The prostate is a gland located inside the penis, around the urethra. Its purpose is to help the sperm. As you get older, the prostate can grow and push against the urethra, making it harder to urinate. The enlarged prostate does not increase the risk of prostate cancer.

You do not always need treatment, but if you have any problems, there are medicines that can help. Benign prostate enlargement is most common in people over 60 years of age.

Symptoms of benign prostate enlargement

It is common to have any of the following problems when you have benign prostate enlargement:

  • When you kiss, the beam is weaker.
  • You need to press to completely empty the bladder.
  • It feels like the bladder is not completely emptied when you have finished kissing.
  • The beam is interrupted one or more times while kissing.
  • You need to pee more often during the day.
  • You need to get up and pee at night.
  • It leaks urine while suddenly feeling pissed. 

When and where should I seek care?

Contact a health care provider if you have symptoms that may be due to prostate enlargement. You can contact many receptions by logging in.

Investigations

You can choose which health center or reception you want to go to when you need outpatient care.

At the doctor’s, you describe your complaints and answer questions about your health, lifestyle, other illnesses, and about the medicines you use. May also do some initial research:

  • General body examination.
  • Prostate examination. The examination is done so that the doctor puts on a glove and gently inserts a finger into the rectum opening to feel the prostate. The examination may feel a bit uncomfortable but does not hurt. The doctor assesses the size of the prostate and if there are hard nodules in the tissue.
  • You can have a blood test to check the kidney function.
  • You may submit a urine sample. It is to exclude other diseases of the urinary tract, such as urinary tract infection.
  • To check if the bladder is completely emptied, the doctor also measures how much urine remains in the bladder after you urinate, so-called restaurant. This is almost always done through an ultrasound examination. The examination takes a few minutes and is completely painless.
  • You are usually given a blood test to check for a substance that is formed in the prostate, called  PSA. The PSA value may be elevated both in benign prostatic enlargement and in cancer. If the PSA value is increased, you may see a urologist for further investigation. A urologist is a doctor who specializes in kidney, urinary tract, and male genital disorders. 

Make measurements at home

You can also make your own measurements of how much you kiss and how long each occasion takes. Then, you enter the result in two protocols.

In a questionnaire, you can also assess how difficult your problems are. It helps the doctor decide which treatment you may need.

You may see a urologist if the doctor finds evidence of any prostate disease for which you may need surgery or other treatment.

Investigations at the urologist

At the urologist, you can do a new examination. The urologist examines the prostate gland by inserting a finger into the rectum and sensing the prostate.

Other common investigations you may do are:

  • You get to pee in a flow meter to measure how fast the urine flows through the urethra.
  • You can do a urinary bladder examination to measure how much urine remains after peeing. The measurement is usually done with ultrasound.
  • You are allowed to submit blood tests and urine tests.

You may sometimes need to do more research. It may be if the urologist cannot safely determine the cause of the inconvenience, or decide which treatment is best.

Ultrasound and tissue samples

An example is an ultrasound examination of the prostate. The study will help the urologist determine the size of the prostate gland. Sometimes, the examination can also be used to take tissue samples from the gland. The examination of the size of the prostate takes a few minutes and does not hurt. Taking tissue samples takes five to ten minutes. You get local anesthesia because it can feel uncomfortable.

cystoscopy

You may also be able to do a so-called cystoscopy. It is a study done to check the bladder and prostate gland.

Pressure and flow measurement

Another study checks the pressure and flows in the bladder. It is called urodynamics or pressure-flow study. Then you get a thin plastic tube inserted into the bladder through the urethra. The tube is called a catheter. Urinary bladder pressure and urine flow are measured simultaneously. Then it is assessed how strong the bladder is and if there is any obstacle to the flow of urine in the urethra.

X-ray

An X-ray examination is done only when there is a specific reason. For example, it may be when the doctor suspects that the kidneys are affected. The kidneys can be imaged either by x-ray or by ultrasound. The doctor can then see if there are changes such as stones or tumors in the kidneys. X-ray shows how the kidneys work and how the urine flows from the kidney down to the bladder.

You have the right to understand

In order for you to be able to participate in your care and make decisions, it is important that you understand the information you receive from the healthcare staff. Ask questions if you don’t understand. You can also ask for information printed so that you can read it peacefully. 

