Symptoms
Typical symptoms of prostate enlargement are difficulty passing urine with reduced urinary flow, passing urine more frequently and having to get up at night to pass urine. This may lead to difficulty emptying the bladder with other problem such as urinary infection and even impaired kidney function. Unfortunately, some men get to the point where they cannot pass urine at all – this is called retention of urine. After a while the bladder may be working too hard to push urine passed an enlarged prostate and this can cause the bladder to be overactive with feelings of urgency and maybe even rushing to the toilet and sometimes incontinence if you are not able to get to the toilet in time. The International Prostate Symptom Score (below) can be used to grade the severity of symptoms & a Bladder Diary (below) is useful to accurately record daily fluid input & output.
Diagnosis
This diagnosis is usually made on the basis of rectal examination of the prostate, PSA test and some specialist tests including urinary flow rates. Uroflows are performed by getting the patient to pass urine into a machine that measure how fast the urine is passed. This gives us a good idea of whether the prostate is causing a blockage to the way out of the bladder. Other tests that may be required include flexible cystoscopy where a small telescope is passed down the penis through the prostate and into the bladder. This allows us to directly inspect the prostate and bladder from the inside. Occasionally more detailed measurements are required and this is called a urodynamic assessment where small tubes are placed into the bladder to measure bladder pressures whilst the man is trying to pass urine.
Treatments
The first line of treatment is modifying behaviour such as reducing fluid intake particularly caffeine. Drug treatments are often tried and can be useful if the first place for improving symptoms. Unfortunately, some men get side effects from taking the drugs for prostate enlargement and some people simply do not like taking drugs long-term. Therefore, surgery is an option to treat these problems.
Surgery
TURP – TURIS
This is the most well established and best-known operation for benign prostate enlargement. During this procedure under an anaesthetic as telescope is passed into the bladder and prostate. Through that telescope a small electric loop is used to cut prostate tissue away from the inside. This is like a re-bore procedure or a coring out procedure that creates a nice open channel through which men pass their urine. Typically, this involves a two-night stay in hospital with a catheter in for at least one night.
Laser procedures
Rather than using electrical energy to cut away the prostate these procedures use a laser. This may be either a green light laser which vaporises or destroys tissue or the Holmium laser which cuts the prostate and allows some tissue to be removed. The main advantage of laser surgery is a reduced risk of bleeding.
Urolift
This is a new procedure which offers many advantages over the laser or TURP operation. This is a smaller procedure in which small implants are placed into the prostate to pull it open. As there is no cutting there is no risk of bleeding. This is usually done as a day case procedure and does not typically require a catheter to stay in afterwards. Importantly as no tissue is cut away there are no risks of sexual dysfunction. As this is a relatively new procedure we do not know whether there will durable long-term outcomes. However, other surgery such as TURP can still be performed after Urolift in the future if needed.
