An enlarged prostate is a benign condition that affects one in two men over the age of 50. The prostate gland increases in volume under the influence of hormonal changes. An enlarged prostate is also called prostatic hypertrophy or benign prostatic hypertrophy (BPH).

 

The complaints associated with an enlarged prostate arise through 2 mechanisms:

• Because the prostate gland increases in volume, the urinary tract that runs right through the prostate is squeezed. This can cause the following complaints: weak jet, interrupted jet, dribbling, hesitation, ...

• Due to the narrowed urinary tract, the bladder muscle has to provide more force to bring the urine out, causing a 'nervous' bladder: frequent getting up at night to urinate, frequent urination during the day, urgent urination, cannot hold urination for long ,…

 

The possible 'danger' with an enlarged prostate is that over time the bladder will no longer be able to expel all the urine. As a result, urine remains in the bladder, this is called 'residue formation'. Without treatment, this can cause bladder infections and kidney problems.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

To diagnose benign prostate enlargement, the urologist can perform the following tests:

• Urine sample: rule out urinary tract infection (can cause similar complaints)

• Blood collection: determination of PSA value (protein that is largely produced and secreted by the prostate, an enlarged prostate gives an increased PSA)

• Flow and residue measurement: Flow measurement is also called flowmetry. The uroflow meter is an instrument that measures the force of the urine stream as well as the amount of urine that is passed out. After the jet measurement, the amount of residual urine is determined by ultrasound (residue).

• Rectal examination: a gloved, well-smoothed finger is introduced into the rectum through the sphincter muscle. This allows the size, shape, firmness and surface area of ​​the prostate to be assessed. This is a short and simple examination, which is usually not painful but can give you an unpleasant feeling, because the sphincter of the rectum has to be passed.

• Transrectal ultrasound: Internal ultrasound through the anus and rectum can measure the size of the prostate.

 

Depending on the severity of your urinary symptoms and the result of the above examinations, there are various therapeutic options:

 

1. MEDICATION:

   1. Alpha blockers: promote the flow of urine, improvement noticeable within a few days

   2. 5-alpha reductase inhibitors: stop prostate growth and shrinkage of prostate, only improve after a few months

   3. Anticholinergics or beta agonists: reduce bladder irritation and nervous bladder complaints

   4. Combination of the above medications

 

1. SURGERY:

   1. TURP (transurethral resection of the prostate): the central glandular tissue is scraped via a viewing instrument through the urethra

   2. HoLEP (holmium laser enucleation of the prostate): via a viewing instrument through the urethra, the central gland tissue is enucleated with a laser, after which this detached gland tissue is reduced to small pieces with the help of a second device (morcellator)

   3. Robot-assisted adenomectomy: removal of the central prostate tissue