Prostate Gland Enlargement
What is prostate gland?
The prostate gland is about the size of a chestnut. It is present only in men. It is positioned just beneath the bladder where it surrounds the urethra which is the water pipe as it leaves the bladder. The prostate gland produces fluid which protects and enriches the sperm. The prostate gland gets bigger after the age of about 60. The growth of the prostate itself is harmless and the condition is called benign prostate hyperplasia (BPH). Prostate enlargement is very common after the age of 70 and is present in about 8 of 10 men at that age. Those who develop symptoms will require assessment and treatment.
Symptoms of Prostate Enlargement
These are also called lower urinary tract symptoms (LUTS) as the prostate enlarges it causes narrowing of the first part of the water pipe (urethra) as it leaves the bladder. This can lead to the following symptoms:
- Poor urinary flow. The flow of urine is weaker and intermittent.
- Hesitancy. You may have to wait before the urine flow starts.
- Poor emptying. You may notice that after voiding you still have a feeling of incomplete bladder emptying.
- Frequency. You will be passing urine more often than normal. This is one of the most annoying and irritating symptoms of prostate enlargement, although there are many other possible medical causes for frequency of urination.
- Nocturia – which means getting up at night from sleep to pass water.
- Urgency. You may need to rush to the loo to pass water.
- Dribbling, towards the end of urination. You may notice that a few drops dribble out rather than a clean cut at the end of voiding.
Differential diagnosis of lower urinary tract symptoms.
Although lower urinary tract symptoms in men after 50 are commonly related to benign prostate enlargement however the following other conditions can also lead to similar symptoms:
- Urinary tract infections.
- Urinary tract stones either in the kidney or bladder.
- Bladder muscle weakness or overactivity.
- Prostatitis which is inflammation or infection of the prostate.
- Malignancy, prostate cancer or bladder cancer can also lead to some of the above symptoms.
- Neurological conditions. Parkinson’s disease, multiple sclerosis, spinal cord injuries, stroke can lead to a mixture of obstructive and irritative urinary tract symptoms.
- Heart conditions, some cardiac problems can lead to a collection of fluids in the legs which leads to excessive amount of urination at night time (nocturia).
Special Tests Flow Rate and Bladder Residue
- Flow rate study. In this test you will be asked to drink fluid in order to fill up your bladder and then urinate into a funnel which gives an objective assessment of your flow rate.
- Bladder scan. After you have finished your flow your bladder will be scanned with a special scanner which gives the amount of urine left behind in your bladder after urination. Normally the bladder should empty completely, however if there is obstruction caused by the prostate your bladder emptying will be incomplete.
Assessment and Investigation
Clinic Appointment with the Consultant
You will be seen by Mr Syed who will take a detailed history of your urinary symptoms. He will also ask you about any other medical problems and history of your current medication.
This includes examination of your abdomen, external genitalia and digital rectal examination of your prostate. Abdominal examination will reveal if you are retaining any urine behind in the bladder after voiding. Digital rectal examination is one of the most important assessments for your prostate. A benign enlargement of the prostate is smooth with no area of any hardness, irregularity or nodules which are more common in prostate cancer.
- Prostate Symptom Score and Frequency Volume Chart. You will be asked to fill in International Prostate Symptom Score and Frequency Volume Chart which helps quantify the severity of your symptoms and plan further management.
- Urine dipstick test. Your urine is examined in the clinic to rule out any infection or blood in the urine.
- Blood test. You may require a kidney function test, also called urea electrolytes, to assess your serum creatinine and glomerular filtration rate which are abnormal if there is any kidney impairment.
- Prostate specific antigen (PSA). PSA is a prostate specific antigen which is a protein produced by the prostate gland which helps to liquefy the semen. PSA is produced exclusively by prostate epithelial cells, both in benign prostate enlargement and prostate cancer. A raised PSA level may mean you have prostate cancer. However other conditions which are not cancerous (for example enlargement of the prostate, urinary infection, prostatitis) can also cause higher PSA levels in the blood. If your PSA is raised in the absence of any infection or other benign causes you will require a transrectal ultrasound of your prostate and biopsy which is carried out under local anaesthesia. This tissue is then sent to a pathologist after analyzing samples under the microscope to provide a histology report. Even if the biopsy is positive showing prostate cancer you may be advised one of the following treatments:-
One Stop Prostate Assessment Clinic
Mr Syed has set up a one stop Prostate Assessment Clinic which includes consultation with Mr Syed and examination of your prostate.
Blood test, including PSA
Flow rate study
This one stop clinic will allow a complete assessment of your prostate symptoms. You can arrange this appointment either through a GP letter or making a direct call to the following numbers:
Melanie Bryant, Medical Secretary, Spire Little Aston Hospital
Telephone: 0121 580 7405
Fax: 0121 352 1971
Main switchboard at Spire Little Aston Hospital 0121 353 2444
Spire Little Aston Hospital
Little Aston Hall Drive
Outpatient Department for consultation appointments: 0121 580 7151
Comprehensive diagnostic service for a wide range of urological conditions