The prostate is a gland the size of a walnut. It is only present in men, and it is situated under the bladder surrounding the urethra, the passageway which takes the urine to the outside. The gland produces seminal fluid which is mixed with sperm to make semen which the man ejaculates.

With age, the gland may begin to grow - this happens to most men. The growth may eventually cause problems with urination because the gland compreses the urethra as it increases its size.

The growth in itself is harmless and hence the condition is called benign prostate hyperplasia (BPH). This occurs most often in men above the age of 60. Up to 30 per cent of men in their 70s have BPH and experience symptoms due to this condition.

The enlargement of the prostate gland stretches and distorts the urethra and therefore obstructs the urine flow. Symptoms include:

• A weak or interrupted urinary stream.
• Several attempts to empty the bladder may be necessary
• Difficulty starting the urine flow even when the bladder feels full A feeling that the bladder is not completely empty
• A need to urinate often during the day as well as during the night. Increased need to urinate in the night is usually a very early symptom
• A need to urinate right away.
• Some men may experience involuntary discharge of urine Dribbling of urine after urination
• Burning sensation or pain during urination

The symptoms may vary from person to person. It is important to know that the above symptoms do not necessarily prove that the prostate is enlarged . Other diseases may cause similar symptoms. Men with problems urinating should always see their doctor.

The following problems could arise due to BHP:

• For some men, it suddenly becomes impossible to urinate (known as acute retention). Studies have shown that acute retention affects between one per cent and two per cent of men with BPH each year. This condition is very painful and demands immediate medical treatment in order to avoid damage to the kidneys among other things.
• Others find it gradually harder to empty the bladder. Gradually, over time as the condition develops, more and more urine is left in the bladder after urination (known as chronic retention).
• Other complications of the disease include: Repeated attacks of cystitis (infection of the bladder) and development of stones in the bladder.

A doctor will be able to make the diagnosis in the following manner:

Patients will be asked about their symptoms. They may also be asked to record their drinking and urination over a period of three days. By carrying out a rectal examination, the doctor can feel through the rectum wall whether or not the prostate is enlarged

Usually, the patient's urine will be examined, and may be sent for culture, when it will also be tested for sensitivity to antibiotics.

Kidney function will also be examined by a blood test. If there is a need for further tests, they will usually be carried out by a specialist. He or she will be able to check for specific urinary functions like the flow rate of the urine and whether the bladder is emptied on urination. X-rays including ultrasound examinations and blood tests may be necessary. Many hospitals have specialised prostate clinics where a full prostate check is carried out.

There are a variety of treatment strategies for this condition and the following factors should be kept in mind:

Treatment is only necessary if the symptoms are bothersome or complications are present. Each treatment has advantages and disadvantages. The patient and his doctor will have to decide which is most appropriate. A doctor should be consulted regularly to avoid complications setting in.

Medical treatment: There are two types of medication for this problem: Alpha blockers. These drugs help to relax muscle fibres within the prostate thereby reducing the obstruction to the flow. They do not reduce the size of the prostate. Patients occasionally experience side-effects such as dizziness, headache, drowsiness and retrograde ejaculation.

5-alpha-reductase-inhibitors like finasteride inhibit the growth of prostate and decrease the size of the gland. Research studies have shown that both types of drug treatment are effective at improving urinary symptoms in men with BPH. In addition to these two types of medicine there are different kinds of over-the-counter herbal medicines available in the market. A doctor will be the best person to advice those with this condition, regarding the suitability of these drugs.

An operation on the prostate will involve the removal of parts of the enlarged tissue. The most common operation is an endoscopic surgical procedure where parts of the enlarged tissue are peeled off. This is called transurethral resection (TUR). If the prostate is only slightly enlarged, it may be enough to make a little cut in the prostate, without removing tissue, to reduce the constriction of the urethra. his is called transurethral incision (TUI). If the prostate is considerably enlarged it may be necessary to make an incision in the lower abdomen and to carry out an open operation. But this procedure is only carried out rarely.

Surgery carries more risk than medical treatment and there are possible complications including retrograde ejaculation. In retrograde ejaculation, the sperm enters the bladder during ejaculation instead of being expelled through the penis. Later it is flushed out with urine.

Studies estimate that 74 per cent of men will experience retrograde ejaculation after transurethral resection of the prostate (TURP). Surgery has also been linked with side effects of erectile dysfunction (in 14 per cent of men after TURP) and urinary incontinence (five per cent).

But studies are inconclusive as to whether the same rates of these problems would have occurred anyway in men not undergoing surgery. The benefits of surgery are long lasting but because only part of the prostate is removed, some men may eventually need another operation.

Newer treatments for benign prostate hyperplasia already exist and are continually being developed. These techniques are minimally invasive. Some need only local anaesthesia and the risk of complications is smaller.

A couple of general points about these new techniques: It is still not known fully whether the results are as effective as endoscopic surgery. The techniques concerned are still being continually developed and tested.

• Microwave thermotherapy: In this treatment, the prostate tissue is heated to around 45° C by means of microwaves. This reduces the size of the prostate by causing cells in the centre of the prostate to die. This treatment is carried out through the urethra.
• Electrovaporisation: In this procedure, part of the prostate tissue is removed by evaporation by means of electrical current. The treatment is performed with an endoscope.
• Laser-resection: Another endoscopic treatment, in which part of the prostate tissue is removed with laser energy. For this treatment, a passage is created by inserting a tube made of metal or plastic - which remains in place where the prostate gland obstructs the urethra. This procedure is used only on rare occasions, for those patients who are unable to be considered for other forms of treatment..