Prostate Enlargement

Prostate Enlargement - ( BPH) :

Prostate gland is a sex accessory tissue.

The main function of the prostate gland is to secrete an alkaline fluid that comprises approximately 70% of the seminal volume.

The secretions produce lubrication and nutrition for the sperm. The alkaline fluid in the ejaculate results in liquefaction of the seminal plug and helps to neutralize the acidic vaginal environment.

The prostate is located below the bladder neck and surrounds that part of the urethra which starts from the bladder situated behind the pubic bone, ( as shown in picture above).

Normal prostate is around 20-25gm in weight and is approximately the size of a walnut ( ‘ Akhrot’ ).

As age advances, the prostate may also grow in size in some men. As the size increases the prostate presses upon the urethra which is passing through it and also the bladder neck ( shown in the picture above). This leads to difficulty in passing urine which may gradually increase in severity if left untreated.

Symptoms of Enlarged Prostate:

1. Increased frequency of urination.

2. There may be difficulty in starting urination.

3. Flow of urine becomes weak and it falls close to the feet.

4. The stream may get interrupted and stop in between.

5. One may have to strain to empty the bladder

6. There may be dribbling at the end.

7. You may take a long time to pass urine

8. You may have a feeling that the bladder is still not empty,

9. You may have to rush to pass urine.

10. At times some urine may leak before you reach the washroom.

11. Inability to pass urine OR passing only a few drops - Also called Retention of Urine.

This is an emergency situation and demands urgent treatment by way of putting a tube called 'catheter' in the bladder through the penis.

If you have any of the above symptoms you need to get yourself checked.

Enlarged Prostate is diagnosed:

1. From your symptoms as elaborated above.

2. Examination by urologist.

a) He will examine your abdomen to see if your urinary bladder is distended.

b) He may do a finger examination through your rectum to feel the prostate. This will give him an idea of its;

§ size

§ texture ( hard prostate may be due to cancer) and if it is

§ painful ( usually due to infection).

3. TESTS

a) Ultrasound of the KUBP with full bladder

b) Uroflometry with full bladder

c) Urine test

d) Kidney function tests (KFT), if required.

Treatment

This is of two types depending on severity of symptoms and test results.

1. Medical treatment with medicines.

There are two types of medicines,

a) One type ‘eases’ the flow of urine by relaxing the urine passage.

b) Another type reduces the size of prostate gradually over months.

c) Medicines may not ‘suit’ everyone due to side effects OR may not be fully effective due to various reasons ( large size of prostate).

2. Surgical Treatment

This is indicated when:

a) There is failure of medicines to improve symptoms.

b) When the enlarged prostate has affected kidney function.

c) When enlarged prostate is associated with UTI again & again.

d) When there is stone(s) in the bladder along with enlarged prostate.

Types of surgical Treatment: Common Treatment methods are;

1.TURP ( see photo on right)This is the most common method of treatment in more than 90% cases. Here an endoscope is used to remove prostate through the urinary passage. There is no cut on the body.

2.LASER TREATMENT ( HOLEP) ( see photo on right)This is usually done for very large prostates and for enlarged prostates in people who are on blood thinners. It requires special equipment & training. It is also much costlier than TURP.

There is no significant advantage of LASER procedure in routine enlarged prostate treatment.