The Scoop on Enlarged Prostate

You may then be asked to pass your urine into a special receptacle so that the strength of the flow and the amount of urine passed can be measured.

After you have passed your urine, a simple scan of your lower abdomen will be done to determine whether you are actually emptying your bladder.

A sample of urine will be analyzed to see if there is any evidence of infection or other conditions.

Occasionally on your first visit an ultrasound of the kidneys will also be performed to see if there are any problems with the kidneys.

Urodynamic studies (a test to measure the internal pressure and contractions of the bladder) may occasionally be indicated at a later date if your urologist feels that your symptoms are related to bladder problems rather than BPH.

A direct inspection of your bladder may be indicated. This is done by inserting a thin tube containing a lens with a light system (cystoscope) into the urethra to allow direct visualisation of the urethra and bladder.

The procedure, done under local or general anesthesia, can detect various problems and abnormalities, including BPH.

Treatment decisions are based on each patient's condition and the benefits and drawbacks will be discussed with you. Several changes in diet and behavior may help some patients to avoid surgery.

Examples include reducing fluid intake in the evening and eliminating bladder irritants from the diet (and these measures have been discussed in this column previously).

In patients who have moderate symptoms, drugs alone or in combination are often used to control BPH.

The main options are:

• Alpha-blockers can be used to make urination easier by relaxing the muscles where the bladder narrows toward the urethra.
• The use of 5-alpha reductase inhibitors to shrink the prostate gland may take up to six months to take effect and are more effective in men with large prostates. 
• Anticholinergics may be useful in decreasing the urge to urinate and may help to increase the capacity of the bladder.

If medical therapy does not alleviate your symptoms then there is a variety of options available but the gold standard is a transurethral resection of the prostate gland (TURP). This surgery involves the "coring out" of the center of the prostate which is done using a telescope.

This entails a few days in hospital and will allow you to pass your urine with a greater flow.

Laser treatments are also very successful in treating BPH. Other less invasive techniques do not produce the same good results as a TURP.

The main side effect that is noticed by men after a TURP is a reduction in the volume of semen they ejaculate because surgery to the bladder neck may allow semen to flow backwards into the bladder.

Major complications are rare and problems such as impotence (erectile dysfunction) and incontinence are rare.

This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James's Hospital, Dublin.