Prostatitis and Benign prostatic hyperplasia (BPH)

The prostate is a relatively small, peanut shaped gland with an important role in the male reproductive system. The prostate’s main role is that of adding fluid to the semen. The prostate gland is situated near the urethra, underneath the bladder. The urethra is the tube collecting and transporting urine from the bladder to the opening at the end of the penis. Prostatitis is the condition in which the prostate gland is inflamed and swollen causing painful and difficult urination and may become chronic. Benign prostatic hyperplasia refers to the enlargement of the prostate gland causing blockage and difficulty during urination.

Causes

Prostatitis:

Bacterial infections (urinary or sexual in nature)

Immune system disorder

Nervous system disorder

Injury to the prostate or the area near the prostate

 

Benign prostatic hyperplasia:

An exact cause has not been discovered

Possible factor: changes in the balance of sex hormones due to old age

Symptoms and signs

Prostatitis:

Pain or burning sensation when urinating

Difficulty urinating

Frequent urination, especially at night

Urgent need to urinate

Painful abdomen, groin or lower back

Painful perineum (area between the scrotum and rectum)

Painful penis or testicles

Painful ejaculations

Flu-like symptoms – fever, chills (bacterial prostatitis)

Pus-like discharge from the penis

 

 

Benign prostatic hyperplasia:

The size of the enlarged prostatitis does not influence severity of the symptoms

Common signs:

Frequent or urgent need to urinate

Increased need to urinate during the night

Difficulty starting urination

Weak urine stream, or stream that starts and stops

Straining while urinating

Dribbling at the end of urination

Inability to completely empty the bladder

 

Less common signs:

Urinary tract infection

Inability to urinate

Blood in the urine

Unintentional loss of urine

Advice

Prostatitis:

Antibiotics

Alpha blockers for relaxing the muscles in and around the bladder

Anti-inflammatory agents

Prostate massage performed by a physician (disputed results)

Benign prostatic hyperplasia:

Alpha blockers

5-alpha reductase inhibitors for shrinking the size of the prostate by preventing hormonal changes

Combination drug therapy

Erectile dysfunction medication (if erectile dysfunction is also part of symptomatology)

Minimally invasive surgical therapy:

Transurethral resection of the prostate (TURP): a lighted scope is introduced into the urethra to remove all but the outer part of the prostate

Transurethral incision of the prostate (TUIP): a lighted scope is introduced into the urethra to make one or two small cuts in the prostate gland to allow an easier urine flow

Transurethral microwave thermotherapy (TUMT): a special electrode is introduced into the urethra, microwave energy destroying the inner portion of the prostate in order to shrink it and allow for an easier urine flow

Transurethral needle ablation (TUNA): a scope is introduced into the urethra so that needles can be inserted into the prostate gland. Radio waves will then pass through the needles heating and destroying the excess tissue blocking urine flow

Laser therapy

Prostate lift: special tags are used to compress the sides of the gland to increase urine flow

Embolization: the blood supply to or from the prostate is selectively blocked causing the prostate to reduce in size

Open or robot-assisted prostatectomy: an incision is made into the lower abdomen to remove excess tissue of the prostate

MISCONCEPTIONS
  • Prostatitis:

    Treatments cannot cure prostatitis

    If lab tests are negative the condition is non-infectious – in order for a correct diagnosis to be established there is a need for 5 successive drainages of prostate secretion

    If the condition is non-infectious there is no need for protection during sex – one of the main reasons for recurrence of the condition is due to unprotected sexual intercourse

    Prostatitis is caused by pelvic floor tension

    Surgery is needed in treating prostatitis

    It is an ‘old man’s’ disease

    Benign prostatic hyperplasia:

    Size of the prostate is directly linked to pain and symptoms

    It causes impotence – rarely and temporarily stress-induced impotence

    It leads to prostate cancer

Statistics

Prostatitis is more likely to affect men younger than 50 years of age

 

BPH usually occurs in men older than 50 years of age

 

The risk of developing BPH grows with age:

1 in 12 chances – age 31 to 40

1 in 2 chances – age 51 to 60

More than 8 in 10 chances – over 80

 

About 5% to 10% of men develop prostatitis during their lifetime