Prostate Gland Enlargement (BPH)
BPH is an abbreviation used in medicine for benign prostatic hypertrophy (an enlarged prostate gland).
Unless extraordinarily dextrous, no man can feel his own prostate, as this small organ which sits behind the base of the penis can only be felt by placing a finger through the anus, where the prostate can be felt as a firm lump on the front wall of the rectum (last part of the large bowel).
The prostate is about the size of a golf ball and consists of glands, fibrous tissue and muscle. It produces a substance that makes up part of the semen a man ejaculates during intercourse that is essential for the nutrition of the sperm. If the prostate enlarges (prostatomegaly), the patient will have difficulty in starting the urinary stream, and when it does start, the urine will dribble out onto his shoes, rather than jet onto the porcelain. Up to 20% of all men over 60 have benign enlargement of the prostate gland, which is usually associated with a drop in sexual activity. The absolute cause unknown, but as the gland enlarges, it squeezes the urethra (urine-carrying tube) that passes through it, making it steadily harder to urinate.
There are only three causes for prostate gland enlargement (prostatomegaly):-
- prostatomegaly (prostate enlargement) is normal with age, and virtually all men over the age of seventy have some degree of this problem.
- prostate cancer is a very slowly progressing cancer that increases in incidence with age. It spreads to bone early, and bone pain is the first symptom in some men.
- prostatitis (infection of the gland), often from a sexually transmitted disease, may cause a temporary swelling and difficulty in passing urine at any age.
With prostate enlargement the man develops increasing difficulty in passing urine, and eventually the urethra becomes completely blocked, causing extreme distress as the pressure of urine in the bladder increases. If back-pressure of urine in the bladder becomes persistent, kidney damage can occur.
In the acute situation, a flexible tube is passed up the urethra through the penis into the bladder to release urine, but if this is unsuccessful a large needle must be pushed through the lower wall of the abdomen into the bladder. In some cases drugs (eg. finasteride, prazosin, terazosin) can be used to shrink the enlarged prostate slightly. Most cases require surgery once symptoms develop.
The operation can vary from simply dilating the urethra, to making a small cut in the prostate to allow it to open up slightly (bladder neck incision), scraping away the part of the prostate constricting the urethra by passing a specially shaped knife up it (transurethral resection of prostate – TURP), or completely removing the gland. Holium laser therapy is being used in some centres to burn away part of the gland.
Treatment almost invariably successful, with no subsequent effect on the general health of the patient, but there is sometimes subsequent sexual dysfunction.