Enlarged Prostate Symptoms

August 17, 2023
The prostate gland in young men is a relatively smooth organ about the size and shape of a walnut, apricot, or golf ball and weighs about 20 to 25 grams. It is seated deep within the groin region of the pelvis and is situated between the base of the penis and the rectum. The prostate is unique to a male’s reproductive physiology and is necessary for reproduction. At its peak performance from puberty – through a man’s 20s, the prostate is a normal size. However, as most men age, their prostate tissue tends to enlarge to the point where it can easily double or more in size. This prostate enlargement is called benign prostatic hyperplasia, or BPH, and is believed to be caused by hormonal changes as a man gets older. In fact, men who have had their testicles removed before puberty because of cancer or another concern, don’t develop BPH.1 Over time BPH can begin presenting urinary flow related enlarged prostate symptoms or lower urinary tract symptoms (LUTS) such as decreased urine flow, starting and stopping, the inability to fully empty the bladder, or urinary urgency that ends up becoming bothersome for many men. Even though an enlarged prostate, or BPH, is not prostate cancer, the two can occur together, so it is always a good idea to see a urologist or primary care provider if any pain or urinary symptoms occur. An enlarged prostate doesn’t lead to sexual problems such as erectile dysfunction or retrograde ejaculation, but some BPH treatments utilized to address an enlarged prostate can lead to sexual dysfunction. By the time a man reaches his 50s, he will find that roughly half of all male peers his age will have an enlarged prostate. This percentage grows each decade beyond 50 years until about 80% of all men will have BPH by the time they reach their 80s.1 It is interesting to note that for some men, an enlarged prostate won’t present any urinary issues even though they are diagnosed with benign prostatic hyperplasia. Yet many men will have to deal with enlarged prostate symptoms and all the lifestyle adaptations that are necessary to live as normal of an existence as possible. As shown in the next section, the list of enlarged prostate symptoms can be quite extensive and the lifestyle changes or treatments can be a lengthy list as well.

The Symptomatic Prostate

When a man is young and his prostate is a normal size, the prostate gland is an asset. It is an important organ in the male reproduction effort since it supplies a portion of the seminal fluid (semen) that mixes with sperm. These prostatic fluids then help the sperm survive longer and travel more easily to their eventual destination. As a man ages beyond his 20s and into his 30s, 40s, 50s, 60’s, and beyond, the prostate keeps enlarging for most men. When the prostate continues growing to the point where it doubles, triples, or quadruples its original size, it can begin causing urinary issues to the point where they become bothersome, life-changing, or even health-threatening. Some men will experience an enlarged prostate or benign prostatic hyperplasia and show no symptoms at all; or very minor ones. And prostate size doesn’t necessarily always determine the severity of urinary blockage or symptoms. Some men with very large prostates have little urinary blockage and few symptoms, whereas other men who have minimally enlarged prostates show greater instances of blockage and quite a few more symptoms.1 It could very well just depend on the orientation of prostatic tissue growth, individual anatomical spacing, and other differences. However, many men are likely to experience more enlarged prostate symptoms each decade until treatment is sought. A man can expect some of the following symptoms if benign prostatic hyperplasia is diagnosed. These symptoms can range from nuisances – to lifestyle modifiers – to health risks, and include the following common complaints from men experiencing an enlarged prostate brought on by BPH.
  • Flow – urination velocity is weak
  • Frequency – urinating 8 or more times per day
  • Hesitancy – trouble starting or stop and start urine flow
  • Straining – bearing down to urinate
  • Dribbling – after urination
  • Urgency – having to “go” immediately
  • Nocturia – waking up frequently to urinate
  • Retention – not able to empty some or all urine
  • Incontinence – accidentally leaking urine
  • Pain – after urination or ejaculation
  • Hematuria – blood in the urine (not as common)
  • Infection/Smell – can cause bladder, kidney, or urinary infections and smell

Complications of an Enlarged Prostate

Even though an enlarged prostate or benign prostatic hyperplasia is present in half of all men in their 50s and up to 90% of men in their 80s, only about half of men diagnosed with BPH will show any lower urinary tract symptoms.1 This is encouraging news for half of the adult male population, because even though they have an enlarged prostate, or BPH, their prostate has either enlarged less or it has enlarged in a way that doesn’t present lower urinary tract symptoms. However, for the other half of adult men who have BPH and experience lower urinary tract symptoms, those symptoms can remain mild, become moderate, or in some cases become extreme and health or life-threatening. If an enlarged prostate is left untreated and expands in the wrong direction or is allowed to grow unchecked for too long, the following complications can arise.
  • Acute (severe and sudden) urinary retention
  • Chronic (recurring or long-term) urinary retention
  • Bladder Outlet Obstruction (BOO)
  • Urinary tract infections (UTIs)
  • Blood in the urine
  • Bladder stones
  • Bladder damage (including a decompensated bladder)
  • Kidney damage
The majority of men diagnosed with BPH won’t develop the complications listed above, especially if they receive the best treatment for benign prostatic hyperplasia that they can get. However, bladder damage, if incurred, can be debilitating and life-altering, and kidney damage can be health-threatening. An enlarged prostate is a condition that the vast majority of men will have to deal with in their lifetime. It is not prostate cancer and doesn’t lead to prostate cancer. And luckily, only half of all men diagnosed with prostate enlargement, or BPH, will show noticeable symptoms. Some men who are diagnosed with benign prostatic hyperplasia and end up experiencing mild symptoms may be able to take a watchful waiting approach, possibly combined with some lifestyle changes, to facilitate relief. For other men, BPH can be improved or possibly cured with other treatments like BPH medication. And other men will encounter more robust LUTS brought on by BPH and need to decide on a surgical treatment to take care of their symptoms. The key is to employ the least invasive, yet most effective BPH treatment, to address lower urinary tract symptoms brought on by BPH. Whether it’s lifestyle modifications, medicine, or a minimally invasive procedure, the sooner enlarged prostate symptoms can be addressed, the better, before lower urinary tract symptoms become severe enough to cause more extensive or permanent damage.   References:
  1. https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostate-enlargement-benign-prostatic-hyperplasia

All surgical treatments have inherent and associated side effects. Individual’s outcomes may depend on a number of factors, including but not limited to patient characteristics, disease characteristics and/or surgeon experience. The most common side effects are mild and transient and may include mild pain or difficulty when urinating, discomfort in the pelvis, blood in the urine, inability to empty the bladder or a frequent and/or urgent need to urinate, and bladder or urinary tract infection. Other risks include ejaculatory dysfunction and a low risk of injury to the urethra or rectum where the devices gain access to the body for treatment. Further, there may be other risks as in other urological surgery, such as anesthesia risk or the risk of infection, including the potential transmission of blood borne pathogens. For more information about potential side effects and risks associated with Aquablation therapy for Benign Prostatic Hyperplasia (BPH) treatment, speak with your urologist or surgeon. Prior to using our products, please review the Instructions for Use, Operator’s Manual or User Manual, as applicable, and any accompanying documentation for a complete listing of indications, contraindications, warnings, precautions and potential adverse events. No claim is made that the AquaBeam Robotic System will cure any medical condition, or entirely eliminate the diseased entity. Repeated treatment or alternative therapies may sometimes be required.

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