Overview
Prostate gland hypertrophy (enlargement) is a common medical problem in men over 50. The prostate begins to grow after the age of 25. As the prostate enlarges, it presses on the bladder and the urethra, obstructing the flow of urine and causing discomfort.
Symptoms
Prostate gland hypertrophy is related to lower urinary tract symptoms, such as a urine stream that is hesitant, interrupted or weak and an urgent need to empty the bladder. Other symptoms include leaking, dribbling, feeling that the bladder is not empty after urinating and more frequent urination, especially at night.
Patients may also experience symptoms related to bacteria in the urine remaining in the bladder, such as frequent urinary tract infections and the development of bladder stones. In more severe cases, prostate gland hypertrophy may lead to urinary retention (being unable to urinate) and kidney failure, though this is less common.
Diagnosis
During the initial evaluation your doctor will ask you questions about your medical history and your urinary problems. The diagnostic work-up includes a digital rectal examination and testing your urine and blood.
You may have an ultrasound through your abdomen or rectum to calculate the size of your prostate and evaluate its structure. Ultrasound may also be used to calculate the residual urinary volume after urinating.
Treatment
Conservative treatment for prostate gland hypertrophy includes making changes to your lifestyle, such as reducing stress and avoiding drinking fluids in the evening. There are also several medications that may alleviate your urinary symptoms.
If conservative treatment does not relieve your symptoms, you may be advised to have a prostatectomy (the surgical removal of the prostate). This may be performed via open surgery or via transurethral resection. Transurethral resection is considered the treatment of choice and involves removing part of the prostate gland through the urethra. It is widely performed in patients not responding to conservative treatment. Complications of surgical treatments include urinary tract infections, narrowing in the affected area, post-operative pain, incontinence, sexual dysfunction and blood loss. There are also risks associated with the anaesthesia used during the procedure.
Alternatively, you may undergo a minimally invasive technique called prostate artery embolisation, which has been used to treat prostate gland hypertrophy with promising results. Prostatic artery embolisation can be used in cases where the prostate is too large for transurethral prostatectomy.
Prostatic artery embolisation is performed under local anaesthesia. During the procedure, an interventional radiologist inserts a catheter into the patient’s femoral vein (in the upper thigh). Under fluoroscopic guidance, they will direct the catheter to the prostatic artery and insert microspheres to block the artery that feeds the gland. This will cause the prostate gland to shrink. The success of the procedure can be confirmed using imaging after the procedure. The procedure is performed on an out-patient basis and patients can resume normal activities immediately.