The prostate may subject to conditions such as hyperplasia, infection, and cancer. A normal prostate is walnut-sized and composed of glandular tissue that produces ejaculatory fluid, its only known function. Since prostatic tissue surrounds the urethra, its enlargement or other abnormalities can affect urination. BPH occurs when cells of the prostate proliferate, causing the prostate to grow beyond its normal size. The underlying causes of BPH are not yet fully understood. Symptoms of the disease include those of bladder outlet obstruction—weak stream, hesitancy, urinary frequency, urgency, nocturia, incomplete emptying, terminal dribbling, overflow or urge incontinence, and complete urinary retention. Diagnosis involves examining the prostate by digital rectal examination to determine its size, symmetry, texture, and nodularity.
- Avoiding the use of anticholinergics, sympathomimetics, and opioids
- Use of α-adrenergic blockers (eg, terazosin, doxazosin, tamsulosin, alfuzosin) or 5α-reductase inhibitors (finasteride, dutasteride)
- Transurethral resection of the prostate or a less invasive procedure
Patients suffering from urinary retention may require immediate bladder decompression. Passage of a standard urinary catheter is first attempted; if a standard catheter cannot be passed, a catheter with a coudé tip may be effective. If this catheter cannot be passed, flexible cystoscopy or insertion of filiforms and followers (guides and dilators that progressively open the urinary passage) may be necessary (this procedure should usually be done by a urologist). Suprapubic percutaneous decompression of the bladder may be used if transurethral approaches are unsuccessful.
Surgical transurethral resection of the prostate (TURP) is the standard for patients not responding to drug therapy or develop recurrent UTI or upper tract dilation. Erectile function and continence are usually not affected, although about 5 to 10% of patients may experience post surgical problems, most commonly retrograde ejaculation. The incidence of erectile dysfunction post TURP falls between 1% to 35%, and the incidence of incontinence is approximately 1 to 3%. Approximately 10% of men undergoing TURP require a repeat procedure within 10 years due to prostate growth. Larger prostates (usually > 75 g) may require open surgery via a suprapubic or retropubic approach. All surgical procedures require postoperative catheter drainage for 1 to 7 days.