How risky is having an enlarged prostate?

Benign prostatic hyperplasia (BPH), also known as an enlarged prostate, is a health issue that becomes more common in men as they grow older. In fact, by the age of 60, about 30 percent of men show moderate to severe symptoms of BPH.

The experience

Frank Mubiito (53) first noticed signs of an enlarged prostate about six years ago. The initial sign was frequent urination, forcing him to wake up every three hours in the night to go to the bathroom.

“I used to drink a lot of water in the evening and I thought this was why I was waking up often to urinate. However, even when I stopped taking the water, there was no change. When I started suffering from frequent urinary tract infections, I went to hospital,” he says.

The doctor diagnosed Mubiito with an enlarged prostate and prescribed medication that would help relieve his symptoms. However, after taking them for some time, there was no change.

“I was scared about having surgery but by now, whenever I bent to reach for something on the ground, I felt dizzy. When I told the doctor about this new symptom, he recommended surgery, saying it was a simple, less invasive procedure that would require a short stay in the hospital. He called it the transurethral resection of the prostate,” Mubiito says.

When he finally agreed to have the surgery, he was in hospital for only two days and within three weeks, he had returned to work.

Causes

Dr Job Kuteesa, a consultant urologist at C-Care Hospital in Kampala, says besides age, there can be other causes of an enlarged prostate, including but not limited to an inflamed prostate, narrowing of the urethra, urinary tract infections, scarring in the bladder neck due to surgery, problems with nerves that control the bladder and cancer of the prostate or bladder.

“Men above 40 get an enlarged prostate because of the declining levels of testosterone, the male hormone. However, males who are sexually active (between the ages of 20 to 30) usually get an enlarged prostate from an infection that blocks the passage of urine,” Dr Kuteesa says.

Signs and symptoms

An enlarged prostate can cause symptoms such as blocking the flow of urine out of the bladder. This in turn causes problems such as urinary urgency and any delays in emptying the bladder can make one to start the urine flow without control.

Frequent urination is also a common symptom among men with an enlarged prostate and may be accompanied by waking up at night to urinate, trouble starting to urinate, weak urine stream, or a stream that stops and starts, dribbling, incontinence (where one cannot completely empty their bladder) and hesitating when there is a delay to start the flow of urine.

Dr Kuteesa warns that a man may not be able to feel that the prostate has enlarged since the prostate cannot be touched by a lay-man. However, it is important that one seeks medical attention once they notice such symptoms.

“Your general practitioner will refer you to a specialist if they notice anything suspicious. However, conditions such as an injury to the pelvis, some neurological problems and some drugs such as those that treat high blood pressure can cause similar signs and symptoms. These, the urologist will be able to identify,” he says.  

The size of the prostate does not always determine how serious the symptoms are because in some men, even with a slightly enlarged prostates, one can have major symptoms. Others who have very enlarged prostates can have minor problems while some men with enlarged prostates do not have any symptoms at all.

Diagnosis

Before the urologist diagnoses an enlarged prostate, a background study of the patient’s signs and symptoms will be taken. Several tests such as the Prostate-Specific Antigen (PSA) will be done to rule out prostate cancer. 

The doctor may recommend an ultrasound scan, digital rectal exam and other tests that would help confirm the enlargement.

Dr Kuteesa advises all men above 40 to do a PSA that would help them detected early for prostate cancer or an enlarged prostate.  

“Talk to your general practitioner about your symptoms, even if they do not bother you. Having an enlarged prostate is not thought to raise the risk of getting prostate cancer but it is important to find out if there are any causes of the symptoms that can be treated. If you cannot pass any urine, get medical help right away,” he warns.

Complications

An enlarged prostate can cause complications such as not being able to urinate and if not treated early, one may need to have a catheter placed in their bladder to drain the urine.

Not being able to empty the bladder completely due to an enlarged prostate increases the risk of urinary tract infections. Also, an enlarged prostate that is not treated can cause erectile dysfunction, Dr Kuteesa says.

A bladder that does not empty fully can stretch and weaken over time. As a result, the muscular wall of the bladder no longer squeezes properly to force urine out.

“Blocked urine flow can also cause damage to the kidney or even the risk of kidney failure since the infections from the bladder can reach the kidneys. With damaged kidneys, one will have to be on dialysis for the rest of their life or have a kidney transplant,” he says.

Treatment 

Depending on the symptoms and level of severity of the enlargement, your urologist will discuss with you the treatment options available to you. These may range from behavioural medications to surgery but there is no one-size-fits-all option for this condition.

If the enlargement is simple or mild, one may just need only medication but severe and complicated cases may need surgery. During the transurethral resection of the prostate (TURP), the doctor inserts a scope through the tip of the penis into the tube that carries urine from the bladder.

This helps them see the extra enlarged tissue and trim away sections of the prostate that may be blocking the flow of urine.

“Surgery to treat an enlarged prostate can be done through the urethra without any incisions, using laser or bipolar techniques which are minimally invasive,” Dr Kuteesa adds.