Hi everyone. This lesson is on the signs and symptoms of an enlarged prostate. So we're going to talk about signs and symptoms that can occur in benign cases of an enlarged prostate, which is known as benign prostatic hyperplasia. But we're also going to talk about some warning signs and symptoms that can occur in patients who have prostate cancer. Before we get into the signs and symptoms of an enlarged prostate, let's talk about what the prostate is and why it enlarges in the first place.

So the prostate is a male reproductive organ located at the base of the bladder. So it's located directly at the base of the bladder and male patients and it surrounds the urethra, which originates from the bladder. So you can see here in this image, this is the bladder and this is the urethra exiting the bladder. This is where urine comes out of the bladder and the prostate surrounds the urethra. It actually encircles the urethra.

As the prostate gets enlarged, you can see that there can be issues in constricting the urethra and pushing on the bladder. And this is going to explain a lot of the symptoms that can occur within a large prostate. So enlargement of the prostate can be a non malignant process, which we would refer to as benign prostatic hyperplasia or BPH. But in some patients, enlargement of the prostate can be malignant, which means it is prostate cancer. So these are two cases of an enlarged prostate, but by far the most common is going to be benign prostatic hyperplasia.

Now, what is the pathophysiology? Why does the prostate enlarge in the first place? The prostate likely enlarges due to hormonal changes in testosterone and estrogen levels. So it has been believed that testosterone being converted to a stronger form of testosterone as dihydrotestosterone, can act on the prostate tissue to cause it to enlarge over time. But it has also been noted that changes in estrogen levels can also lead to this process as well.

So there's probably a role of both testosterone and estrogen levels leading to changes in the size of the prostate over time. So as mentioned before, benign prostatic hyperplasia is going to be by far the most common form of an enlarged prostate. And prevalence of BPH increases with increasing age. It has been estimated that as much as 50% to 60% of male patients in their 60s are affected by BPH and these rates increase as the patient gets older. It's been estimated that upwards of 80% to 90% of patients over the age of 70 have some type of enlargement of their prostate.

So very, very common condition and there's an increased risk in certain patient populations, particularly those with metabolic syndrome and obesity. And there's likely a genetic predisposition for some patients to get this condition as well. Now, the topic of this lesson is that an enlarged prostate can lead to certain signs and symptoms and we're going to talk about those signs symptoms and why they occur in the next upcoming slides. So, what are some of the most common signs and symptoms of an enlarged prostate? By far one of the most common symptoms of an enlarged prostate is difficulty initiating and maintaining urination.

So you can imagine that if the prostate that encircles the urethra, if it gets larger and larger, it's going to compress the urethra, it's going to push on the bladder and it's going to cause issues to try to get urine through that constricted urethra. There's going to be something called urinary hesitancy. This essentially means that there is difficulty initiating and maintaining urinary stream. So again, difficulty initiating urination. You can imagine that if you're trying to start to urinate with this very tightly constricted urethra, it's going to be very difficult to push urine through that.

So patients are often going to strain to get urine through. So straining is very, very common. In fact, significant straining may be required in order to initiate or maintain a urine stream. Now this also ties in with the next symptom of an enlarged prostate, which is intermittent urine stream. So intermittent urine stream or a weak urine stream.

So it's not going to flow as easy as it used to. So even after initiation, after the patient might have strained to get started, the urine stream may become intermittent. And that means that it essentially turns on and off. So looking at this diagram, again, you can imagine that the patient has to strain to get urine through that constricted urethra. So they increase pressure in the bladder and it can push past that bulge of prostatic tissue.

But that prostatic tissue can essentially once in a while overcome that increased pressure. So it can kind of turn off the urine stream. So that's why we can see an on and off type of intermittent urine stream. So again, this is due to urine traveling through a partially obstructed urethra. Now, another sign of an enlarged prostate is prolonged urination.

