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Prostate Enlargement 

The prostate is a walnut-sized gland located below the bladder and surrounding the urethra. An enlarged prostate can squeeze the urethra and cause difficulty with urination. Urinary problems from enlargement of the prostate are very common and can be seen in men as young as 30 years old.

Symptoms of prostate troubles are divided into two categories:

  • Obstructive symptoms: these include waiting and straining to start the urine stream, weak stream, and dribbling after finishing
  • Storage symptoms: these include frequent and urgent urination, waking at night, and difficulties holding urine (including loss of urine before making it to the bathroom); these may be signs of more advanced problems.

Symptoms can become worse over time and cause complications that may include:

  • Inability to urinate (urinary retention)
  • Bladder or kidney damage
  • Bladder stones
  • Urinary infections

The cause of these symptoms is typically non-cancerous growth of the internal portion of the prostate. It is also considered an age-related condition, as more than half of men over 50 and 90% over 80 have prostate enlargement.

Diagnosing a patient with prostate enlargement includes a thorough history, rectal examination, prostate specific antigen (PSA) blood test, and simple urinary flow tests done in the office. On occasion, more advanced testing may be required.

Take our quiz to find out if you have prostate problems.

Urologist Dr. Richard Natale
Urologist Dr. Richard Natale

Treatment for Enlarged Prostate

Lifestyle Changes

Initial treatment is geared towards behavioral modifications such as urinating on a fixed schedule and avoiding urinary irritants such as caffeine. You will also need to limit evening beverages and urinate when you first feel the urge.  Increasing your physical activity level can also help.

Medication

Often times, men may also need to be started on medications. There are two general categories: medications that increase flow (e.g. “alpha blockers” such Rapaflo, Flomax, Uroxatral, Cardura, or Hytrin), and medications that shrink the prostate (e.g. Proscar and Avodart). Recent studies indicate that using combinations of medications which work by different pathways may be more effective than a single medication to treat BPH. More than 65% of men with BPH, however, will have worsening problems and may ultimately need surgical treatment.

UroLift®

UroLift is a novel technique for the treatment prostate enlargement without the need for physical removal of tissue. This revolutionary procedure allows for the improvement or resolution of BPH symptoms with minimal risks of long-term side effects, such as erectile dysfunction and retrograde ejaculation. Learn more about UroLift.

UroLift - Before & After

Surgery

Surgery is designed to open the prostate channel by ‘removing’ the excess tissue in the area. Office-based procedures include transurethral needle ablation (e.g. Prolieve) and transurethral microwave therapy (e.g. Urologix). These procedures are minimally invasive and effective; however, they may be associated with a higher rate of recurrent symptoms than other procedures, often at 5 years.

Traditionally, the excess tissue is removed using a small electrical loop in a procedure known as transurethral resection of the prostate or TURP. This procedure is considered the gold standard therapy, but it does require an overnight hospitalization and has a higher risk of bleeding than the other procedures mentioned.

Greenlight Laser prostatectomy is a safe, effective, and minimally invasive means of treating prostate enlargement. While it does require sedation, this procedure can sometimes be done in the office setting as it does not require an overnight hospitalization. The risk of bleeding is significantly lower than with the TURP.

Only your doctor can help you determine which the best option is to help your urinary problems.

Risks of Surgery

Although not very common, you should be aware of the potential risks associated with surgery, which includes (but is not necessarily limited to):

  • Urinary tract infection
  • Bleeding (this may occur for 6-12 weeks after surgery and is usually very mild)
  • Urinary retention / difficulty emptying the bladder
  • Scarring of the urethra from the opening of the penis to the opening of the bladder
  • Retrograde ejaculation (very little ejaculate will be seen once you have climaxed during sexual activity; this is very common)
  • Erectile dysfunction (rare)
  • Permanent incontinence (inability to control your urine) in very rare circumstances (less than 1%)
  • Persistence of urinary complaints
  • Injury to adjacent organs (e.g. bladder)
  • Development of deep venous thrombosis (DVT)
  • Risks associated with the administration of anesthetic

Pre-operative instructions:

Please notify your physician if you are taking aspirin, Plavix, Coumadin, Eliquis, Xarelto, Pradaxa, or NSAID medications (e.g. ibuprofen). These medications increase the risk of bleeding and will need to be held off 5-7 days before surgery. On some occasions, you may need to notify your primary care physician of the need to stop ‘anti-coagulation.’

You may not have anything to eat or drink for 8 hours prior to your procedure. Typically, the surgeon and the anesthesiologist will ask our patients not to eat ‘after midnight.’ The purpose of having an empty stomach; vomiting before/during/after anesthetic can increase the risk of ‘aspiration,’ which can lead to pneumonia and other complications with breathing.

On occasion your doctor’s office may order post-operative medications ahead of time, including:

  • Antibiotics to take after the procedure (typically Cipro)
  • Medications to control bladder spasms, which may feel like a strong feeling that you need urinate while the catheter is in place (typically Ditropan)
  • Medication to help with urinary burning once the catheter is removed; this medication will discolor your urine (Pyridium)
  • Narcotic pain medications (typically Ultram)

It is important to realize that the medications you will be exposed to during and after the procedure are notorious for causing constipation. You should begin an over-the-counter stool softener, such as Colace, before the procedure.

Post-operative instructions

Catheter:

  • You will be discharged with a catheter in your bladder, which will be connected to a drainage bag. You will be given a large bag that can be used at night and a smaller bag that can be strapped to your leg and concealed under your clothing.
  • The catheter will need to remain in place for a period of at least 24 hours.
  • The nursing staff will instruct you on proper care and maintenance.

Blood:

  • It is common to see blood in the urine. This may vary from a very slight pink color to a more pronounced red or dark maroon. There is no need to be alarmed. Drinking plenty of water (more than 32 ounces per day) will help keep your bladder flushed.
  • You may also see blood occasionally drain around the catheter. Again, there is nothing to be alarmed by.
  • You should notify your doctor, however, if you begin to pass several large, stringy blood clots

Spasms:

  • It is also very common to have the sensation that you need to urinate. Typically, this is caused by spasms of the bladder as a result of the catheter balloon. You will be given medication that is intended to make these spasms more tolerable. It is also helpful to relax and take slow, deep breaths.
  • Occasionally, you may notice urine draining around the catheter. This is yet another sign of a bladder spasm.
  • You should notify your doctor, however, if you notice blood clots and experience strong symptoms of bladder spasms.

Activity:

  • Showering is ok with the catheter in place.
  • Do not strain or lift heavy objects with the catheter in place.
  • Typically, it’s best to avoid strenuous activities for 2 weeks following surgery.

You should call your physician immediately if you experience temperatures more than 101.4, shaking chills, significantly bloody urine with clots, absence of urine draining into your bag, pain uncontrolled by medications, or any other concerning change in your health.

Don’t let your problem running to the bathroom ruin your life anymore. Schedule an appointment today to discuss these treatment options with Dr. Natale.

Request an appointment online or call (704) 786-5131.

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