WHAT IS PROSTATE
A male reproductive organ which secrete prostate fluid, one of the components of semen.
CAUSES OF ENLARGED PROSTATE
teEnlargement of prostate is a normal part of ageing. However mere presence of a larger than normal size on ultrasound does not warrant treatment unless decided by presence of clinical symptoms or complications arising due to it..st
SYMPTOMS OF PROSTATE ENLARGEMENT
- A weak, slow or interrupted urinary stream.
- A feeling of incomplete bladder emptying.
- Frequent urination.
- Urgency to urinate.
- Getting up frequently at night to urinate.
- Some present with complications of prostate like blood in urine, complete blockage of urine, or urinary infection.
IS THERE A DIFFERENCE IN SYMPTOMS BETWEEN CANCEROUS AND NON CANCEROUS ENLARGEMENT OF PROSTATE
The answer is NO ! That is why you must see a urologist to differentiate the condition. It can be differentiated by rectal finger examination along with a blood test called as PSA(Prostate Specific Antigen).
1.Digital Rectal Examination to feel the size and texture of prostate by inserting a gloved finger through the anus.
2. PSA(Prostate Specific Antigen): The levels of this enzyme in blood rise in case of cancer of prostate or urine or prostate infection.
3.Ultrasound KUB with post void residual volume. It checks:
4.size of the prostate,
5.any swelling in kidneys(hydronephrosis
6.efficiency of bladder emptying (residual volume of urine after urination)
7.or any unsuspected disease like bladder tumor or stones
9.Specialized tests like urodynamic studies may be indicated in certain situations
WHEN DOES PROSTATE REQUIRE TREATMENT
An enlarged prostate by itself does not warrant treatment. It needs treatment only when symptoms or complications present.
Is there any prevention ?
PROSTATE HEALTH AND DIET
Diet rich in fruits, vegetables, tomatoes , whole grains and beans may have protective impact on prostate health. A diet low in animal proteins should be followed.
However remember that not even the healthiest diet is the sole treatment for prostate enlargement or cancer!
A wide variety of treatments are available for enlarged prostate ranging from no intervention,i medication and minimally invasive surgeries. The best treatment choice for you depends on several factors, including:
If your symptoms are tolerable, you might decide to postpone treatment and simply monitor your symptoms. For some men, symptoms can ease without treatment by simply following some changes in fluid habits .
Medication is the most common treatment for mild to moderate symptoms of prostate enlargement. The options include:
- Alpha blockers. These medications relax bladder neck muscles and muscle fibers in the prostate, making urination easier. These need to be taken daily.Side effects might include dizziness and a harmless condition in which semen goes back into the bladder instead of out the tip of the penis during ejaculation (retrograde ejaculation).
- 5-alpha reductase inhibitors. These medications (Finasteride and Dutasteride) shrink your prostate by preventing hormonal changes that cause prostate growth. might take up to six months to be effective. Side effects include reduced libido.
- Combination of above two medicines required in some situations
- Tadalafil : Some studies suggest this medication, which is often used to treat erectile dysfunction, can also treat prostate enlargement.
- Failure of medicines
- Acute stoppage of urine requiring catheter placement more than once.
- Repeated episode of blood in urine
- Repeated episodes of urine infection
- Swelling in kidneys as a result of urine going back into the kidneys (Hydronephrosis) with or without kidney dysfunction
- 6. Formation of stones in the bladder Imagine prostate like an orange ! Surgery for non cancerous prostate involves scooping out of pulp of the prostate (the Orange!),leaving behind the capsule of prostate(peel of orange!) intact. All these procedures are done through the urinary passage Various forms of energies can be used to scoop out the pulp.
- Green light laser(PVP),
- Blood in urine
- Urine infection
- Retrograde ejaculation: semen going back to urinary badder instead of coming out the tip of penis
- Stricture of urethra or bladder neck contracture: A scar formation can happen inside the urinary passage due to instrumentation of urinary passage. This scarring leads to narrowing of urinary passage and recuurance of symptoms similar to that of prostate. This can happen within days , months or even years after the prostate surgery. The chances of strictures can range from 5 to 10 percent . some strictures are soft and can be managed by simple dilatation of passage on outpatient basis but some strictures are stiff and require another surgical procedure to correct it.
- Generally requires 1 to 2 days of hospital stay.
- A catheter is left in urinary passage for a day or two (occasionally longer in few condition) for urinary drainage
- some degree of blood in urine is expected for upto a month after the surgery. The healing of wound inside takes three to four weeks during which some degree of blood in urine, some burning or discomfort, frequency or lack of control of urine might happen.
- Rarely catheter may need to be placed again in situations of excessive bleeding with clot formation or inability to pass urine. Most of these conditions are self limiting.
- urine infection with high fever may require hospitalization and intravenous antibiotics
- After discharge from hospital, bathing , walking, climbing stairs is allowed. Patient is advised to avoid any strenuous activity like jogging, sports, cycling , sexual activity or straining to pass stool. Sometimes laxatives are prescribed to prevent constipation.
