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The prostate is a small gland present only in men and located just below the bladder. It is usually about the size of a walnut. The gland is made of two lobes or regions, enclosed by an outer layer of tissue.

Scientists do not know all the prostate's functions, although it has many functions for sure. Main function is conducting the sperm from the sperm ducts to the urethra, and producing the small amounts of alkaline secret that is being mixed up with sperm to form the ejaculate. It also squeezes fluid into the urethra.

The problem with this small gland is that it usually begins to enlarge at mid-life. Because the process doesn’t stop spontaneously, as men age, the prostate continues to grow and may push in on the urine passage, which is the most common complication. 

Enlargement of the prostate

When a prostate gland is larger than normal, it is usually called hypertrophic prostate gland. Medically, the condition is called benign prostatic hypertrophy or simply BPH. The enlarged prostate doesn’t necessarily indicate the presence of prostate cancer. The enlargement caused by aging is inevitable. The right cause of this enlargement is still unknown but it is believed that it has something to do with sexual hormones and their decreasing with age. As men age, the amount of active testosterone in the blood decreases. From birth to young adulthood, the prostate gland grows from the size of a pea to about the size of a walnut. As the prostate enlarges, the layer of tissue surrounding the prostate stops it from expanding which is causing the pressure against the urethra. Bladder starts to contract more strongly and with time, eventually, the bladder weakens and loses the ability to empty itself.

Benign prostatic hyperplasia (BPH) is common and causes obstructive symptoms in 40% of men in their 50s and 90% of men in their 80s.

Symptoms of prostate enlargement

There are several symptoms that could be caused by enlarged prostate and every man, especially those older then 50 should think of this condition first.

Depending on the size of the prostate, there are several complications that could occur.

    * A moderately enlarged gland is about the size of a plum and in most cases it doesn’t cause any symptoms;

    * a very enlarged gland is about the size of an apple or orange;

    * An extremely enlarged gland can reach the size of a grapefruit.

Most common symptoms are:

    * Weak urine stream.

    * Hesitancy when starting to urinate.

    * Stopping and starting of urine stream.

    * Sensation of incomplete emptying of the bladder.

    * Frequent daytime urination.

    * Recurrent urinary tract infections.

    * Urgency with or without leakage of urine.

    * Getting up at night to urinate.

Testing for benign prostatic hypertrophy

1. Physical examination- The evaluation of prostate enlargement should always begin with a physical examination, which is done by a rectal exam. Via rectal exam, doctor should estimate the size of the prostate gland.

   2. Laboratory tests - Beside physical examination, laboratory tests are also very useful for the proper diagnosing and they include urinalysis and a blood test for PSA. What exactly is PSA? PSA is a substance produced by the prostate, which may be increased in the presence of prostate problems.

   3. Uroflowmetry - Uroflowmetry is a diagnostic tool that has also proved to be very effective and useful. This diagnostic tool measures the force of the urine stream and the amount of urine passed.

   4. Ultrasound – The ultrasound is usually done to detect the presence of urine left in the bladder after urinating. An ultrasound examination of the prostate is useful to determine the exact size of the gland and to check for any areas suspicious for cancer.

   5. Cystoscopy – Before this procedure, injected solution numbs the inside of the penis so all the sensation is lost. During this exam, the doctor inserts a small tube through the opening of the urethra in the penis. The tube is called a cystoscope and contains a lens which enables the doctor to see the inside of the urethra and the bladder.

The presence of residual urine in the bladder may lead to urinary tract infections, which may travel up the urinary tract to the kidneys.

Treatment of the prostate enlargement

The prostate enlargement can be treated in many ways, but it could be hard to decide what to do. The key is to know the pros and cons of each treatment option. Different treatments provide different degrees of relief.

Medication treatment

Many researches have been done in order to find a way to shrink or stop the growth of the prostate without using surgery. Therefore, there are several drugs, which are proven to have these effects.
    * Finasteride

    * Dutasteride

Both of these drugs inhibit production of the hormone DHT, which is involved with prostate enlargement.

