One of the most common problems a man faces with increasing age is difficulty with urination. This is usually caused by a benign enlargement of the prostate. The prostate is a walnut shaped gland located beneath the urinary bladder deep inside the male pelvis. It surrounds the urethra (urine channel) like a donut. The prostate begins to enlarge on a microscopic cellular level when a man is in his late twenties or early thirties. In some men the prostate continues to grow and this may cause an impingement on the urethra and restrict urine flow. The bladder muscle may have to work harder to generate enough force to push the urine past the blockage. The bladder muscle may even become enlarged (hypertrophy) or irritated.
The symptoms of prostate enlargement may include waking up at night to urinate (nocturia), frequent urination, difficulty starting or stopping the stream, dribbling, urgency, a feeling of incomplete emptying of the bladder,or loss of urinary control. This can lead to urinary tract infections, stone formation and kidney damage. Occasionally the blockage may become so severe that urination becomes impossible. These symptoms may be intermittent and can be exacerbated by such things as over the counter cold medications.
The diagnosis of prostate enlargement is made after a complete history and physical examination. The prostate is inspected to determine its size and to check for any firm areas or lumps which could indicate prostate cancer. A blood test that measures the PSA (prostate specific antigen) can help detect prostate cancer at an early stage. It is recommended that men age fifty or older have this test on a yearly basis. A uroflow test and post void residual urine check are performed to assess the degree of urinary restriction and amount of urine retained in the bladder after urination. Based on these and other tests, the problem is classified as mild, moderate or severe.
Treatment options for prostate enlargement are based on the severity of the symptoms and the patient's desires. We offer a full range of therapies from oral medications and diet modification to surgical intervention and prostate vaporization. In the last few years advances in our understanding of prostate physiology have allowed for the development of two types of drugs which reduce the size and tension of the prostate gland. Technological advances have aided in the refinement of instruments and surgical techniques. Prostate removal can be performed safely on an outpatient basis and with minimal bleeding or discomfort.