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Enlarged Prostate

FAQ

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	Overview

	Benign Prostatic Hyperplasia (BPH) is not simply a case of too many prostate cells. There is no cure for BPH and once prostate growth starts, it often continues, unless medical therapy is started. The prostate grows in two different ways. In one type of growth, cells multiply around the urethra and squeeze it, much like you can squeeze a straw. The second type of growth is middle-lobe prostate growth in which cells grow into the urethra and the bladder outlet area. This type of growth typically requires surgery.

Signs & Symptoms

Blood in the urine (i.e., hematuria), 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 severe cases of BPH, another symptom, acute urinary retention (the inability to urinate), can result Acute urinary retention causes severe pain and discomfort. Catheterization may be necessary to drain urine from the bladder and obtain relief.

Diagnosis

A physical examination and evaluation of symptoms provide the basis for a diagnosis of Benign Prostatic Hyperplasia. The physical examination includes a digital rectal examination (DRE), and symptom evaluation is obtained from the results of the AUA Symptom Index.

Digital Rectal Examination (DRE)

DRE typically takes less than a minute to perform. The doctor inserts a lubricated, gloved finger into the patient's rectum to feel the surface of the prostate gland through the rectal wall to assess its size, shape, and consistency. Healthy prostate tissue is soft, like the fleshy tissue of the hand where the thumb joins the palm. Malignant tissue is firm, hard, and often asymmetrical or stony, like the bridge of the nose. If the examination reveals the presence of unhealthy tissue, additional tests are performed to determine the nature of the abnormality.

AUA Symptom Index

The AUA (American Urological Association) Symptom Index is a questionnaire designed to determine the seriousness of a man's urinary problems and to help diagnose BPH. The patient answers seven questions related to common symptoms of benign prostatic hyperplasia. How frequently the patient experiences each symptom is rated on a scale of 1 to 5. These numbers added together provide a score that 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.

	PSATest

	Blood tests taken to check the levels of prostate specific antigen (PSA) in a patient who may have benign prostatic hyperplasia helps the physician eliminate a diagnosis of prostate cancer.

	UroflowmetryTest

	This is a simple test performed to record urine flow, to determine how quickly and completely the bladder can be emptied, and to evaluate obstruction. With a full bladder, the patient urinates into a device that measures the amount of urine, the time it takes for urination, and the rate of urine flow. Patients with stress or urge incontinence usually have a normal or increased urinary flow rate, unless there is an obstruction in the urinary tract. A reduced flow rate may indicate BPH.

	Post-voidresidual(PVR)

	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 blockage.

There are several treatment options for men with benign prostate hyperplasia, depending on the severity of symptoms.

	Laser Treatment

	Holmium Laser Enucleation of Prostate It is the latest modality used in the management of Enlarged Prostate. In this procedure, a 550 Micron Fiber attached to a 100-Watts Holmium Laser is used to remove obstructive prostatic tissue and seal blood vessels. The enucleated gland is then pushed into the bladder, which is later sucked out with the help of a Morcellator. The whole procedure takes around 45-90 minutes, depending on he size of the gland. This procedure is nearly bloodless as the laser beam when cuts the gland also seals the blood vessels. In most of the cases there is no need to blood transfusion. At the end of surgery, a Foley's catheter is inserted to keep the bladder in place. It continuously drains the urine into a sterile collection bag. The catheter is usually kept for 24 to 48 hrs and patient is discharged without catheter.

Advantages of HOLEP over TURP:

Holmium Laser Enucleation of Prostate It is the latest modality used in the management of Enlarged Prostate. In this procedure, a 550 Micron Fiber attached to a 100-Watts Holmium Laser is used to remove obstructive prostatic tissue and seal blood vessels. The enucleated gland is then pushed into the bladder, which is later sucked out with the help of a Morcellator. The whole procedure takes around 45-90 minutes, depending on he size of the gland. This procedure is nearly bloodless as the laser beam when cuts the gland also seals the blood vessels. In most of the cases there is no need to blood transfusion. At the end of surgery, a Foley's catheter is inserted to keep the bladder in place. It continuously drains the urine into a sterile collection bag. The catheter is usually kept for 24 to 48 hrs and patient is discharged without catheter.


	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 neck contracture & impotence	Insignificant	High risk

Approximately 4-5% of patients with large prostates (>100 gm) experience stress incontinence after undergoing HoLEP. In most cases, incontinence resolves within 6 weeks.