Symptoms can include nocturia (waking to void at night), frequency, urgency, hesitancy, intermittency, poor flow and straining to void and incomplete emptying.
The initial investigations will usually include blood and urine tests, a renal ultrasound and a rectal examination.
Initial treatment is usually medical therapy with either alpha blockers, 5 Alpha reductase inhibitors or a combination of both.
There are also medical therapies for symptoms of overactive bladder.
There are relative and absolute indications for surgery. Surgery is usually necessary in patients who are in urinary retention and require a catheter, those with bladder stones or recurrent infections. It is also offered to those who don’t improve adequately on medical therapy.
The gold standard treatment for Benign Prostatic Enlargement is a Trans Urethral Resection of the Prostate. This procedure is done through a telescope inserted through the urine tube in the penis under general or spinal anaesthesia. The inside of the prostate is cored out to allow more space and less resistance thus allowing better voiding. The procedure can take between 45 minutes and 2 hours depending on the size of the prostate.
A catheter tube will be left in the bladder for 2-3 nights and will then be removed to allow voiding before discharge from hospital. Initially voiding will be urgent and regular and may contain blood. This will take a few weeks to settle. You will be given Ural which is an alkalinising agent post operatively to decrease the discomfort. You will need to refrain from exercise and heavy lifting for at least 2 weeks. The amount of time you need off work will depend on your job.
This a fairly new procedure that involves placing clips in the prostate through a cystoscope which hold the tissue open to create a better channel for voiding. It is a minimally invasive procedure which is a day stay or overnight procedure. It is ideal for patients who do not wish to take tablets longterm or have side effects.
Urolift does not preclude other treatments for benign disease or prostate cancer in the future. It does not effect sexual function or ejaculation. It is not for very large glands or patients with predominantly irritative rather than obstructive symptoms.