A chronically enlarged prostate can lead to bladder stones, in the past much more frequently than now. The great religious reformer Calvin was a sufferer. ‘When he could no longer endure the pain,’ writes the
Italian essayist Guido Ceronetti, ‘the old Calvin [in 1563 he was 54, which in those days counted as old] mounted his horse on his doctors’ advice, and rode at the trot, in dreadful pain, until the jolting caused the stone to descend into the urethra.’ On returning home he urinated slimy blood and the following day the stone — as big as a hazelnut — was expelled with the aid of hot compresses. This was followed by a spurt of blood. ‘Thus God relieved Calvin of the stone and left the stone, with Calvin, to the inhabitants of Geneva,’ wrote Ceronetti.
Bladder stones and incontinence are only two in a whole spectrum of prostate ailments. Other problems caused by an obstructive prostate are urinary blockage, or the inability to urinate, renal pelvic inflammation and loss of the kidneys. Fortunately things rarely if ever reach that stage nowadays. More frequent urination, a less powerful stream of urine, dribbling and suchlike prompt men to consult their gp in good time. The taboo surrounding prostate ailments has gone. The worried well with minor problems often need no treatment, rather reassurance about the presence or otherwise of prostate cancer. With moderate symptoms it is preferable to start with medication. Only if that fails to solve the problem is there reason to consult a urologist, who may choose to operate in one of two ways: via the urethra or, if the prostate is very enlarged, via an abdominal incision. Complications include incontinence, in most cases temporary, narrowing of the urethra (5% risk), and blood loss in the urine, sometimes continuing for a period of weeks. Up to now alternative treatments such as warming the prostate (‘microwave’ therapy) have proved less effective.