Help him correct the enlarged prostate gland

By Dr Brigid Monda

As I mentioned in the piece on May 9, when the prostate gland enlarges, it results in a condition called Benign Prostatic Hypertrophy (BPH) or Benign Prostatic Enlargement (BPE).

The enlargement grows inwards compressing the urethra like a clamp on a garden hose and thus obstructing the outflow of urine. The man will get an urgent feeling to urinate and does it more frequently especially at night. He will have dribbling and leakage, a hesitant, interrupted, weak stream and may require several seconds to get urination started. There may be a burning sensation when urinating due to infection.

Sometimes a man may not know he has BPH until he suddenly finds himself unable to urinate at all especially after overindulging in alcohol. This is because alcohol makes the kidneys go into overdrive producing a lot more urine than normal and the bladder overfills obstructing it’s neck that is already narrowed by the enlarged prostate. The same can happen after taking over-the-counter cold or allergy medicines, which contain a decongestant drug whose side effect, is to prevent the bladder from opening, relaxing and allowing urine to empty.

Common tests

Digital Rectal Exam (DRE): The doctor will examine the back portion of the prostate by inserting a gloved finger into the rectum through the anus. The doctor feels it and notes its size. The normal or enlarged prostate feels smooth and pliable like the tip of your nose. A cancerous gland feels hard and lumpy like the knuckles of your hand.

Prostate Specific Antigen (PSA): It is a blood test conducted to rule out prostate cancer. PSA is a protein produced by prostate and its levels are high when cancer is present.

Ultra sound: This is done to ensure that the enlargement is not cancerous.

Treatment

Watchful waiting: When the gland is not very large, a regular check-up to watch for early problems is what you require.

Drug treatment: They stop the growth of the prostate or shrink it by blocking the action of the powerful male hormone that stimulates its growth. Other drugs act by relaxing the smooth muscle of the prostate and bladder neck to improve urine flow and to reduce bladder outlet obstruction.

Surgical treatment: Surgery is the best long-term solution for BPH. Only the enlarged tissue that is pressing against the urethra is removed in order to relieve the obstruction. Trans Urethral Resection of the prostate (TURP) is used for most BPH surgeries where the surgeon passes an instrument through the urethra to remove the obstructing tissue one piece at a time like chipping away a potato.

Sexual function after surgery

Even though it may take a while for sexual function to return fully, with time, most men are able to enjoy sex again. The exact length of time depends on how long the man had BPH and on the type of surgery done. If you were able to maintain an erection before surgery, you should be able to do so after. Surgery may also cause "Retrograde Ejaculation" or "Dry Climax". Normally, during sexual activity, as sperms enter the urethra, a muscle blocks off the entrance and the semen is expelled through the penis. Prostate surgery may damage this muscle and the semen takes the path of least resistance and enters the wider opening to the bladder rather than being expelled through the penis and is later harmlessly flushed out with urine.

If a good part of the prostate is left behind during surgery, it is still possible for BPH to recur. It is thus important to continue having a DRE and ultrasound once a year after the operation. A small percentage of the men who had TURP for BPH at an early age may eventually need a second operation to snap out recurrence.

BPH and prostate cancer

Although some of the signs of BPH and prostate cancer are similar, BPH does not increase the chances of getting prostate cancer but you could have undetected prostate cancer or may develop it in the future. Hence, it is recommended that all men over 40 have a DRE and PSA once a year and/or a prostate scan depending on your doctor’s advice. These tests should be done as routinely as women do their pap smears and mammograms. After BPH surgery, the tissue removed is routinely checked for cancer cells. A few have some cancerous tissue but it is often of a non-aggressive type of cancer, and no treatment is needed.