Prostatism is the term used to describe the symptoms of urinary difficulties men experience due to an enlarging prostate as they get older. Typical complaints are those of a reduction in the urinary stream, the need to void more often (frequency), the need to get up at night (nocturia) and the sudden urge to void, sometimes with leakage - urge incontinence. Some patients also take a while to initiate micturition, which we call hesitancy. There may also be a sensation of incomplete bladder emptying and terminal dribbling.
Prior to treating prostatism it is important to exclude any abnormalities within the urinary tract. An ultrasound of the urinary tract, urine culture, PSA and prostate examination are baseline investigations.
Once prostate cancer has been excluded, which does not usually present in this way, the first treatment to be used is drugs. These are called alpha blockers which relax the musculature within the prostate and allow the urine to pass more freely. One can also use drugs which shrink the prostate and there are now drugs available which perform both of these functions.
The indications to perform prostate surgery for urinary outlet obstruction are failure of medical treatment, the presence of complications such as a bladder which does not empty, bladder stones or obstruction to the kidneys.
Where surgery is indicated the obstructing prostatic tissue needs to be removed and this is done with a telescope removing the prostate tissue by the traditional transurethral resection technique or using a laser.