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The prostate is a walnut-sized gland in males, located below the urinary bladder, and it encircles the upper part of the urethra. This part of the urethra is called the prostatic urethra. Urine from the urinary bladder passes out through this urethra. Hence it is clear that whenever the prostate becomes enlarged, it is likely to put pressure on this part of the urethra, i.e., the prostatic urethra, causing obstruction when the patient passes urine. In very early cases, there may not be any symptom or there may be negligible/minimal symptoms, since the force of the contraction of the urinary bladder may be able to overcome the small initial obstruction cause.d by the enlargement of the prostate gland. As the obstruction increases, urine will stay in the urinary bladder for a longer period, and if obstruction is severe, urine may collect, as a result of back pressure, in the ureters, and finally in both the kidneys. One can imagine that such stagnation of urine in the whole urinary tract will cause an enormous growth of bacteria, leading to inflammation of the entire urinary tract, from the urethra to the kidneys. There will then be inflammation of the urethra (urethritis), the urinary bladder (cystitis), the kidneys (pyelonephritis) and even the prostate may be affected by the infection called prostatitis. If early steps are not taken, kidney failure may occur as a result of the chronic infection of the kidneys, i.e. chronic pyelonephritis. Regarding cancer of the prostate, it has already been described in the chapter on cancer. Here we are dealing with the 'benign' enlargement of the prostate, i.e. the condition is non-cancerous in nature. Such an enlargement of the prostate occurs in old people, usually after the age of 50. It has been rightly said that as the hair turn grey, there is, likewise, an enlargement of the prostate gland. What are the early symptoms and signs of the BEP? Since an enlarged prostate causes obstruction in the flow of urine in the urethra, the patient experiences varied difficulties while passing urine. There is a narrowing or decrease in the calibre of the urethra, and, therefore, (i) the patient does not pass urine with normal force, and the stream becomes thin, (ii) he experiences difficulty both while starting and stopping urination, (iii) he always feels that he has not passed the whole urine, (iv) urine falls in drops/trickles after he has passed urine, (v) the patient passes urine frequently, especially during the night, (vi) he takes more time in passing urine, (vii) he always feels like passing urine, and it becomes unavoidable most of the time. The above early- symptoms and signs must be known by old people, so that they can report it to their physicians/ surgeons for early diagnosis and treatment, and save themselves from the grave complications of UTI. As the prostate enlarges more, and the calibre of the urethra decreases further, the patient experiences more and more inconvenience while passing urine. One factor is of great importance in such a diagnosis. If the patient is unable to pass urine completely, there is a strong possibility of 'residual urine' in the urinary bladder. This increases as the disease progresses. Residual urine is a valuable guide and indicates the severity of blockage in the urethra. The amount of residual urine is measured with the help of ultrasonography, and the line of action of the treatment is decided. Residual urine, more than 40-50 ml in the urinary bladder, is considered significant, and at this stage, treatment should not be delayed further.
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