The prostate is men’s secondary sexual gland with weight of 20-25 gram and located in front of the rectum and below the bladder. Both urethra and vas deferens (semen expelling canal) pass through the prostate.

Besides it, prostate secretion increases the sperm volume by mixing with it (30-35% of sperm consists of prostate secretion) and eases its movement in the women reproductive organs.

Another important function is urine extraction. It enlarges with age and disrupts urination and other functions. While it is found in 50% of the men over 50, it becomes 100% after reaching the age of 90. Studies in the Europe and US show urination disorders in 65% of the men above 60. After 40 years in 10% of the men, there is microscopic prostate enlargement. Before reaching 80, 1 out of 3 men gets surgical treatment due to enlargement of the prostate. In fact, prostate operation holds the second place after cataract (eye operation) among the most common operations in the world. Enlargement of the prostate is benign and one should not mix it with prostate cancer.

Enlargement of the prostate is not done by normal cell division and it is caused by increase in the reproduction rate of its cells (hyperplasia). Enlargement in the periureteral glands occurs with aging and as a result compresses the real prostate tissues to the sides, to the rectum and bladder, particularly to the neck of the bladder. As a result, it narrows the bladder’s neck and causes pathologic changes in the urethra, bladder, ureters and kidneys. Later, it also creates favorable conditions by narrowing the bladder’s neck, for stone formation there and enlargement of the kidneys. Enlarged prostate results in difficult urination by narrowing the bladder’s neck and even in anuria (absence of urine). Consequently, it decreases renal functions and impairs normal functioning of the kidneys.

What causes the prostate enlargement?

Prostate enlarges with aging, particularly after 50. Besides this, secondary factors of enlargement are hormonal changes (estrogen and testosterone) in the men.

What are the signs and symptoms of the prostate enlargement?

Patients with prostate adenoma (enlargement) apply to us with complaints on night urination, thin and intermittent urination, difficulty in urination, forking of urine to the sides, feeling of incomplete emptying of the bladder after urination, frequent urination, incontinence (before reaching the bathroom or in drops) or anuria. Usually they do not have night urinations, it occurs when prostate increases.

Complaints of the patients with adenoma (enlargement) of the prostate divide into two groups:

1.Storing function (urine deposition)

• Frequent urination (Pollakiuria – 7 or more visits to the bathroom during the day or desire of urination every 2 hours)
• Night urinations (nocturia)
• Sudden urge to urinate (urgency)
• Incontinence before reaching the bathroom after urgency urination (urge incontinence)
• Burning upon urination (dysuria)

2. Urinating function

• Hesitancy before urination
• Intermittent urination
• Terminal dribbling at the end of urination
• Low urination pressure, thin urination
• Feeling of incomplete emptying
• Approach to a patient with enlargement of the prostate (adenoma)

Anamnesis - identify previous operations, traumas, other diseases, prostate adenoma (enlargement) and prostate cancer history in the family, urogenital infections etc.

Physical examination - in the patients having prostate adenoma (enlargement) volume, structure of the enlarged prostate is firstly examined by digital rectal examination (DRE – is very informative way of examination). DRE helps to differentiate prostate enlargement and prostate cancer. Depending on the doctor’s experience, it gives correct information in 69-89% of the cases.

General urine analysis is made to identify infections, hematuria (blood in the urine) etc. Microscopic hematuria (invisible by naked eye) indicates possibility of the prostate cancer or other urological problem within 3 years in 4-5% of the men.

Lab analysis- PSA is only made in the prostate, its value in the blood changes by age. Checking PSA level is important to differentiate enlargement of the prostate from prostate cancer. Level 0-4 is considered normal. Level beyond 4 requires mandatory additional tests and the best information is obtained by the prostate biopsy. In 28% of the men with adenoma of the prostate PSA is above 4, despite it in 20-30% of the men with prostate cancer PSA level is normal.

Evaluation of the kidney functions - 13.6% of the men with adenoma of the prostate have kidney function insufficiency. Considering this, in the men with adenoma of the prostate, kidney function also has to be evaluated by measuring the creatine level in the blood and use of other visualizations (US, CT, X-ray etc.)

Evaluation of urination:

Uroflowmetry: – measuring of urine pressure and flow speed. It identifies the fastest, medium flow, overall urination time, urination curve and overall volume (if it is under 150 ml, further investigation is required). The fastest urination shall be more than 15ml/sec.

Finding the residual urine after urination - practically no residual urine in the bladder shall be left in healthy men (shall be less than 12 ml). In the men with adenoma of the prostate there is residual urine left in the bladder (more than 100ml is an indicator of the problem).

Treatment of adenoma (enlargement) of the prostate

Both medical and surgical options are used in treatment of adenoma of the prostate. Weight and condition of the prostate is important here. The best thing to do in the life of a man over 50 is to see a doctor and timely reveal the possible problems, and get relevant consultation and treatment. There is an individual approach to a patient with prostate adenoma: by taking into account age, overall condition of the patient and other values, medical or surgical method is selected.

Surgical treatment

Today one of the golden standard surgical treatment option is TURP (Transurethral Resection of Prostate). It is a resection of the increased parts of the prostate without any incision by endoscopic entrance through the urethra. TURP is recommended for the prostates with weight up to 80 grams.

Endoscopic picture of the enlarged prostate

What kind of medical and social disturbances will cause long-term untreated enlargement of the prostate in the patients?

1. Night and day frequent urinations, poor sleep, sleepiness in the daytime and weakness
2. Causes disruption of quality of life and increased depression
3. Significant sexual functions disorder (decrease in sperm pressure, volume, incomplete ejaculation etc.)
4. Increased infections of the urinary-genital tracts
5. Hematuria: blood in the urine
6. Faster and easier formation of stones in the bladder
7. Inguinal hernia as a result of forced urination
8. Disorders of the kidney function, their enlargement, renal insufficiency and other issues

What to pay attention?

Prostate diseases usually occur in three forms. They all occur independently from each other

1. Inflammation of the prostate gland (prostatitis), usually occurs in young men
2. Benign enlargement of the prostate (adenoma)
3. Prostate cancer

In prostate enlargement problems, complaints are more important than sole enlargement of the prostate. Sometimes even small enlargements cause big social and medical problems.

The most important thing in the patients applied with prostate diseases, is to differentiate adenoma of the prostate from prostate cancer. Today, adenoma of the prostate is successfully treated. We can say it based on our daily and international practice.

Note: Nowadays, all the men over 50 without complaints need to pass an urological examination once a year!!!