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Difficulty in voiding the bladder and incontinence in cases of benign prostate enlargement


Normal (a) and enlarged (b) prostate: Constriction of the urethra in connection with prostate enlargement (1) bladder, (2) prostate, (3) urethra, (4) opening of the ureters, (5) opening of the seminal ducts

The prostate is located in the pelvis, below the bladder, encircling the urethra and extending downwards to a position close to the urethral sphincter muscle. It is in the centre of the male urogenital tract, where the urinary and seminal tracts meet. It is made up primarily of glands that form prostate secretions which are the main component in seminal fluid.

The interior of the prostate is divided roughly into an inner zone and an outer zone. The structure of the prostate can be described in visual terms like an orange: the outer zone has a structure like the peel and the inner zone has a structure like the fruit.

As has been mentioned, the inner zone encircles the urethra, and it is also the inner part of the prostate that is affected by benign prostate enlargement, which is primarily an age-related condition.

Benign prostate enlargement is a typical problem of the older male. The growth of prostate tissue makes it difficult for urine to flow out from the bladder, and this interferes with voiding the bladder. If the urethra is restricted by the growing prostate for a prolonged period, there is also the risk of damage to the bladder itself. If it has to overcome ever greater resistance to expel urine, the bladder wall stretches and small areas of sagging in the wall develop. Over time, the bladder muscle weakens, the bladder no longer empties completely, and the urine remaining in the bladder after urination can cause cystitis.

How do you recognise prostate enlargement? In the early stages, an affected man notices very little. He may notice that the urine stream is weaker or that he stays much longer on the toilet than he used to do a few years before. Frequent urge to urinate at night, a more pronounced urge to urinate and dribbling of urine after voiding the bladder are typical signs of an enlarging prostate. 

The symptoms become more severe if the prostate continues to grow. A distinction is drawn between obstructive symptoms, triggered by the  obstruction of the outflow tract, and irritative symptoms, triggered by a constriction or irritation of the entire bladder/prostate system. Irritative symptoms come top of the hitlist of symptoms, which can manifest as frequent nocturnal urinationmore frequent and more pronounced urge to urinate during the day or a feeling that the bladder has not been completely emptied.

Treatment of benign prostate enlargement

Surgery for benign prostate enlargement (TURP - TransUrethral Resection of the Prostate) The excess prostate tissue is gradually removed using an electrical loop inserted via the urethra. The outer zone of the prostate remains intact.

In the early stage of prostate enlargement, plant-based active ingredients such as pumpkin seeds, saw palm extract, nettle root etc. can be used.

As the symptoms become more severe (weaker urine stream, incomplete bladder voiding, more frequent and more pronounced urge to urinate during the day and at night, typical prostate medication (alpha-blockers, reductase inhibitors) can offer significant relief of the symptoms and keep the consequences of prostate enlargement under control for years. 

If medication does not keep the symptoms under adequate control, or if it is not tolerated, surgery to reduce the size of the enlarged prostate should be considered.

For decades, the proven standard procedure has been to use an electrical sling inserted via the urethra to scrape away the prostate. This procedure is known as transurethral resection of the prostate (TUR-P). In the past few years, new procedures have been tested and found successful. They include the use of lasers and vaporisation of prostate tissue.

In older men, or those with medical conditions that make them less suitable for surgery, embolisation of the prostate blood vessels can be considered. This is carried out by sealing the blood vessels in the prostate by a catheter inserted via the blood vessels in the groin. This causes the prostate to shrink, making bladder voiding easier again.