When does an enlarged prostate need surgery in Nigeria?

What an enlarged prostate actually is

The prostate is a small gland under the bladder that wraps around the tube urine passes through. From middle age it slowly grows in most men. This is called benign prostatic enlargement. Benign means it is not cancer, and it does not turn into cancer.

As the gland grows it squeezes the urine tube. That is why men notice a weak stream, waiting before urine starts, dribbling at the end, a feeling the bladder is not empty, and waking at night to urinate. In Nigeria many men put up with this for years, calling it old age, until the night they cannot pass urine at all.

Try these first

For mild or moderate symptoms, mainstream guidance starts without surgery. These steps help many men and cost little:

• Drink less in the two hours before bed, but do not cut your total water in the day, especially in the heat
• Cut down on tea, coffee, energy drinks, alcohol and fizzy drinks, which irritate the bladder
• Empty your bladder twice: pass urine, wait a minute, then try again
• Treat constipation, because a full bowel presses on the bladder
• Review your other medicines with a doctor, as some cold remedies and water tablets make symptoms worse
• Take prescribed tablets: an alpha blocker such as tamsulosin relaxes the prostate within days, and finasteride shrinks a large gland over months

Signs that surgery is the better choice

Surgery is offered when the blockage is doing harm, or when your symptoms still spoil your life despite tablets. Your urologist will usually recommend an operation if you have:

• Retention: you could not pass urine and needed a catheter, especially if a trial without the catheter failed
• Repeated urine infections linked to urine left in the bladder
• Stones in the bladder
• Repeated bleeding from the prostate
• Swelling of the kidneys on scan or worsening kidney blood tests because urine is backing up
• Symptoms that tablets have not controlled, or side effects from tablets you cannot live with

What the operation is

The standard operation is a transurethral resection of the prostate, TURP. There is no cut on the skin. The surgeon passes a thin instrument up the urine tube and trims away the part of the prostate that is blocking the flow. It is done under a spinal or general anaesthetic, and most men stay in hospital for one to three days with a catheter. For a very large gland the surgeon may suggest a different operation, and will explain why.

Before anyone operates: ruling out cancer

Prostate cancer can cause the same symptoms, and Black men have a higher risk of it. So before surgery a urologist will usually examine the prostate, check a PSA blood test, test your urine, check your kidney function, and scan your bladder and kidneys. Do not let anyone operate on your prostate without these checks. Herbal prostate remedies sold in markets and on social media have no good evidence behind them; if you take one, tell your doctor.

When it cannot wait

Go to an emergency department the same day if you cannot pass urine and your lower belly is swollen and painful, if you have fever with urinary symptoms, or if you are passing clots of blood. A catheter relieves retention quickly, and surgery can then be planned calmly.

Common questions