Treatment of benign prostate enlargement

You do not always need to be treated if the studies show that the problems are due to benign prostate enlargement or normal age changes. You only need treatment if you have a problem with the prostate enlargement. The trouble may be that you feel that the jet is weak when you are kissing, that the bladder is not completely emptied, that you have to pee often during the day or get up often at night. It may also be that you feel limited in everyday life or are unsure of what activities you can do because you do not know if there is a toilet close enough.

The trouble can be reduced by itself

It is common for the trouble to reduce by itself, even though the prostate gland does not decrease in size. Sometimes the trouble can come back. The most common thing is that problems are unchanged for a long time.

You may need treatment if the problems with urination become worse, or if the prostate enlargement leads to complications.

Different treatment methods for enlarged prostate

When getting treatment for benign prostate enlargement, there are the following methods to choose from:

  • You can get treatment with prescription drugs. You can get the treatment from either a doctor at a health center or a urologist. It is usually the doctor at the health center who follows up the treatment.
  • You can be operated on.
  • Microwave or other heat treatment.
  • You can get treatment with a spiral that prevents the prostate from compressing the urethra, or catheter in the bladder.

Surgery, heat treatment, and other types of surgery are usually done at urological clinics or at clinics that have access to urologists. Access to a urological clinic or urologist varies depending on where you live in the country. You can get a referral from a doctor at a health center.

Treatment of benign prostate enlargement with drugs

There are different types of drugs used in prostate enlargement.

One is called the alpha receptor blocker and relaxes the muscles around the urethra and the prostate gland. The size of the prostate gland does not decrease, but the problems can still decrease. The drugs work quickly, already within two to three weeks.

The other is called 5-alpha reductase inhibitor and reduces the size of the prostate gland. The drugs only have an effect when you have a clearer enlargement of the prostate gland. It may take up to six months for the drugs to full effect.

You who have both benign prostate enlargement and difficult to get hold can get a drug that is commonly used in erection problems. Then you may notice that the urinary tract problems get better one to two weeks after starting treatment.

Sometimes surgery is needed

Surgery is usually recommended if the prostate enlargement has caused some complications, such as you cannot urinate at all, or if the kidneys are working poorly. You may also need surgery if you get repeated urinary tract infections or with repeated bleeding from the prostate. Likewise, surgery may be needed if you have severe problems emptying the bladder or problems due to stones in the bladder. An operation does not affect the risk of getting prostate cancer later in life.

Surgery when prostate tissue is removed via the urethra, TURP

If you need surgery, it is common for the prostate gland to be made smaller using a method called the planing method or TURP, which stands for transurethral resection of the prostate.

You get anesthesia before surgery, usually back anesthesia. In this way, the entire lower body is anesthetized. During the operation, you lie on your back with your legs in raised support and the operation takes 30-60 minutes.

The prostate gland tissue is removed by inserting an instrument, a narrow tube, into the urethra. At the top of the tube is a small electrical tool with which the doctor can cut tissue by piece so that the urinary tract can regain its shape and function well again.

After the operation, you usually have a catheter in the urethra. The catheter is usually allowed to sit for someday and during that time you usually have to stay in the hospital.

Most of those operating in this way experience a good result. There is a small risk that the problems will recur. About one-tenth of the operation is relapsed during a ten-year period.

It is uncommon for the ability to have an erection to deteriorate after a TURP operation. However, it is common for the semen to go back into the bladder instead of passing through the penis, making it more difficult to have biological children.

Operation through an incision in the abdomen

Sometimes it is not possible to remove tissue from the gland by cutting off small pieces gradually. This is especially true if the prostate gland is greatly enlarged. Then the gland can instead be removed with an operation through the lower abdomen, below the navel.

Such an operation is more extensive and requires both longer hospital time and longer catheter time. You can expect to have to stay in the hospital for a week. The operation usually gives a great improvement to the problems.

Good to quit smoking

There are many benefits to quitting smoking before operation if you smoke. The wounds heal faster, blood circulation and fitness improve so you recover faster. You should quit smoking altogether, but if it does not succeed then it is good if you can refrain from smoking before the operation and even the first weeks afterward. If you need help to quit smoking, your doctor can tell you what support is available.

Heat treatment can reduce the size of the prostate

You can also undergo treatment when parts of the enlarged prostate tissue are destroyed by heat.

Microwave heat treatment, THUMB

The most common method is called TUMT, a transurethral microwave treatment, which means that the heat comes from microwaves. When you are treated you first get local anesthesia in the urethra. Then, a catheter is inserted into the urethra and up to the prostate gland. The catheter contains a microwave antenna that produces heat so that the inner parts of the prostate gland are heated until the tissue is destroyed. When the innermost parts disappear, the size of the gland decreases.

