BPH

What is the prostate gland?

The prostate is a walnut shaped gland surrounding the junction of the urinary bladder (balloon like organ that stores urine) and the urethra (tube that throws urine out through the penis). It is present in every male by birth.In adulthood, it produces a liquid that comes out in the semen along with the sperms. Its normal size ranges from 11 to 16gm.

What is the commom disease affecting the prostate gland?

There are three diseases mainly.

1. Age related prostate growth and disease

2. Prostate Infection (Prostatitis)

3. Prostate Cancer

Age related prostate growth is the most common disease. The prostate gland may increase in size with age, especially after the age of 50 years. An enlarged or sometimes even a normal sized prostate gland may compress on the urethra (tube that throws urine out through the penis). This would create difficulty in passing urine.

What are the common signs of prostate disease?

Prostate diseases can affect you in 2 ways

1. Voiding (Urine passing) symptoms: Difficulty in passing urine, prolonged time taken to pass urine, need to apply pressure to pass urine, thin or interrupted urine stream, feeling of incomplete emptying of the urinary bladder.

2. Urine Storage symptoms: Frequent desire to pass urine, unable to control the desire to pass urine with or without leakage of few drops of urine in the clothes.

Other common symptoms of prostate diseases are blood in the urine, burning while passing urine, pain in the lower abdomen while passing urine.

Do these symptoms confirm prostate disease only?

No. Similar symptoms can also be present in patients with diabetes, neurological diseases like paralysis, slipped disc compression, etc.

How does one confirm whether he has a prostate disease?

You need to consult your Urologist. Besides examination by the doctor, Sonography of the abdomen, uroflowmetry (a test to assess your urinary flow), urine test and blood tests need to be done. 2 important blood tests are Creatinine (kidney function status) and PSA (prostate cancer screening test).

Can a person prevent prostate disease?

No. But you need to modify your lifestyle with age to prevent increasing your symptoms. These are simple steps such as: Prevent constipation, Increase fibre intake in your diet,take regular fluid instead of over drinking large amount of fluid at one time, and pass urine at regular intervals instead of delaying your urination for lengthy periods.

What is the treatment for age related prostate disease?

The most important part of treatment is lifestyle modification as highlighted above.

Prostate diseases can be treated by medicines or endoscopic surgery. Majority of patients with early prostate disease can be controlled by medicines. Medicines are of various types. The size of the prostate and the age of the patient help in deciding the correct medicine.It is important to remember that medicines do not permanently cure the disease. Hence they need to be taken daily and almost life long. They do not cause any serious complications or side effects.Your Urologist would guide you your correct type and dose of medicines.Regular checkups once every 2 to 6 monthly is important to assess whether the disease is well controlled by the medicines.

When is Surgery required?

Indications for surgery include:

1. No relief with medicines.

2. Severe obstruction in the flow of urine.

3. Urinary retention (total urinary blockage with need to pass a tube to remove the urine from the urinary bladder).

4. Complications like formation of stones in the urinary bladder, hernia formation, frequent bleeding in the urine, kidney failure, etc.

Management

Prostate problems, particularly BPH are the natural part in men who are growing older. Prevention is better than cure there are specific steps to be taken to keep the prostate healthy such as low saturated fat diet and consuming high fruits and vegetables, maintaining hygiene of penis to prevent prostatitis.

Antibiotics for treating prostatitis, prostate cancer can be treated with surgery, chemotherapy or radiation therapy.

Surgical Management: Surgical interventions to treat prostate related problems includes:

TURP (Transurethral Resection of the Prostate): It is a urological procedure to remove the excessive growth of prostate gland resulting from BPH. Its performed under general anesthesia the urologist uses a thin metal tube containing a light, camera and a loop wire called resectoscope which is inserted into the urethra and reaches the prostate then electric current is used to heat the loop wire cuts away a section of the prostate finally a catheter was inserted to pump fluid to bladder and flush away the pieces of prostate.

Bipolar Enucleation of the Prostate

It is a new method similar to TURP by using plasma kinetic resection system, which is becoming important in recent years and the first choice of treatment for larger sized prostate glands. Here the urologist performs the procedure under general anesthesia by using resectoscope for visualization; the resectoscope is inserted via the mouth of the urethra to reach the prostate gland after it an incision is made near the ejaculatory duct. Then by using a laser of 200 waltz bilateral lobes of the prostate are detached, then the blood vessels are coagulated to resects the adenoma. Finally, the urologist inserts a catheter to irrigate prostate pieces.

HoLEP (Holmium laser enucleation of the prostate)

A minimally invasive procedure for severely enlarged BPH Performed under general anaesthesia were the urologist inserts a resectoscope into the bladder through the urethra and using a laser fibre to cut away pieces of prostate which is then flushed into bladder, then chopping up the pieces of prostate and sucked out using a special instrument. After removing the pieces the bleeding points are carefully ligated with the laser then the catheter is placed to flush the bladder and to remove any remaining clots or pieces.

ThuLEP (Thilium Laser Enucleation Of The Prostate)

This procedure involves complete removal of the transitional zone of prostate no matter the size. This technique involves maximum efficiency with minimal side effects. The procedure is performed under general anesthesia were the urologist uses laser energy of 70 – 90 w to make an incision near the end of ejaculatory ducts and bladder neck to remove the lobes of prostate and then lesser energy of 30 w is used to coagulate the blood vessels. After crossing the transitional zone and bladder neck lateral lobes of the prostate are dissected then irrigation is done after placement of a catheter.

Can there be any complications after endoscopic surgery?

The chances of complications after the endoscopic surgery are minimal. The common side effects are infection and stricture (obstruction in a part of urinary tube in the penis). These occur in 5 to 10%. Also there can be some loss of sexual function. These side effects are however negligible with plasma or laser technique.