So it essentially takes longer to urinate. Again, this all has to do with what we talked about before. Urine takes longer to go through the urethra due to that partial obstruction of the urethra due to that enlarged prostate. So because of that weak urine stream and that intermittent stream, it's going to take longer to actually complete urination. So this is going to all contribute to increased time duration of urination.

We can also see nocturia occurring in patients with an enlarged prostate. So nocturia is urinating at night time. So it's in the word urea refers to urination. And noct is a prefix referring to nighttime. So we can think of words like nocturnal.

So patients are often awoken at night with a sense to urinate. So this can be very, very common in patients within a large prostate. They can often be awoken many, many times through the night and they can get poor sleep because of this. And although they are awken many, many times at night to urinate. They might not urinate that much.

So they feel like they have to urinate. They get up, they go to the bathroom, and then there's only a small amount of urine volume. Then they go back to bed, and then not too long after, they may feel like they have to go back and use a washroom again. So this can be very, very repetitive and cause very disrupted sleep for patients. Now, there's another finding in patients with enlarged prostate, and that is known as encore voiding.

So you might be wondering what is encore voiding? So encore voiding is when completing urination, after you have finished, you feel like immediately after finishing, you have to urinate again. So this is an encore voiding. So you avoided, you've completed, but then right away you feel like you have to go again. And this may be due to residual urine volume within the bladder.

So imagine that trying to push urine out of the bladder through that obstructed urethra can be very difficult. So there going to be some residual urine in there. So you might feel like you still need to urinate even after you've completed, or you felt like you've completed, but it can also be due to the enlarged prostate pushing up against the bladder. This area, the bladder is known as the trigon, and this is a very, very sensitive portion of the bladder. This actually is one of the most sensitive portions of the bladder, so it causes a sensation that you need to urinate again.

So this is another reason why we can see patients have not only nocturia feeling that they have to urinate many times, even with a small amount of urine in their bladder, but they can also have encore voiding after they've completed urination, they still have to urinate again. Now, there are some other signs and symptoms of an enlarged prostate that go along with what we've talked about before. One of them is increased urinary frequency. So this is an increased frequency of urination. We've alluded to this before, nocturia having many, many times throughout the night, needing to use the washroom.

But this can happen even during the day as well. So increased frequency of urination can occur during the day. And the patient may often feel like they have to urinate many, many times during the day. And again, despite increased urination, their urine volumes may be low. So it's not about them filling up their bladder and needing to actually go to the washroom many times, which can be related to other conditions.

This has to do with the irritation of the bladder from the prostate or from residual urine volume in the prostate due to incomplete voiding. So even though they feel like they have urinating, they go to the washer many, many times per day. Their urine volumes that they're actually avoiding are very small. Urinary urgency is also another finding in patients with an enlarged prostate. Urinary urgency is a feeling or urge to urinate quickly.

So because of the prostate pushing up against the bladder, again in that sensitive area we talked about before, this will make the patient feel like they need to urinate very quickly. And this can often occur after positional change. So one example might be rolling over in bed so this can contribute to the nocturia we mentioned before. Perhaps if they have used a washroom to go back to bed and then they roll around in bed and that movement, that positional change can cause the prostate to press or push on the bladder in a different way and that can cause the patient to feel like they have to use the washroom again and may feel like they have to use the washroom quickly. So this is another finding in patients with a large prostate dysuria is another finding in patients within a large prostate.

Dysuria is a burning sensation when initiating urination. So you can imagine that if you're trying to push or strain urine past that partially obstructed urethra, when you're trying to urinate, it might cause a little bit of irritation. So it could feel like a burning sensation when urinating or especially when starting to urinate. And along with the urinary frequency and urgency, it may resemble a urinary tract infection. So these symptoms can all resemble urinary tract infection.

But because of all these other symptoms we mentioned before, this would be more likely due to an enlarged prostate. But Dysuria is less common, so urinary urgency, urinary frequency are going to be more common. Dysregia burning sensation when urinating is going to be a more uncommon finding in patients with an enlarged prostate. Patients can also have what we call post void Dribbling. So post void Dribbling is when after completing urination, there's Dribbling that may occur.

