symptoms in different severity. These symptoms may be classified as following
increased urinary frequency, nocturia(frequent urination in night), urgency (sudden urge to pass urine which may be difficult to differ), urge urinary incontinence (uncontrolled intense urinary desire which lead to urine leak before reaching toilet).
Voiding symptoms :
decreased urine flow , prolonged time required to pass urine, difficulty to initiate urine ( hesitancy), urine flow is not smooth and interrupt many time (urinary intermittency)
Post voiding symptoms:
sense to incomplete passage of urine that mean patient feel that he could not completely empty his urinary bladder.
Late symptoms / complication:
Acute urinary retention (Patients urine stop suddenly and his bladder becomes full of urine. He will feel tremendous pain due urine retention. In some patient urine retention happens gradually and patient does not feel pain. In this case also bladder is hugely distended and palpable from abdomen. This condition (chronic urinary retention) is more dangerous as this lead to gradual damage of kidney. Urinary infection can happen due to retained urine. It can present as fever, severe pain and burning in urination, blood in urination and abdominal pain. Urinary infection can be life threatening and require urgent intervention in hospital under supervision of urologist. In certain patient whose prostate becomes too large, repeated blood in urine (hematuria) can also happens, due to rupture of engorged fine blood vessels over prostate.
What is medical treatment of BPH?
Early symptoms of BPH can be managed conservatively like restricting fluid , tea and coffee especially in evening. But as symptoms becomes bothersome (mean it starts disturbing daily routine or interfere with your lifestyle ) , then you should consult urologist. Good medicines are available which can help you in these conditions.
Medicines like Alpha blockers ( Tamsulosin, Alfuzocin, Silodosin etc) relaxes smooth muscles fibers inside prostate and make urethral passage wider during urination. Urine flow improves and urine frequency reduces with these medications. Other class of medications named “5-Alpha Reductase” ( Finasteride and Dutasteride) , gradually reduces prostate gland size over three to six months.
Surgery is required in following conditions:
- When patient get urinary retention due to prostate and required more than once catheterization.
- If gradual urinary retention is causing damage to kidney
- If patient is getting repeated urinary infection due to retained urine in urinary bladder.
- If patient is having repeated blood in urine due to large size of prostate.
- If patient is not satisfied with medicines or having side effect due to medication or want to get rid of lifelong medications.