- There is no specific dietery advise after surgery. Fluid intake is advised as per urine color and control of urine after the procedure.
- The night time frequency of urine if present before the surgery may not necessarily improve even after the surgery as in most of the patients the cause is generally not the enlargement prostate.
- if patient had an unstable bladder before the surgery and events inability to control urine following a sudden urge, then some of these symptoms may persist and a need to continue some medicines for the same.
- Minimal bleeding
- Discharge on the same day
- Resume normal activities in 2 to 3 days with caution
- Return to vigorous activity level in 4 weeks
- Complications occur infrequently and are mild if they do
- Erectile Dysfunction is not typical in PVP patients
- Long-term success in improved urine flow
- Fewer symptoms of urinary obstruction
WHEN IS SURGERY A MUST FOR PROSTATE ?
Transurethral resection of the prostate (TURP)
A endoscope is inserted into your urine passage, and the surgeon removes the pulp of the prostate leaving the capsule behind. TURP generally relieves symptoms quickly, and most men have a stronger urine flow soon after the procedure
A high-energy laser removes overgrown prostate tissue. Various types of laser energies can be used to remove prostate, including
In this experimental procedure, the blood supply to or from the prostate is selectively blocked, causing the prostate to decrease in size. Long-term data on the effectiveness of this procedure aren't available.
SIDE EFFECTS OF PROSTATE SURGERY PROCEDURES
WHAT TO EXPECT AFTER PROSTATE OPERATION
FOLLOW UP VISITS
I generally ask my patients to see me after a week, at one month and then at three months. A biopsy report of the prostate tissue( if sent for biopsy) is discussed at first follow up visit .
Remember that Surgery for Removal of Non cancerous prostate DOES NOT prevent against future occurrence of prostate cancer. The reason is that cancers generally happen in capsule of the prostate , which is not and cannot be removed in these procedures.
So an annual check up is still required to rule out a cancer.
CLINICAL CONDITIONS WHICH CAN MIMIC A PROSTATE DISEASE
1.A stricture in the urinary passage( stricture urethra): can be diagnosed based on age, previous surgery history or cathetrisation of urinary passage, occasionally graphical pattern of uroflowmetry and certainly on an invasive X ray study called as ascending urethrogram, which your doctor might advice based on suspicion. The treatment remains surgical as it cannot be treated with medications. Sometimes a stricture is diagnosed incidentally while performing surgery of the prostate. Stricture is simultaneously incised (cut )from inside the urinary passage followed by removal of prostate. In such situations doctor may advise to keep a catheter longer than 2 days. Strictures generally require a close follow up with need for repeated procedures as they have a very high rate of recurrence.
2.Weak bladder:(Atonic or hypotonic bladder) A poorly functioning bladder is seen in
3.Myelitis, disc prolapse, spine injuries , brain conditions like a previous stroke,parkinsonism or brain surgery.
4.Mediines like antideprassants, cough suppresents, anti allergics, some blood pressure medicines, some parkinsonism medicines and medicines given for control of urinary incontinence fall in this category. An excees amount of sudden fluid intake, tea or coffee or a bout of alcohol can temorarly cause symtoms to worsen and sometimes even retention of urine.
5.The prostate surgery results in such weak bladders may be less optimal than expected but nonetheless beneficial in some as it might reduce the effort of the bladder to pump against an obstruction.
WHICH MODALITY SHOULD ONE CHOSE FOR PROSTATE SURGERY
Information on internet may confuse one for choice of procedure for the removal of prostate. The best procedure for you is the one which the operating surgeon is most comfortable and experienced working with.!
Is Greenlight™ Laser PVP Treatment right for me?
GreenLight™ Laser PVP is a recent addition to the minimally invasive techniques in the treatment of BPH. The procedure uses the technology of high-powered laser light combined with fiber optics to vaporize the overgrowth of prostate cells quickly and accurately. As the surgeon directs the laser at the prostate, the intense pulses of light emitted from the fiber are absorbed by the blood. Within moments, the temperature of the blood becomes so great it causes the nearby cells to vaporize. GreenLight™ is being used as an alternative to transurethral resection of the prostate (TURP)and has been shown to be its equal in terms of effectiveness in an improvement of symptoms. There is growing interest in this technique by patients and practitioners because of its simplicity and efficiency. GreenLight™ stands alone in its ability to give patients quick symptom relief, ease and comfort of urinary flow, and minimal short-term side effects. This technique is too new for long-term studies to have been completed, but after five years it has been shown to maintain its level of improvement in urinary flow and comfort, and for giving men the quality of life they deserve.
Benefits of Greenlight™ Laser PVP
Is GreenLight™ Laser PVP Safe?
GreenLight™ Laser PVP is a significant breakthrough in laser techniques in precisely vaporizing the overgrowth of prostate cells using high powered laser energy through scope passed through urinary passage without damage to surrounding tissues and vessels. Green light laser technique is a much safer, faster and more precise compared to the other options and results in a faster recovery.
© Copyright 2018 Dr.Aman Gupta's Urology Services