Enlarged Prostate
Benign enlargement of the prostate (BPE)
BPE occurs whenthe prostate enlarges, and as it does so it may compress the urethra problems urinating. It is extremely common, occuring in most men beyond middle age.
BPE can cause various urinary symptoms, known collectively as lower urinary tract symptoms (LUTS) these include:
- Hesitancy-difficulty in starting to pass urine
- slowing of the urinary stream
- waking at night
- dribbling at the end of the stream
- bladder irritability
- passing blood in the urine
International prostate symptoms score (IPSS questionnaire) can be used to validate your symptoms.
During an assessment, you will be asked about your symptoms and medical history, followed by an examination, including a rectal examination to feel the prostate.
You should also bring a fresh urine sample with you so a urinalysis can be done. You will be asked to do a flow rate, which involves you passing urine into a measuring device which then measures the rate at which you pass urine. Following this, a measurement of residual urine in the bladder.
There are a series of other tests that may be offered. These include:
- prostate specific antigen (PSA), a blood test
- urine cytology, a urine test to look for abnormal cells in the urine.
- flexible cystoscopy, allows direct visualisation of the urethra and/or bladder using a small flexible scope.
- Bladder diary
What are the treatments for BPH?
Men who are bothered by their symptoms have an array of available treatments. Some men are able to cope with them by altering their fluid intake. Others take medication. If neither of these help, then surgery is usually the best option.
What medication is available?
There are two groups of drugs which may be prescribed for patients with BPH. These are alpha blockers, and 5 alpha-reductase inhibitors. Alpha blockers workby relaxing the smooth muscle of the prostate and bladder neck to improve urine flow and reduce bladder outlet obstruction. Side effects can include headaches, dizziness, light-headiness, fatigue and ejaculatory dysfunction, but the tablets are well tolerated by the vast majority of men. 5-alpha-reductase inhibitors (5ARIs), work by reducing the size of the prostate by preventing the conversion of testosterone to one of its more active metabolites.. They can relieve BPE symptoms (though they may take up to 6 months to do this) and increase urinary flow rate. Side effects can include impotence, decreased libido and reduced semen release during ejaculation, but are also rare.
What are the options if tablets do not work?
If there is no response to drugs, symptoms can be improved by an operation to core out the prostate gland. These are either minimally invasive treatments (MIST) or more invasive surgeries. Mr Zakikhani performs laser prostatectomy either en-bloc Holmium laser enucleation of the prostate or Green light vaporisation. He also offers traditional treatments when appropriate as well as MIST procedures such as Urolift and REZUM.