Prostate Enlargement

The prostate is a walnut-sized gland that forms part of the male reproductive system. The gland is made of two lobes enclosed by an outer layer of issue. The prostate is located in front of the rectum and just below the bladder and surrounds the urethra, the canal through which urine passes out of the body.

Though the prostate continues to grow during most of a man's life, the enlargement doesn't usually cause problems until late in life. BPH rarely causes symptoms before age 40, but more than half of men in their sixties and as many as 90 percent in their seventies and eighties have some symptoms of prostate enlargement.

• 33% of the people above 60 yrs are affected by it.
• Symptoms can be : Obstructive symptoms such as hesitancy, having to strain to pass urine, weak stream, sense of incomplete evacuation.
• Irritative symptoms: frequency of urination, urgency and urge incontinence leakage of urine before reaching toilet.

• Acute urinary retention (AUR) ( sudden painful inability to urinate). The patients will need a catheter to drain the urine
• Urinary tract infections (UTI) ( painful urination.)
• Bladder stones, These are mineral deposits that can cause infection, bladder irritation, blood in the urine and obstruction of urine flow.
• Bladder damage, where the bladder may loose its capacity to contract which function may not be recovered in the elderly even after surgery.
• Kidney damage, ( hydronephrosis, swelling (dilation) of the urine-collecting structures in one or both kidneys and may lead to inability of kidney to remove waste products in the body causing permanent kidney.

• The size of the prostate does not always determine how severe the obstruction or the symptoms will be. Some men with greatly enlarged glands have little obstruction and few symptoms while others, whose glands are less enlarged, have more blockage and greater problems In general larger the size of the gland, there is increased risk of symptoms and urinary retention (Stoppage of urination requiring catheter drainage).
• Clinical examination of prostate and PSA blood test are required to detect and treat early prostate cancer.
• Annual PSA is a must person over the age of 60 years.
• Medical treatment is very effective in the early stages of BPH when symptoms are mild and no complications have developed. Side effects are very minimal and even very elderly patients tolerate medications very well. It is very important to come for regular checkup which can confirm that treatment is effective and any complications can be detected early.

Surgery is required when medical treatment is not effective and or complications have developed such as complete blockage of urine (Retention of urine ), recurrent urinary tract infection, passing of blood in the urine , reduction in kidney function, bladder stone, large bladder diverticulum (out-pouching from bladder).

• In endoscopic surgery of prostate , part of the prostate blockage called adenoma is removed and shell of part remains . This can regrow and can cause further problem in 5 to 7% of cases.
• Similarly prostate cancer can develop with in the shell of prostate remaining. Annual PSA blood check and digital rectal examination of prostate is a must.

It is called Laser Enucleation of prostate using Holium laser ( HOLEP).

Enlarged Prostate (Adenoma) removal is done through urethral passage. It is called Transurethral Resection of Prostate (TURP). Common methods are called Mono polar TURP and Bipolar TURP. Most modern and more effective procedure is done using Laser.

• Procedure is done through natural passage ( Urethra).
• Patient’s fitness is assessed by physician, cardiologist and Anesthetist before admission. Endoscopy is passed to check the urethra, Bladder and Prostate.
• Special instrument called resectoscope is passed which has a channel to pass laser fibre. Most powerful 100 watts Holmium laser is used. Prostate is enucleated and then it is broken into small pieces using a morcellator.
• A catheter is placed to drain the urine and is usually removed 24 hours later.

• Painless procedure, no blood loss.
• Safe in elderly, cardiac patients and those taking blood thinners.
• Smooth recovery, early discharge.
• patient can return to work early.

• Initially urinary frequency, urgency can be present and usually settles in few days.
• Very small percentage of patients may experience mild stress leak which settles in few days.

• Diabetics are prone to reduced contraction of bladder wall an this leads to inefficient emptying of urine from the bladder. Ultimately these patients can retain more urine and surgery at that stage will not give good result.
• Endoscopic Laser prostate surgery is advised early in Diabetics with residual urine to get good results after surgery.