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. D

epending 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.