Prostate

The prostate is a small organ about the size of a walnut. It lies below the bladder (where urine is stored) and surrounds the urethra (the tube that carries urine from the bladder). The prostate makes a fluid that helps to nourish sperm as part of the semen (ejaculatory fluid). Prostate problems are common in men 50 and older. An urologist is a specialist in diseases of the urinary system, including diagnosing and treating problems of the prostate gland.

What is benign prostatic hyperplasia?

Benign prostatic hyperplasia is nonmalignant (noncancerous) enlargement of the prostate gland, a common occurrence in older men. It is also known as benign prostatic hyperplasia and abbreviated as BPH. BPH generally begins in a man’s 30s, evolves slowly, and most commonly only causes symptoms after 50.

What are symptoms of BPH?

In BPH, the prostate gland grows in size. It may compress the urethra which courses through the center of the prostate. This can impede the flow of urine from the bladder through the urethra to the outside. It can cause urine to back up in the bladder (retention) leading to the need to urinate frequently during the day and night. Other common symptoms include a slow flow of urine, the need to urinate urgently and difficulty starting the urinary stream. More serious problems include urinary tract infections and complete blockage of the urethra, which may be a medical emergency and can lead injury to the kidneys.

Investigation for Prostate

  • USG of KUB: An ultrasound procedure called transrectal ultrasonography (TRUS) may be used to help the doctor see where to take the needle biopsy. Ultrasound is not effective as a diagnostic tool by itself because it cannot differentiate very well between benign inflammations and cancer.
  • Uroflometry: Uroflowmetry is a diagnostic test used to measure the flow of urine during urination. The speed of urine flow is measured electronically and the flow rate is calculated as milliliters of urine passed per second. Both average and maximum flow rates can be measured. The peak flow rate, also known as Qmax is generally used as the basis for determining the severity of any blockage or obstruction. Low flow may indicate such conditions as obstruction of the urethra, enlarged prostate or poor bladder function.
  • Urine analysis: Urinalysis is a basic tool for urologists. This test is aimed at looking for white blood cells and bacteria, signifying infection. The urine may also be cultured to identify the bacteria that are responsible for the infection, but results will take up to seven days to return. The results will help confirm that the antibiotic chosen is correct and may help choose an alternate antibiotic should the illness progress.
  • PSA: The PSA blood test measures the level of a protein called prostate-specific antigen. It is able to detect early prostate cancer, although it has limitations. PSA testing is not recommended for men over age 75. Because of shortened lifespan, responding to abnormal PSA results in this age group may lead to overly aggressive treatment. Prostate specific antigen (PSA) is a protein produced in the prostate gland that keeps semen in liquid form. Prostate cancer cells appear to produce this protein in elevated quantities. Measuring PSA levels increases the chance for detecting the presence of cancer when it is microscopic. While PSA is used as a prostate cancer screening tool, it can also be elevated whenever the prostate is inflamed.

How is BPH treated?

There are several different ways to treat BPH. Medical treatment of BPH is usually reserved for men who have significant symptoms. The available drugs include

  • Alpha blockers: They relax the smooth muscles of the prostate, and the bladder neck, which helps to relieve urinary obstruction caused by an enlarged prostate in BPH. Side effects can include headaches, fatigue, or lightheadedness.
  • 5-alpha reductase inhibitors: They block the conversion of the male hormone testosterone into its active form in the prostate (DHT). The prostate enlargement in BPH is directly dependent on DHT, so these drugs lead to an approximate 25% reduction in prostate size over six to 12 months.

Surgery or office procedures may also be used to treat BPH, most commonly in men who have not responded satisfactorily to medication or those who have more severe problems, such as a complete inability to urinate.

  • Transurethral resection of the prostate (TURP): can be used for patients for whom benign prostatic hyperplasia (BPH) affects everyday life. TURP is a commonly used surgical treatment during which a surgeon inserts a resectoscope into the urethra. The resectoscope is a tool that allows a surgeon to see the enlarged prostate gland. The surgeon will place a cutting loop through the resectoscope to remove a small piece of the prostate gland tissue. He then runs an electrical current through the cutting loop and cuts off small pieces of the prostate gland in “chips.” After finishing cutting away chips, the surgeon will flush the urethra and the bladder to remove the tissue that has been extracted from the prostate. Finally, a catheter is inserted to allow the passage of urine out of the body. When the catheter is removed a few weeks later, the body has a wider channel to pass urine out of the body. This wider passage alleviates severe symptoms of BPH.
  • Laser procedures: A number of laser procedures are available, some of which can be performed in the doctor’s office with minimal anesthesia. These procedures also involve the removal of obstructing prostate tissue. They are generally associated with less bleeding and quicker recovery than TURP but may not be as effective over the long term in some men.
  • Microwave therapy: This procedure is generally performed in the office and involves the use of microwave energy delivered to the prostate to kill some of the cells leading eventually to shrinkage of the prostate.
  • Open Prostatectomy for big prostates: Open prostatectomy is the surgical removal of an enlarged (noncancerous) prostate. It is done under a general or spinal anesthetic. Usually, an incision is made through the lower abdomen, although sometimes the incision is made between the rectum and the base of the penis. A catheter may be placed in the bladder through the lower abdominal skin to help flush the bladder (postoperative bladder irrigation) and another catheter comes out of the penis to drain the urine. The procedure requires a slightly longer hospital stay and recovery period than transurethral resection of the prostate (TURP). Open prostatectomies may be needed only for men with very enlarged prostate glands (it may be more effective than TURP in relieving the blockage of urine flow), for men with bladder diverticula (pockets) or stones, and if TURP is not possible.
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