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Everyone has experienced the urge. You’re in your car on a road trip when you suddenly feel a strong pressure in your bladder. The need to urinate becomes an inevitable interruption requiring a rush to a rest-stop bathroom. Such urges can even happen at night, disrupting vital sleep.
This rush is something that Britain’s King Charles III, admitted to a London hospital on Friday, might have encountered prior to his decision to undergo prostate surgery.
Why do I feel that pressure to pee?
Your kidneys produce urine. The liquid waste then travels down ducts called ureters to the bladder. Similar to an elastic balloon, it stretches to store urine. When it’s time to urinate, your bladder contracts to help release all the stored urine, which exits through the tubular urethra. In the male urinary tract, the urethra runs through a part of the reproductive system called the prostate and then through the penis.
About the size of a walnut, the prostate is situated directly below the bladder, in front of the rectum, and wraps around the urethra. The prostate’s function is to produce nourishing fluid that transports sperm.
As the body ages, factors like family history, lifestyle and hormonal changes can cause the prostate to enlarge. This common condition, known as benign prostatic hyperplasia, varies in severity, and it’s often noticeable around age 50.
Prostates can range in size from a walnut to larger than a baseball. All prostates grow, but not all prostates cause symptoms. Your primary care doctor or urologist can estimate the size through a digital rectal exam during routine screenings. Conducting an imaging test with ultrasound or MRI can also capture the prostate’s size.
Doctors evaluate the size of the prostate and possible symptoms. A mildly enlarged prostate can cause noticeable symptoms such as a weaker stream when urinating or increased frequency, especially at night. A significantly enlarged one might not cause any symptoms.
If you notice changes in urination, consult your doctor. There are effective medical and surgical options to improve your condition if an enlarged prostate is affecting your daily life.
Just like many people experiencing these symptoms, King Charles likely decided to undergo prostate surgery following a similar need for relief and improvement in quality of life. His situation highlights the importance of paying attention to these symptoms and seeking medical advice. Prostate health is a key aspect of men’s health, and advancements in treatment options offer hope and solutions to those affected.
Medical treatment options
To assess your condition, doctors inquire about urination patterns, classify the condition’s severity, and may conduct lab tests for kidney function and prostate cancer screening. This comprehensive evaluation guides the treatment plan.
In managing an enlarged prostate, several medical options are available, each tailored to the severity of symptoms and the patient’s overall health.
Alpha-blockers, such as tamsulosin and alfuzosin, are commonly prescribed to relax the muscles in the prostate and bladder neck, facilitating easier urination.
For those with larger prostate glands, 5-alpha-reductase inhibitors may be recommended. These medications, such as finasteride and dutasteride, work by shrinking the prostate over time. In certain cases, a combination of these drug classes is used for more effective symptom relief.
Surgical options for an enlarged prostate
1. Open prostatectomy: Rarely performed today, this procedure can be done with an incision in the lower abdomen or with robotic surgery to remove part of the prostate. This option is usually reserved for extremely large prostates and carries a higher risk of complications such as bleeding and infection. The procedure may require one or two days in the hospital, and it’s not the surgery done to remove the entire prostate when a person has prostate cancer.
2. Transurethral resection of the prostate: A less invasive option, TURP involves inserting a scope through the urethra to trim away excess prostate tissue with bipolar energy. The procedure improves urinary symptoms with a shorter recovery time but has risks such as bleeding and potential effects on sexual function. The patient may go home the same day or stay in the hospital overnight for observation.
3. Prostate lift: The minimally invasive procedure uses small implants to lift and hold enlarged prostate tissue, thus unblocking urine flow. The surgery is quick, and it has a short recovery time and lower risk of sexual dysfunction. This is an outpatient surgery, meaning the patient goes home the same day.
4. Steam vaporization: In this treatment, steam destroys excess prostate cells. The minimally invasive procedure is effective, with a low risk of side effects and a quick return to normal activities. This outpatient option does not require an overnight hospital stay.
What to expect after a prostate procedure
The medical team may place a catheter for a short duration to aid urination. It’s also common to notice blood in the urine for a few weeks post-surgery. Depending on the procedure, sexual function may be temporarily affected, but most patients regain normal function over time.
Urinary symptoms such as frequency, urgency or difficulty with urination may persist for a few weeks or months after the procedure. Recovery times can vary, with minimally invasive procedures typically allowing for a quicker return to normal activities compared with more extensive surgeries.
It’s important to note that benign prostatic hyperplasia is not associated with prostate cancer and does not increase your cancer risk. However, the condition can make prostate cancer screening more challenging. Therefore, regular check-ups including a digital rectal exam and discussions with your health care provider are crucial for a comprehensive approach to prostate health.
Dr. Jamin Brahmbhatt is a urologist and robotic surgeon with Orlando Health and past president of the Florida Urological Society.
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