Prostatic obstruction

Below is a brief introduction to prostatic obstruction. Please always consult a doctor for an examination if you experience symptoms of or suspect prostatic obstruction.

What is prostatic obstruction?

Prostatic obstruction is an obstruction of urine flow through the prostate due to pressure from the prostate against the urethra, which impedes the body’s ability to pass urine. Prostatic obstruction can occur in varying severity from light cases with limited symptoms and some continued flow of urine, to complete and acute obstructions with severe symptoms and no urine passage. Symptoms or suspicions of prostatic obstruction should always be consulted with a doctor.

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What causes prostatic obstruction?

Prostatic obstruction is typically caused by either benign prostatic enlargement (known as BPH) or prostatic cancer. Benign prostatic enlargement is a common condition among older men. Most men are believed to have a continued prostatic growth throughout life, which at a certain age will place sufficient pressure on the urethra to limit the flow of urine.

How is prostatic obstruction diagnosed?

The diagnosis of prostatic obstruction typically involves questions from the doctor about the severity and type of symptoms experienced. Examinations may also be performed in the form of urine flow study, blood test, cystoscopy, ultrasound, MRI or rectal exam. If cancer is suspected a biopsy test will often be performed, along other tests depending on the stage of the cancer.

Symptoms of prostatic obstruction

Whether caused by benign prostatic enlargement or cancer, the severity of the symptoms varies, but have a general tendency to increase over time. If you are in doubt about whether you are experiencing symptoms, a doctor can examine and evaluate if treatment is necessary. Examples of prostatic obstruction symptoms can be seen below

  • Difficulty in starting urination
  • Interrupted and/or weak urinary stream
  • Continuous feeling of having a full bladder
  • Inability to empty the bladder completely
  • Frequent urination especially at night
  • Blood in the urine

What are the treatment options for prostatic obstruction?

The selection of treatments of prostatic obstruction depend on whether it is caused by cancer or benign enlargement. Examples of prostate cancer treatment are radiation therapy, chemotherapy, surgery etc. Below follow examples of how benign prostatic enlargement can be treated including examples of their respective advantages and disadvantages.

Watchfull waiting

If the symptoms of prostatic obstructions are limited in severity and do not interfere with the patient’s everyday life, some doctors may prefer to monitor the condition and follow up frequently to evaluate the symptom development closely. Watchful waiting has the advantage of no side-effects or complications but comes with the risk that the condition is not treated in due time.

Pharmaceutical treatment

Pharmaceuticals are the least invasive and typically first choice of treatment. The treatments normally relax the bladder neck to enable urine flow and limit further growth of the prostate. Pharmaceutical treatment may, however, not be sufficient in the long term to relief the symptoms adequately, and also cause risk of certain side-effects such as dizziness, fatigue and sexual dysfunctions.

Surgery

Surgical options range from resection (TURP) to laser, vaporization etc., which generally aim at removing tissue from the prostate and thereby allow urine to flow through. Surgery is often effective and provides long-term symptom relief, but also causes risk of side-effect such as permanent retrograde ejaculation (dry orgasms), urinary incontinence, and impotence. Some forms of surgery e.g. TURP also causes risk of bladder neck stricture.

Catheters

Catheters are long plastic tubes plastic inserted through the obstruction in the prostate to enable urine flow. Catheters can be single-use devices for self-catheterization, or indwelling catheters which are fixed in the body and exchanged approximately every 15-30 days. Catheters are less invasive than surgery but may also cause discomfort and pain to the user, affect quality of life, and carry a high risk of urinary tract infections.

Stents

Stents are short tubes fixed at the location of the obstruction to allow urine to pass through. Stents are less invasive than surgery and affect the everyday life of patients less than catheters, but cause risk of obstruction from kidney stones, and may pass involuntarily through the urine. In either case the stents can be replaced by a new one, or replaced with different treatment method. Certain non-metallic stents also cause risk of tissue growth into the stent, making the removal process difficult.

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