Y Magazine

When The Flow Won’t Go

Dr Mahesh Krishnaswamy, a specialist in urology at Burjeel Hospital, Muscat, advises on the importance of treating enlarged prostates.

What is the prostate gland?

The prostate is a walnut-sized male sexual accessory gland located below the urinary bladder, in front of the rectum surrounding the urethral passage.

What is BPH or benign prostatic hyperplasia?

It is a non-cancerous enlargement of the prostate in males above the age of 50 years. The prostate enlarges and blocks urine flow. The severity of the blockage will vary from individual to individual.

Does the size of the prostate decide the severity of obstruction?

Generally, the size of the prostate enlargement has no correlation to the severity of urinary obstruction. Sometimes, a small prostate can cause severe obstruction while large glands may not cause any symptoms.

What are the symptoms indicating BPH?

Hesitation in starting urination, interruption of urine stream, feeling of incomplete emptying, poor urinary stream, increased frequency of urination (especially at night) and the inability to hold urine are the most important symptoms. 

What if the symptoms are ignored?

If these symptoms are not evaluated and treated in time, there can be a worsening of symptoms that can lead to urinary retention (inability to pass even a small quantity of urine leading to painful over-distension of the urinary bladder). Long-standing retention can cause damage to both kidneys leading to renal failure. Some patients can have recurrent urinary infections, bladder stones or hematuria (blood in urine).

How is BPH evaluated?

It is evaluated by digital rectal examination, urinalysis, renal function tests and PSA, uroflowmetry and an ultrasound scan of the kidney, prostate and bladder.

What is PSA ?

It is a blood test to detect the level of prostate specific antigen, which is an indicator of prostate cancer. If the levels are persistently high a prostate biopsy is mandatory to confirm the diagnosis.

What is the treatment of BPH?

There are two types of treatment: medical and surgical.  Medical treatment has to be life-long, and some patients may require surgery later due to the failure of treatment.

What are the medicines used?

There are two types of medicines:

1. Those that relax the muscular part of the prostate and improve the flow of urine

2. Those that shrink the glandular part of the prostate and reduce its size. The first group gives faster relief of symptoms while the second group gives improvement over the long term. The choice of drugs depends on the size of the gland and the severity of the symptoms.

Do these medicines cause side effects?

Some can cause giddiness on standing up from the lying down position due to a sudden fall in blood pressure. Some may reduce the amount of semen during ejaculation. But most patients can consume these medications for a long time without any problem.

What are the surgical methods of treatment?

Surgical treatment is done endoscopically through the urethra, removing the enlarged portion of the gland using an electric current or laser. Since it is done without any external wound, the patient has a faster, painless recovery and he can go back to his normal life soon afterwards. On occasion, open surgery may be required in very large glands.

What are the problems due to surgery?

Complications can occasionally happen after this surgery such as bleeding, infection, urine leak, passage of semen into bladder during ejaculation, narrowing of urethral passage causing obstruction etc. Some patients may require prolonged catheterisation due to impaired bladder function, and some may require repeat surgery due to the significant residual gland.

Is there a risk of BPH turning into malignancy?

There is no additional risk of BPH turning into cancer if untreated and the chance of developing a cancer is similar to that of the general population.