    * Terazosin

    * Doxazosin

    * Tamsulosin

    * Alfuzosin
All four drugs act by relaxing the smooth muscle of the prostate and bladder neck to improve urine flow and reduce bladder outlet obstruction.

Minimally invasive therapy

   1. Transurethral microwave procedure- This method is done by a device that uses microwaves to heat and destroy excess prostate tissue. The device sends microwaves through a catheter to heat selected portions of the prostate to at least 111 degrees Fahrenheit.

   2. Transurethral needle ablation - The Special system delivers low-level radiofrequency energy through twin needles to burn away target regions of the enlarged prostate.

Surgical treatment

The fact is that most doctors recommend removal of the enlarged part of the prostate as the best long-term solution for patients with prostate enlargement. There are several types of surgical treatments and approaches! Laser surgery is the newest and the most effective method!
Surgery is still the most effective and long-lasting treatment for BPH.
Recovery takes longer.
Symptom relief is often quicker and lasts longer than with non-surgical treatments.
Stay in the hospital for a couple of days.
After surgery, you're less likely to need a re-treatment for your symptoms.
Serious side effects, including erection problems, incontinence and permanent narrowing of your urethra
Some surgical techniques allow prostate tissue to be checked for signs of prostate cancer.
Surgery isn't perfect. You may still have symptoms afterward.

Prostate laser surgery

The bottom line is that the laser surgery uses a high-energy laser to destroy enlarged prostate tissue. The good thing about this method is that the laser doesn't penetrate tissue deeply, so surrounding tissue isn't harmed. All laser operations are done under general or spinal anesthesia. There were many problems with the lasers before, because they were high penetrating and thus causing many side effects. The modern laser therapies use a high-energy and low-penetration laser that destroys prostate tissue on contact. The laser also seals off blood vessels and reduces the risk of bleeding.

There are four types of laser surgery

  1. Transurethral evaporation of the prostate (TUEP).With this method, the prostate tissue is destroyed by laser energy. It is generally a safe procedure, and causes small amount of bleeding.

   2. Visual laser ablation of the prostate (VLAP). This treatment uses great amounts of laser energy to dry up and destroy excess prostate cells. It can cause some complications and patients may also experience a burning sensation during urination for days or even weeks.

   3. Photosensitive vaporization of the prostate (PVP). This is one of the newest forms of laser treatment for prostate gland enlargement and one of the most effective ones. PVP uses laser energy to destroy prostate tissue. Problem is that, it can be very complicated to perform this procedure if the prostate is too enlarged. In general, PVP is better for smaller prostates.

   4. Holmium laser enucleation of the prostate (HoLEP). This is also a newer laser procedure which has shown to provide results similar to classical surgical methods, but with less chance of bleeding and a shorter recovery time.

What's best about the laser operations?

They often provides immediate symptom relief, although you may experience painful urination for days or even weeks. Compared with classical invasive operations, laser surgery causes little blood loss and you recover more quickly. Retrograde ejaculation is also a common side effect of laser surgeries, which means that the ejaculate is being held in prostate, and cannot come out to urethra.

However, it’s also possible that the surgery can damage nerves or blood vessels causing erection problems. The good thing is that these erection problems are not permanent.

Read More: Prostate Enlargement: Benign Prostatic Hyperplasia (BPH) Symptoms and Treatment

Classic surgery methods

   1. Transurethral resection of the prostate (TURP) - Very common procedure used in almost all prostate surgeries. An instrument called a resectoscope, which is about 12 inches long and 1/2 inch in diameter is inserted through the penis. The resectoscope contains an electrical loop that cuts enlarged prostate tissue.

   2. Transurethral incision of the prostate (TUIP) - This procedure is done in order to widen the urethra by making a few small cuts in the bladder. TUIP typically is an outpatient procedure that takes 20 minutes.

   3. Open surgery – When none of these transurethral procedures cannot be used, open surgery may be the only solution. Open surgery requires an external incision and it is done when the gland is greatly enlarged.

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