Benign enlarged prostate
The prostate is a walnut-sized gland that sits beneath the bladder. The urethra, the pipe allowing urine to exit the bladder via the penis, passes through the prostate. As men get older the prostate can enlarge, compressing the urethra and making it difficult to pass urine. These men may develop symptoms such as a weak urinary stream, urinary urgency, or waking up at night to urinate. This differs from prostate cancer, which rarely presents with symptoms until very advanced.
What complications arise from an enlarged prostate?
If left untreated, benign prostatic hyperplasia (BPH) may lead to a number of complications. These include infections in the urine, bladder stones, complete inability to pass urine and kidney failure.
Complete inability to pass urine is called urinary retention. Acute urinary retention occurs suddenly and causes worsening pain as the bladder fills. Chronic urinary retention occurs if a man carries around a large volume of urine in his bladder without experiencing pain. This usually develops silently over time. These men often leak urine at night without realising it, a phenomenon called overflow incontinence.
Bladder symptoms from urinary obstruction can also occur due to strictures of the urethra, blood clots or stones. Conditions that affect the nerves leading to bladder, such as spinal cord injury or multiple sclerosis, can also cause urinary retention.
How do we treat BPH?
Medical therapy for BPH works through either: 1) relaxing the muscles with the prostate or; 2) shrinking the size of the gland over time. These medications may be used alone or in combination, depending on the circumstances of each patient, with the combined approach yielding better results. Patients who do not respond to medical therapy, or who develop complications of BPH like retention or recurrent infections, will require surgery.
During transurethral resection of the prostate (TURP) the surgeon the part of the gland causing blockage using instruments passed through a telescope down the urethra. Depending on the size of the prostate, the operation can take about 40 minutes to 1 hour.
We perform a bladder neck incision in men with small prostates or who have obstruction caused by narrowing or scarring at the bladder neck. Instead of boring out the prostate as in a TURP, the surgeon cuts the gland at strategic locations to allow the channel for urine to spring open.
Some men with BPH develop stones in the bladder as a result of poor bladder emptying. These stones can be broken down and removed, often at the same time as TURP, using either a laser fibre or special instruments passed down the telescope.
The UroLift System utilises tiny implants to lift and retract prostate tissue so it no longer blocks the urethra. It avoids cutting, heating or removal of prostate tissue. Most patients go home the same day with rapid symptom relief, and should the procedure fail (13%) other treatment options remain available. The main benefit is preservation of ejaculation, which is often lost after TURP and medical therapy.