Prostatic Hyperplasia (BPH)

The prostate is a male gland about the size of a chestnut, which surrounds the urethra (water pipe) just below the bladder. The prostate is thought to have a role in male fertility. The vas deferens tube (which carries sperms from the testicles) passes through the prostate and the sperms are mixed with seminal fluid to make semen.
In many men, with increasing age, the prostate grows and as it does so it may compress the urethra.

Symptoms

Picture1The enlarged prostate gland may or may not cause any symptoms.
The severity of the symptoms does not depend on the size of the prostate so a small prostate may result in more symptoms and a big prostate may not cause symptoms.

Symptoms include the following.

Hesitancy: difficulty starting the urine flow, even when the bladder feels full.
A weak or interrupted urinary stream.
Incomplete emptying: a feeling the bladder is not completely empty after passing urine.
Frequency: a need to urinate often during the day and during the night. Increased need to urinate in the night is usually a very early symptom.
Urgency: a need to urinate right away. Some men may experience involuntary discharge of urine (known as urge incontinence).
Dribbling of urine after urination. This is known as terminal dribbling.
Dysuria: a burning sensation or pain during urination.

Following are the late sequels of BPH.
Acute retention of Urine -Some men experience a sudden onset of inability to pass urine (known as acute retention). Studies have shown that acute retention affects between 1 and 2 per cent of men with BPH each year. This condition is very painful and demands immediate medical treatment. The usual treatment in the emergency situation is insertion of a urinary catheter to drain the bladder and relieve the obstruction.
Chronic retention of urine -Other men find it gradually harder to empty the bladder. As the condition develops, more and more urine is left in the bladder after urination known as chronic retention.
Cystitis (infection of the bladder)
Stones in the bladder.
Renal failure

DIAGNOSIS

A doctor can often make the diagnosis on the following grounds.
Patients will be asked about their symptoms and may also be asked to fill out a symptom questionnaire to let the doctor know the nature of the symptoms and how troublesome they are. The symptom score lets the doctor quantify how severe the symptoms are.
They may also be asked to record their drinking and urination over a period of one to three days.
By carrying out a rectal examination, the doctor can feel through the rectum wall whether or not the prostate is enlarged.
Usually, the patient’s urine will be examined, and may be sent for culture, when it will also be tested for sensitivity to antibiotics. Kidney function will also be examined by a blood test.
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It’s usual for the doctor to send a blood sample to check the prostate specific antigen (PSA) level. A raised level of PSA may indicate a risk of the presence of prostate cancer – this may require biopsies of the prostate to investigate further.
If there is a need for further tests, they will usually be carried out
Doctor may ask for  flow rate of the urine and whether the
bladder is emptied after  urination.
X-rays,
including ultrasound examinations, and blood tests, may be
necessary.

TREATMENT

The treatment for BPH depends on the severity of the symptomsand presence of complications if any.For Mild to moderate symptoms — Medical therapyFor severe symptoms and BPH with complications or patientsNot getting benefit of medical therapy — surgery – TURP Transurethral resection of the prostate (TURP) During TURP, a combined visual and surgical instrument (resectoscope) is inserted through the tip of your penis and into the tube that carries urine from your bladder (urethra). The urethra is surrounded by the prostate. Using the resectoscope,your doctor trims away excess prostate tissue that’s blocking urine flow and increases the size of the channel that allows you to empty your bladder.

TURP generally takes 60 to 90 minutes. You’ll be given either a spinal anesthesia, which allows you to be awake during the procedure but unable to feel pain in the surgical area, or a general anesthesia, which will put you to sleep. The doctor may also give you a dose of antibiotics to prevent infection.
During the procedure
a combined visual and surgical instrument (resectoscope) is inserted into the tip of your penis and extended through your urethra and into the prostate area. By accessing the prostate through your penis, your doctor won’t need to make any cuts (incisions) on the outside of your body. The resectoscope has a light, valves for controlling irrigating fluid, and an electrical loop to cut tissue and seal blood vessels.
The doctor will use the resectoscope to trim tissue from the inside of your prostate gland,
one small piece at a time. As small pieces of tissue are cut from inside your prostate, irrigating fluid carries them into your bladder. They’re removed at the end of the operation.

After the procedure
After surgery, you’ll need to stay in the hospital for one to two days. Talk to your doctor about what you can expect and any precautions you need to take after you go home.

At the time of discharge

You’ll have a catheter. The catheter enters through the tip of your penis and goes into your bladder to drain your urine into a collection bag. The catheter is generally left in place for four to seven days, until you’re able to urinate on your own. In some cases, a catheter is needed for a longer period of time — especially if you have a relatively large prostate. You may urinate around the catheter, which is normal because your bladder may try and squeeze out more urine than the catheter can accommodate.
Urination may be painful. You may have a sense of urgency as urine passes over the surgical area. You may also need to urinate frequently. Painful urination generally improves in one to four weeks.
You may see blood in your urine. This is common right after surgery. If you have clots or so much blood in your urine that you can’t see through it, contact your doctor.

These steps can help you recover after your procedure.

  • Drink plenty of water to flush out the bladder.
  • Avoid straining during a bowel movement. Eat fiber-containing foods and avoid foods that can cause constipation. Ask your doctor if you should take a laxative if you do become constipated.
  • Don’t take blood-thinning medications until your doctor says it’s OK.
  • Don’t do any strenuous activity, such as heavy lifting, for four to six weeks or until your doctor says it’s OK.
  • Don’t have sex. You’ll likely be able to resume sexual activity in about four to six weeks.
  • Don’t drive until your doctor says it’s OK. Generally, you can drive once your catheter is removed and you’re no longer taking prescription pain medications

RESULT OF SURGERY

 

Following TURP, most men experience significant relief of symptoms. Because surgery leaves behind part of the prostate gland, it is possible for BPH symptoms to redevelop. However, surgery can offer relief for between seven and 15 years for most people.
After TURP, it’s important to have a digital rectal exam once a year to check your prostate and screen for prostate cancer, as you would normally. If you notice any worsening urinary symptoms, make an appointment to see your doctor. In some cases, follow-up treatment to ease symptoms is needed, particularly if many years have passed since TURP was done.
We offer one of the best experiences of treating patients with BPH with medical as well as surgical treatment. The satisfaction of the patients is what we aim for and usually achieve.