You undergo the treatment at one point and it takes less than half an hour. The risk of side effects is small. Afterward, you have a catheter in the urethra for a few weeks. The catheter is needed as the prostate can temporarily swell after treatment and make it difficult to urinate. In addition, residues of the heat-treated prostate tissue are ejected through the catheter and into the collecting bag. It can sting and hurt the urethra while you have a catheter and a few weeks after it is removed.

Laser heat treatment

The prostate gland can also be heated by a laser. As with microwave treatment, the tissue is destroyed and the gland decreases in size. Often the problems with urination are alleviated.

Heat treatment with needles

Another treatment is that needles create heat which then destroys the prostate tissue. The needles are placed in the prostate gland and through the heat is passed from radio waves or lasers. These are less common treatments. 

Heat treatment with steam

The size of the prostate can also be reduced by bringing water vapor up to the tissue through a special instrument.

Advantages and disadvantages of heat treatment

The advantage of a heat treatment that destroys the tissue and reduces the size of the prostate gland is that you can go home the same day. There is also less risk of complications than surgery. One disadvantage is that you have to have a catheter for a long time after the treatment, usually one to two weeks. You usually do not need to change the catheter during this time. There is also a risk that a new treatment is needed.

Catheter in the bladder

When you can’t urinate at all, you need to empty the urine through a catheter that is inserted through the urethra into the bladder. A catheter can also be used while waiting for surgery.

You may need to have the catheter for a longer period of time if for some reason you are unable to operate. Then it is changed every three months, or more often if it stops. The catheter is replaced by a nurse and usually, it happens at your health care center. Sometimes the catheter is operated through the stomach and into the bladder, which can reduce the urethra irritation. When you have a catheter for a long time, there are always bacteria in the bladder that can cause urinary tract infections. 

You can also learn so-called self-tapping by a nurse or ur therapist. Then you use disposable catheters. You empty urine about five times a day. This method causes less irritation to the urethra and bladder.

Alternative treatment

In alternative medicine, various plant extracts have long been used for prostate problems, for example, pollen preparations. Some smaller studies may indicate some effect, but there is no reliable scientific evidence that such agents have an effect.

Complications may require prompt treatment

In some cases, the enlarged prostate can lead to more severe problems and complications. Then you have usually had trouble with urination for a long time.

You need immediate care if you can’t urinate at all but stop urine flow, so-called urinalysis. Then you get severe cramps and it hurts the stomach, usually in the lower part.

You need to get treatment quickly if the studies show that the kidneys are working poorly. The same applies if there is repeated bleeding from the prostate gland and if there is residual urine that produces stones in the bladder, so-called bladder stones.

You also need treatment when a large amount of urine remains in the bladder after peeing. This is because the kiss that remains otherwise can lead to repeated urinary tract infections, which in turn can lead to fever and blood in the urine. It can also lead to urinary incontinence, so-called overflow, or overflow incontinence.

What is the cause of prostate enlargement?

The prostate gland is located around the urethra exactly where it exits the bladder and exits the penis. The prostate is part of the male’s internal genitalia and has the task of forming transport fluid for the sperm on their way from the urethra to the egg in the uterus. The function of the prostate is partly controlled by the hormone testosterone that is formed in the testes. The prostate gland is also called the bladder neck gland.

Difficult to urinate when the urethra is compressed

An enlarged prostate gland often compresses the urethra. Then an increased pressure is needed for the urethra to open and the urine to pass. Peeing can be trickier. Prostate enlargement that is not due to serious illness is called benign prostate enlargement. or benign prostate hyperplasia, BPH. The cause of prostate enlargement is not clear.

Other causes of the trouble

Approximately every other person over 60 years has prostate enlargement and four out of five over 80 years. Just over half of those who have benign prostate enlargement have some sort of trouble. But sometimes the trouble is due to something else, for example, it can be overactive bladder,  urethral congestion, urinary tract infection, and neurological diseases.

Does not lead to cancer

There is no risk of benign prostate enlargement developing into prostate cancer. However, you can have prostate enlargement and prostate cancer at the same time. Since prostate cancer can also lead to enlargement of the prostate gland, the symptoms of the two diseases can sometimes be similar.

Ehtisham Nadeem

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