Benign Prostatic Enlargement

Benign prostatic enlargement is the non-cancerous growth of the prostate gland that occurs with age and obstructs the flow of urine. Many men tolerate the symptoms for years, sometimes until the bladder or kidneys are damaged.

Symptoms

Not everyone gets every symptom, and the pattern can differ in older people, in people with diabetes and in children. These are the ones most often reported.

• A weak or interrupted urinary stream
• Difficulty starting to pass urine and straining
• Getting up several times at night to pass urine
• Urgency, frequency and a feeling of incomplete emptying
• Dribbling at the end of passing urine
• Complete inability to pass urine in severe cases

When to see a doctor

• Complete inability to pass urine with a painful lower abdomen — attend the emergency department
• Blood in the urine
• Repeated urinary infections or bladder stones
• Symptoms disturbing sleep or daily activity, or worsening steadily

Tests that may be advised

Your consultant will order only the investigations that change the plan. Most of the following are available on the SIMS campus, so results usually come back the same visit.

• Clinical assessment with a symptom score and digital rectal examination
• Ultrasound of the kidneys, ureters, bladder and prostate with post-void residual volume
• Uroflowmetry
• PSA blood test to help distinguish benign enlargement from cancer
• Urine examination and kidney function tests

How it is treated

Treatment is decided case by case — by how advanced the problem is, what else you are being treated for, and what you can realistically sustain. Broadly, it involves the following.

• Fluid timing advice — reducing evening fluids, tea, coffee and alcohol
• Medication to relax the prostate muscle or reduce gland size
• Catheterisation for acute retention, followed by planned assessment
• Transurethral resection of the prostate (TURP) for significant obstruction or failed medication
• Regular follow-up with PSA and residual urine measurement