Information for the General Public
Enlarged Prostate Gland As   men   grow   old   the   size   of   the   prostate   gland   increases   causing   all   kinds   of   problem. Increasing   size   of   the   prostate   is   called   Benign   Prostatic   Hyperplasia   often   termed “BPH”.    It    is    a    progressive    condition    which    affects    all    males    over    the    age    of    50. Depending    on    its    size    the    symptoms    can    vary    from    passing    urine    frequently    to causing complete obstruction to flow of urine. The   prostate   gland   lies   just   below   the   bladder   surrounding   the   tube   (urethra)   that transports   urine   out   through   the   penis.   The   gland   found   in   males   is   relatively   small   in boys.   It   starts   to   grow   after   puberty   and   in   normal   adults   is   the   size   of   a   walnut.   The gland    produces    a    fluid    that    mixes    with    the    sperm    that    is    discharged    during intercourse.   In   women   two   rudimentary   structures   called   Skene’s   (or   paraurethral) glands    represent    the    prostate.    Unlike    in    males    they    rarely    cause    a    problem. Occasionally they can cause discomfort from inflammation. Symptoms of BPH Difficulty in starting to pass urine Straining to pass urine Taking a longer time to pass urine Urgency to pass urine and difficulty to control Passing only small amounts of urine Frequently passing urine Getting up in the night to pass urine If   you   have   any   of   these   symptoms   you   should   see   a   doctor   (Urologist).   He   will   not   only   check   you   out   for   an   enlarged prostate but also rule out cancer prostate or infection causing the symptoms. Diagnosing BPH The   Urologist   will   normally   use   a   scoring   system   from   the   symptoms   (international   Prostate   Symptom   Score)   to   decide   on the type of treatment that you will need. He will also do a rectal examination to check the size of the prostate. Others Tests may include: Urine examination to check for infection that can cause the symptoms Blood    tests    to    check    for    kidney    function    and    Prostate    Specific    Antigen    (Increased    PSA    level    may    suggest    cancer prostate) Ultrasound   of   the   bladder   and   Prostate   -   first   with   a   full   bladder   and   then   after   emptying   the   bladder.   If   the   bladder does not empty properly it may mean that the prostate is causing some obstruction. Trans-rectal Ultrasound to measure the size of the prostate accurately. Treatment of BPH The   treatment   will   depend   on   the   severity   of   symptoms.   Minor   to   moderate   symptoms   can   be   managed   by   medication   and life style changes. If symptoms are more pronounced some form of surgical intervention will be required. Lifestyle changes: Regular exercise like walking tends to improve symptoms If you are woken up at night regularly to pass urine, avoid drinking liquids before going to bed Stop or reduce drinking Coffee and Alcohol. They tend to irritate the bladder. Medication for BPH 1 . Medication to reduce the size of the prostate: Finasteride or dutasteride.  (it may take a few months to act). 2 . Drugs   acting   to   relax   the   bladder:   Alpha   blockers   like   Tamsulosin   and   alfuzosin   or   5α1-reductase   inhibitor .   Usually when when 1 & 2 are combined, makes passing urine easier. Any   of   the   drugs   can   produce   side   effects.   Some   worse   than   others.   Side   effects   include   headache,   dizziness,   loss   of   libido and impotence. Discuss the medication with your doctor before starting them. Medications   do   not   completely   stop   the   progress   of   BPH.   They   help   when   symptoms   are   minor   or   moderate.   Ultimately some form of surgery may be required when symptoms get worse. Surgical treatment: Surgery is normally recommended when patients do not respond to medical therapy. 1 . Open Prostatectomy 2 . Transurethral resection of prostate (TURP) 3 . Transurethral incision of bladder neck 4 . Laser Surgery 5 . Robotic Prostatectomy All surgical procedures are done either under a general anaesthetic or under epidural anaesthesia. Open   Prostatectomy:   Previously   symptoms   caused   by   prostatic   enlargement   were   all   dealt   with   by   open   prostatectomy   ie removing the prostate by cutting open the abdomen. This is rarely done now unless the prostate is very large. Transurethral    Prostatectomy    (TURP):     An    instrument    (resectoscope)    is introduced    in    to    the    urethra    through    the    opening    in    the    penis.    The enlarged   prostate   protruding   in   to   the   urethra   is   then   scraped   away   by   a looped   electrical   wire   thus   relieving   the   obstruction.   A   catheter   is   left   in place for 48 hours to help heal the area resected. Transurethral   incision   of   Bladder   Neck:   Similar   to   TURP   but   instead   of scrapping   the   prostate   a   cut   is   made   at   the   neck   of   the   bladder   above   the point   where   the   tubes   from   the   prostate   enter   the   urethra.   This   is   done when urinary flow is obstructed with minimal enlargement of the prostate. Laser   therapy:   This   new   procedure   is   similar   to   TURP.   Here   instead   of   using an   electrical   wire   to   scrap   the   prostatic   tissue   a   “Green   light   Laser”   is   used to   vaporize   the   tissue.   It   is   less   painful   than   TURP.   A   catheter   is   used   for under 12 hours and the operation can be done as a day procedure. Robotic   Prostatectomy:    Robotic   prostatectomy   is   popular   in   the   USA   where   the   minimally   invasive   procedure   is   done   with robotic   assistance.   The   rest   of   the   world   is   catching   up   with   it.   Robotic   surgery   is   useful   when   resecting   prostate   affected   by cancer, as removing all the cancerous tissue is more efficient here. Side effects from surgery; All   surgical   procedures   carry   some   side   effects.   Some   more   pronounced   than   others.   Blood   loss   following   the   procedure   can be considerable with open prostatectomy. Laser surgery has the least amount of loss. Following   any   of   the   procedures   (except   open   prostatectomy)   repeat   surgery   may   be   necessary   as   the   prostate   can   regrow and obstruct urinary flow again. Risk of incontinence and impotence. Retrograde   ejaculation   (semen   does   not   come   out)   is   common   after   prostate   surgery   and   sterility   is   common   after   any procedure. Laser   surgery   has   the   least   risk   for   complications.   The   risks   of   incontinence   and   impotence   are   very   low,   and   the   risk   of retrograde ejaculation is less than that in TURP. K. Badrinath