Condition: Enlarged prostate

An enlarged prostate, also known as benign prostatic hyperplasia (BPH), is a common condition that affects most men as they get older. The exact cause of BPH is not fully understood, but several factors are believed to contribute to its development. These factors include:

• Age: Aging is the primary risk factor for an enlarged prostate. As men grow older, the prostate gland naturally increases in size. It is estimated that more than 50% of men in their 60s and up to 90% of men in their 70s and 80s have some degree of prostate enlargement.
• Hormonal changes: Changes in hormonal levels, particularly the balance between testosterone and estrogen, are thought to play a role in the development of BPH. Testosterone is converted to a more potent form called dihydrotestosterone (DHT) by an enzyme called 5-alpha-reductase. DHT stimulates prostate cell growth, which can lead to enlargement.
• Family history: Having a family history of BPH increases the risk of developing the condition. This suggests a genetic predisposition to prostate enlargement.
• Hormonal imbalances: Other hormonal imbalances, such as elevated estrogen levels or a decrease in testosterone production, may contribute to prostate growth.
• Chronic inflammation: Chronic inflammation within the prostate gland has been associated with BPH. Inflammatory processes can lead to increased cell growth and prostate enlargement.
• Lifestyle factors: Certain lifestyle factors may contribute to the development or progression of BPH. These include obesity, lack of physical activity, and a diet high in fat and red meat.

It's important to note that an enlarged prostate is not linked to the presence of prostate cancer. However, some symptoms of BPH, such as urinary difficulties, can overlap with those of prostate cancer. If you experience any symptoms or concerns, it's advisable to consult with a healthcare professional for proper evaluation and diagnosis.

An enlarged prostate, or benign prostatic hyperplasia (BPH), can cause a variety of urinary symptoms. These symptoms are primarily related to the resistance to the flow of urine out of the bladder through the prostate, this resistance related both to the size and shape of the prostate.The common symptoms of an enlarged prostate include:

• Frequent urination: You may feel the need to urinate more frequently, especially during the night (nocturia). This can disrupt sleep patterns.
• Urgency: You may experience a sudden and strong urge to urinate that is difficult to postpone.
• Weak urine flow: The urine stream may be weak, hesitant, or intermittent. It may take longer to start urinating, and the flow may feel insufficient or incomplete.
• Difficulty starting and stopping: It may become more challenging to initiate urination, and it may take longer to completely empty the bladder. You may also experience dribbling or the sensation of residual urine after urinating.
• Straining during urination: You may need to exert more effort or strain to maintain the urine flow.
• Incomplete bladder emptying: You may feel as if the bladder does not completely empty after urination, leading to the need for more frequent trips to the bathroom.
• Urinary retention: In some cases, an enlarged prostate can cause a complete inability to urinate, leading to urinary retention. This is a medical emergency and requires immediate medical attention.

It's important to note that these symptoms can vary in severity and may not necessarily indicate an enlarged prostate. Other conditions, such as urinary tract infections or prostate cancer, can also cause similar symptoms.

Benign Prostatic Hyperplasia (BPH) is typically diagnosed through a combination of medical history, physical examination, and various diagnostic tests. Common methods used for diagnosing BPH include:

• Physical exam
• Prostate symptoms questionnaire and bladder diary
• Ultrasound of the urinary tract
• PSA test or other blood tests
• Flow tests
• Cystoscopy
• MRI

If left untreated, an enlarged prostate (benign prostatic hyperplasia or BPH) can potentially lead to more serious health conditions and complications. These can include:

• Urinary tract infections (UTIs): An enlarged prostate can obstruct the normal flow of urine, leading to stagnant urine in the bladder. This stagnant urine provides an environment for bacteria to multiply, increasing the risk of UTIs. Recurrent or untreated UTIs can cause further complications, including kidney infections.
• Acute urinary retention: In some cases, an enlarged prostate can cause a complete blockage of the urethra, preventing the passage of urine. This condition, known as acute urinary retention, is a medical emergency and requires immediate intervention to relieve the obstruction and drain the bladder.
• Bladder stones: When urine remains stagnant in the bladder due to an enlarged prostate, minerals in the urine can form crystals and eventually solidify into bladder stones. Bladder stones can cause pain, frequent UTIs, and further obstruct the flow of urine.
• Kidney damage: In severe cases, chronic obstruction of urine flow due to an enlarged prostate can result in kidney damage. The prolonged back pressure on the kidneys can impair their function and lead to complications such as kidney stones, kidney infections, or even kidney failure.
• Bladder diverticula: The increased pressure caused by an enlarged prostate can lead to the development of small pouches or outpouchings in the bladder wall, known as bladder diverticula. These diverticula can further complicate urinary symptoms and increase the risk of infections.

While these complications are possible, it's important to note that not all individuals with BPH will experience them. Regular medical check-ups and appropriate management of BPH can help minimise the risk of complications and ensure early intervention if necessary.

There are several treatment options available for an enlarged prostate (benign prostatic hyperplasia or BPH), depending on the severity of symptoms, the size and shape of the prostate, and individual preferences. Treatment options can include:

• Watchful waiting: For mild symptoms, regular monitoring without immediate intervention is recommended.
• Lifestyle changes: Modifying habits like fluid intake, avoiding caffeine/alcohol, maintaining a healthy weight, and regular exercise can help alleviate symptoms of benign prostatic hyperplasia.
• Medications: Various medications can be prescribed to manage the symptoms of BPH. These medications include alpha-blockers, 5-alpha-reductase inhibitors or combination therapy. If medications are intolerable, ineffective, or if a patient prefers a non-pharmacological approach, then the next step is to discuss surgical intervention.

Minimally invasive surgical treatments

These procedures look to achieve a lower level of symptom improvement but complete protection of all aspects of sexual function. Being delivered as rapid day case procedures, they allow rapid discharge from hospital and a quicker return to normal activity. These include:

• Prostatic urethral lift (UroLift): This procedure involves inserting small implants to hold the enlarged prostate lobes apart, relieving compression on the urethra, much like drawing apart curtains, and improving symptoms.
• Water Vapour ablation of the prostate (Rezum): This procedure involves the injection of steam into the obstructing prostate tissue, causing it to shrink over time to relieve obstruction and improve symptoms.
• iTIND: This device is placed across the urethra and neck of the bladder, left in place and then removed 5 to 7 days later. During that time 3 incisions are made slowly through pressure, remodelling the outlet from the bladder, relieving obstruction and improving symptoms.

Surgical approaches: 

The standard surgical options look to remove tissue to create a wide cavity through the prostate to maximise the reduction in resistance to the flow of urine. Examples include:

• Transurethral resection of the prostate (TURP): This procedure involves removing the excess prostate tissue through the urethra using an electro-cautery.
• Laser therapy: Various laser techniques can be used to vaporise or enucleate the excess prostate tissue.
• Aquablation of the Prostate: This most novel procedure in this group, employs ultrasound imaging, planning software and robotic technology to accurately deliver a high-pressure water jet to wash the tissue from the prostate without the use of heat.