ENLARGED PROSTATE
The Prostate is a gland present in the male human body. It appears and measures similar to a walnut and is located below the bladder, surrounding the urethra, which is the tube providing plumbing to urine from the bladder and all the way out through the penis. Prostate glands produce prostatic fluid, which makes the major component of semen.
After the age of 40 years, the prostate glands in males start to become larger in size. The condition is medically termed as benign prostatic hyperplasia (BPH). The condition is not cancerous, neither has it elevated the risk of developing cancer.
Usually, Benign Prostatic Hyperplasia (BPH) is confused with a condition wherein the male body develops too many prostate cells. On the contrary, BPH is a non-treatable condition, and once the growth of the prostate starts it continues to take place until and unless medical therapy is given to the patient. In this condition, the growth of the cells expedites, squeezing the urethra. Another prostate growth is in the middle region in which the cells start developing into the urethra and the bladder outlet area. This condition is treatable by a surgical process.
Causes of Enlarged Prostate
There is no known reason behind prostate enlargement. The experts believe that aging factors and the testicles themselves are responsible for the abnormal growth of the gland. In the case of any testicle removal surgery in men at an early age (for treatment of testicular cancer), there is no risk of developing BPH.
A male body produces a large amount of testosterone (male hormone) as well as a small amount of estrogenic (female hormone). As men age, the levels of testosterone in the blood decreases, which results in higher levels of estrogenic. As per the studies conducted on animals, the experts have derived that the high levels of estrogen may cause the enlargement of the gland.
Reports suggest that dihydrotestosterone (DHT), a substance extracted from testosterone in the prostate, may be helpful in controlling the growth. As animals age, the ability to produce DHT gradually decreases. However, contrary to the studies, some research work suggests that the presence of even a drop of testosterone in the male body is enough to keep the DHT levels high in the prostate. The high levels of DHT are considered as a possible reason for the growth of cells. It has also been noted that when there is no DHT in the male body, the chances of developing BPH is zero.
Signs & Symptoms
- Blood in the urine (i.e. Haematuria), caused by straining to void.
- Dribbling after voiding.
- Feeling that the bladder has not emptied completely after urination.
- Frequent urination, particularly at night (i.e. Nocturia).
- Hesitant, interrupted or weak urine stream caused by decreased force.
- Leakage of urine (i.e. Overflow incontinence).
- Pushing or straining to begin urination.
- Recurrent, sudden, urgent need to urinate.
In the case of severe BPH, a more complex symptom develops known as Acute Urinary Retention, which is the inability to urinate. Acute Urinary Retention is a painful condition that promotes discomfort in the body. The doctors use a catheter to allow the body to drain urine from the bladder.
Diagnosis
The doctor would recommend a physical examination through a digital rectal examination (DRE) and evaluation of symptoms via AUA Symptom Index results to diagnose Benign Prostatic Hyperplasia.
- Digital Rectal Examination (DRE): It is a short test that takes less than a minute to perform. A lubricated, gloved finger is inserted into the patient’s rectum to feel the surface of the prostate gland through the rectal wall. This helps the doctor in assessing the size, shape, and consistency of the gland. When healthy, prostate tissue appears soft, similar to the fleshy tissue of our palm, at the point where the thumb joins the palm. In the case of malignant growth, the tissue is firm, hard, and asymmetrical or stony in most of the cases. In case the presence of malign tissue is identified, the doctor suggests further tests to be performed to identify the nature of the abnormality.
- AUA Symptom Index: The AUA (American Urological Association) Symptom Index is a questionnaire that helps in determining the complexity of the urinary problems. It is a great aid in diagnosing BPH. There are seven questions related to common symptoms of benign prostatic hyperplasia that a patient has to answer. Each question has a rating scale from 1 to 5. The scores are added to make a grand total which is used to evaluate the condition. An AUA score of 0 to 7 means the condition is mild; 8 to 19, moderate; and 20 to 35, severe.
- PSA Test: The test checks the levels of prostate-specific antigen (PSA) is the blood levels.
- Uroflowmetry Test: The test measures the time in which a patient completely empties his bladder. The test measures the flow of urine. The patient urinates in a device that measures a range of factors including the amount of urine, the time it takes for urination, and the rate of urine flow. When there is extra pressure or urge to urinate, the urinary flow is higher.
- Post-Void Residual (PVR): This test measures the amount of urine that remains in the bladder after urination. The patient is asked to urinate immediately prior to the test and the residual urine is determined by ultrasound. PVR, less than 50 ml. generally indicates adequate bladder emptying and measurements of 100 to 200 ml. or higher often indicate a blockage.
Treatment for Enlarged Prostate
In the case of BPH with symptoms, it is important to avail of some kind of treatment in due time. However, there are several doubts about availing treatment in case of early identification and mild enlargement of the gland. The results of several studies indicate that early treatment is not mandatory as in one-third of the cases of mild enlargement, the BHP condition is auto treated. The experts, however, suggest to avail regular check-ups to watch for early problems. The treatment is recommended in cases when the condition poses a danger to the patient’s health or develops major inconvenience.
Before the treatment of BPH, the doctors offer antibiotic treatments as in most of the cases there are chances of urinary tract infection.
- Self-Care at Home: There is precaution available that can help you prevent the worsening of the condition and related complications, this includes:
- You must never ever ignore an urge to urinate.
- Completely empty the bladder whenever you urinate.
- Avoid alcohol and caffeine post-dinner.
- Take small quantities of fluid at a time.
- Avoid drinking fluids before and after 2 hours of bedtime.
- Stay warm and exercise regularly. The symptoms may worsen in case of cold weather and lack of physical activity.
- Drug Treatment: Alpha-blockers and 5-alpha-reductase inhibitors are two primary medications used for the treatment of BHP. In most of the cases, Alpha-blockers help relax muscle fibers, however, if they don’t, ask the doctor for an alternative treatment. 5-alpha-reductase inhibitors hamper the production of a hormone called dihydrotestosterone (DHT).
- Surgery for Enlarged Prostate: When the symptoms of the condition do not fade away after home remedies and medication, surgery is recommended. There are two types of surgical methods: Transurethral resection of the prostate (TURP) is a common operation for BPH wherein a surgeon inserts a thin, tube-like telescope (a resectoscope) into the urethra. The resectoscope has a camera that allows a clear vision of the prostate clearly. This is a minimally invasive method. Transurethral incision of the prostate (TUIP) is recommended in the case of a less enlarged prostate. In case of an extremely enlarged prostate, open prostatectomy is recommended.
Holmium Laser Enucleation of Prostate (HOLEP)
The most modern modality used in the management of an enlarged prostate is HOLEP. The procedure uses a 550-micron fiber attached to a 100-Watts holmium laser machine that removes obstructive prostatic tissue and then seals the blood vessels. Once the procedure is done, the enucleated gland is placed back into the bladder. The procedure takes around 45-90 minutes.
The doctors install a catheter to allow the patient to urinate. The entire procedure is completely bloodless.
Advantages of Holmium Laser Enucleation of Prostate (HOLEP)
| Key Factors | HOLEP | TURP |
|---|---|---|
| Size of Prostate | 200 gms | Not >80 gms |
| Patients on anticoagulants | Can be done | Contraindicated |
| Irrigation | Not needed | Usually required |
| Catheterization | Short | Long |
| Blood Transfusion | 1 in 10000 | 10-15 in 100 |
| Recovery | Very soon | Few weeks |
| Hospital stay | 36-48 hrs. | 4-7 days |
| Risk of Stricture, Bladder | Insignificant | High Risk |
