Treating an Enlarged Prostate

Having an enlarged prostate is not only annoying. It can be embarrassing as well. To make matters worse, the condition can lead to life-threatening complications.

“If after you think you’ve emptied your bladder there are still several ounces of urine left behind, you are at risk for acute urinary retention. That means that one day while you are on a train, a plane, climbing a mountain, driving on some remote highway, or scuba diving off a tropical island hours away from medical help, you may suddenly have to ‘go’ and find that you can’t. The signal to void becomes progressively more intense and painful until you have to be rushed to the nearest medical facility where a catheter inserted into the bladder via the penis is the only way to release the retained urine. If help is a long way off, you may be in real trouble,” explained Dr. Isadore Rosenfeld of the New York Hospital Sloane-Kettering Cancer Center in “The Best Treatment.”

Before that happens, what are your options? How do you deal with benign prostatic hyperplasia (BPH)?

In the past, the only option for people with BPH or an enlarged prostate was surgery. Called transurethral prostate resection (TURP), this procedure involves “shaving” or removing small pieces of the enlarged prostate that block the flow of urine.

TURP is done with a tiny instrument called a resectoscope or operating cystoscope equipped with a light and electric cutting device at its end. The instrument is inserted into the urethra (the tube where urine flows) and a miniature telescope enables the urologist to see the area and cut portions of the prostate gland.

“After the operation, the resectoscope is removed and a catheter is inserted through the urethra into the bladder, where it remains for a day or two so that that the bladder can void while the enlarged channel heals. The hospital stay generally is about a week,” according to Dr. David E. Larson, editor-in-chief of the “Mayo Clinic Family Health Book.”

TURP usually relieves the uncomfortable symptoms of BPH but there are a few problems. First, the prostate may enlarge again, requiring another operation. This is true for one in five men who may have to undergo a second TURP procedure in five years. Secondly, surgery does not prolong life. One study suggests that it actually reduces a person’s lifespan by a year.

In rare cases, TURP can cause impotence or complete inability to control urination. The most common side effect, however, is retrograde ejaculation, that is, the ejaculated semen enters the bladder instead of shooting out of the penis. This may impair a man’s fertility.

“Men who have had a TURP experience no decrease in sexual desire and retain the ability to have erections, engage in sexual intercourse, and ejaculate. Unfortunately, the surgical procedure may cause damage to the internal bladder sphincter, the valve responsible for forward ejaculation of semen. A damaged bladder sphincter cannot close prior to ejaculation, resulting in retrograde ejaculation of semen into the bladder,” said Dr. Richard F. Spark, associate clinical professor of medicine at Harvard Medical School in “Male Sexual Health: A Couple’s Guide.” (Next: Laser for prostate enlargement.)

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