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Enlarged Prostate or Benign Prostatic Hyperplasia (BPH)

The prostate is a gland located at the junction between the male bladder and urethra with the first part of the urethra going through the gland. The prostate can enlarge with age or due to other reasons – Prostate enlargement is also known as Benign Prostate Hyperplasia or BPH. When this happens, it squeezes the urethra so that passing urine becomes troublesome, painful and sometimes impossible. About half of the men with enlarged prostate will present with symptoms which include incomplete bladder emptying and a persistent urge to urinate.

Nearly 50% of all men have an enlarged prostate when reaching 50 years of age.  By the time they are 80, the condition affects about 90%. It is not clearly understood why this enlargement occurs but there appears to be a correlation with the production of male hormones, testosterone and the continued production of sperm.

The problems from an enlarged prostate are varied:

  • Difficulty initiating a urine stream.
  • Sense of incomplete bladder emptying.
  • Weak flow.
  • Urge to urinate frequently.
  • Passing small amounts of urine.
  • Increased frequency at night.
  • Urine leakages.

Sometimes there can be total urine blockage (retention), hard to treat urinary tract infections, and other lower urinary tract conditions with similar symptoms all of which are important to understand before commencing prostate specific treatment.

Consequences of an enlarged prostate

With a narrowed urethra, more force is needed to push the urine out. This thickens the bladder causing it to lose elasticity making emptying difficult. Repeated urine residue in the bladder becomes a good media for bacterial growth and increased risk of urinary tract infections (UTI).

Treatments

There are many treatment options. Mild cases can be left alone but monitored. For others with symptoms that cannot be ignored, medications to reduce the size of the prostate, and surgery either for partial prostate reduction or (prostatectomy) may be indicated.

For urine retention relief, your doctor may recommend intermittent or Foley catheterization. This would make passing urine fast and easy enabling complete bladder emptying. It would do away with most of the discomfort of not being able to evacuate including having to wake up at night or refraining from social activities for fear of embarrassing leaks.

Foley and intermittent catheters

For urine retention relief, two types of catheters can be used:

1.Foley or Indwelling catheters

2.Intermittent catheters (ISC)

Foley catheters are usually retained for longer periods. They should only be used when necessary and for the shortest time possible because they have complications associated:

  • Inflammation.
  • Catheter related urinary tract infections (CAUTIs).
  • Bladder stones.
  • Urethral strictures.

Intermittent catheters are used “intermittently” whenever there is a need to urinate. The technique, Intermittent Self Catheterization (ISC), is meant to imitate the natural voiding with periods of continence between catheterizations.

Both types of catheterizations are used as a palliative measure while waiting for medications to work or for a scheduled surgery.

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