So they're, there may always be some Dribbling, but this can be often a lot of Dribbling. It can take time for it to stop. And again, this is due to residual urine volume in the bladder after voiding due to issue passing that enlarged prostate. So passing through that constricted urethra, it may be difficult to get all of the residual.

Urine out. So there's going to be some post void dribbling that can occur in patients with an enlarged prostate. And then when the prostate gets so enlarged and so severe, this can lead to urinary retention. So you can imagine that the prostate grows more and more and grows so much that it tightens and squeezes that urethra so tightly that no urine can pass. And that is what can happen in urinary retention.

So urinary retention is going to be an inability to urinate. So they're not even going to get started urinating. They're going to have difficulty even getting any urine out. They might get a little tiny bit even with a full bladder, but they might not get any out at all. So no urination or a very, very reduced ability to urinate, so their bladder can be full and painful.

And this is going to be essentially a bladder outlet obstruction. And we're going to see this in severe cases of benign prosthetic hyperplasia, when the prostate hasn't learned so much that it squeezes so tightly on the urethra that no urine can come out, or very, very little urine can come out. And this is going to lead into a complication we're going to talk about, which is acute kidney injury. So acute kidney injury can occur due to urinary retention. So the reason acute kidney injuries can occur is because the kidney continues to make urine even when the bladder is full.

And what happens is the bladder becomes filled and then the kidney keeps making urine and the urine is going to back up. It's going to back up from the bladder up to your readers, which are the tubes that connect the kidney to the bladder. So this is one ureter here and the urine is going to back up the ureter and eventually get into the kidney. And that's going to cause damage. That can cause what we call hydro nephrosis, where there's fluid in the kidney.

Kidney keeps making urine, but it has nowhere to go. And this is going to cause kidney damage. And if this is not treated or resolved in time, this can lead to chronic kidney disease, which can ultimately lead to dialysis in some patients. So it's very important to remove this obstruction in order to allow urine to flow properly because of what happens in urinary retention. So all of these can be complications of an enlarged prostate.

Patients can also have hematauia. So hematuria is blood in the urine, but most likely it's going to be microscopic Hemati. They're not going to see the blood, it's not going to be visible blood in their urine, but it could be. And this is due to irritation and inflammation of the Erythrom, an enlarged prostate. Now, I want to talk about some warning signs and symptoms that can occur in patients with prostate cancer.

Now, all of these signs and symptoms can occur in prostate cancer as well. But these falling warning signs and symptoms are going to be more likely to occur in prostate cancer. One of them is weight loss, another one is fever and chills. So these are constitutional symptoms. Another one is hot flashes and night sweats.

So due to changes in hormone levels and due to the cancer itself, there could be hot flashes, there could be night sweats or drenching. Night sweats can occur. Signs and symptoms of spinal cord compression can occur. So if the prostate enlarges so much due to that prostate cancer, it can press on the spinal cord causing depression and leading to what we call Cauda aquina syndrome. So caught aquina syndrome causes what we call saddle anesthesia.

So saddle anesthesia is where around the pelvic area it's numb or tingling sensation. That would be considered something in a Coda Aquina syndrome, along with urinary incontinence. So incontinence can occur as well with Coda aquina syndrome, silent renal failure can also occur. So silent renal failure is when the kidneys are damaged and ultimately fail without obvious urinary retention, without obvious signs and symptoms that might have foreseen that occurring. And then back pain can also occur.

This is going to occur in the case where the prostate cancer has metastasized into the spine. So all of these are going to be warning signs and symptoms that an enlarged prostate may be prostate cancer. So it's very important to recognize these and seek medical aid if you have any of these signs and symptoms as well. So if you want to learn more about certain diet choices that can reduce the size of the prostate or reduce signs and symptoms of an enlarged prostate, please check out my full lessons on those topics. And if you haven't already, please like and subscribe for more lessons like this one.