Prostate Disease

What is the prostate gland?

The prostate is a walnut-sized gland weigh around 20 gram. It is part of male reproductive system. It is located below the urinary bladder and surrounds the upper portion of the urethra (the tube that carries urine out of the body). Its growth is dependent on male hormone Testosterone

What is its function?

The prostate gland makes the fluid portion of the semen. This fluid energizes the sperm and makes the vaginal canal less acidic.

What is benign prostatic hyperplasia (BPH) ?

The prostate gland begins to enlarge after 40 years of age. About half of all men between the ages of 50 and 60 have BPH. Up to 90% of men over age 80 have BPH. The reason for the enlargement is not fully clear, and is likely to be due to some hormonal changes on aging. This enlargement is not due to cancer.

What are the consequences of this enlargement?

The prostate tissue as it enlarges squeezes the urethra, creating a mechanical obstruction to emptying of the bladder. Initially the bladder respond by contracting more strongly so that the urine can be emptied and the patient has no symptoms except slight diminution of flow. Later the obstruction causes irritability of the bladder muscle causing increased urinary frequency day & night and urgency. As the disease progresses, the bladder weakens, resulting in incomplete bladder emptying, eventually progressing to stoppage of urinary flow and  retention of urine. Sometimes the high pressures generated in the bladder due to obstruction are transmitted back to the kidneys. This is a potentially dangerous situation, and can result in serious kidney damage.

What are the symptoms of BPH?

The most common symptoms of BPH are :

Increased urinary frequency both day and night.

  • Urgency -Feeling that urinating can't wait
  • Weak urine flow
  • Dribbling of urine
  • The need to stop and start urinating several times
  • Trouble starting to urinate
  • The need to push or strain to urinate
  • Sense of incomplete empty

Does the size of the prostate determine severity of symptoms?

The size of the prostate gland does not always correlate with severity of obstruction and symptoms . Some men with greatly enlarged glands have little obstruction and few symptoms while others, whose glands are less enlarged, have more blockage and greater problems.

What causes acute urinary retention?

In a patient of BPH with partial obstruction, severe constipation, alcohol, cold temperatures, or a long period of immobility can bring on urinary retention. Certain drugs like cough syrups and cold remedies may also precipitate urinary retention.

How is BPH diagnosed?

  • AUA/IPSS Symptom score
  • Digital rectal examination - The doctor inserts a gloved finger into the rectum and examine the prostate gland next to the rectum, and get a general idea of its size and condition.
  • Urinanalysis
  • Serum PSA
  • Uroflowmetry
  • Ultrasonogrphy of kidney, ureter, bladder, prostate and post void tesidual urine volume

What are the complications of BPH?

  • Recurrent urinary tract infection.
  • Urinary retention
  • Bladder and kidney damage.
  • Bladder stone.
  • Haematuria- blood in urine

If the bladder is permanently damaged, treatment for BPH may be ineffective. When BPH is found in its earlier stages, there is a lower risk of developing such complications. So sooner the treatment started better is the outcome

Does BPH cause cancer?

BPH does not cause cancer. However, cancer does occur more often as men get older. Therefore, it is important that the prostate gland is checked regularly. All men over age 50 should have an annual prostate examination and those who have a higher risk because of a family history should be examined yearly starting at age 40.

what are the treatment?

1. life style modification

2. Medical treatment

3. Surgical treatment

What are the oral medications available?

The prostate gland is made up of muscles and glands, There are mainly two groups of drugs available that work on these tissues.

1. Alpha-blocking drugs such as Tamsulosin, relax the muscles at bladder neck and prostate and helps in improving voiding symptoms. These drugs have certain side effects like dizziness, tiredness, as they tend to lower blood pressure also retrograde ejaculation of semen.

2. 5-Alpha reductase inhibitors like finasteride inhibit production of the hormone DHT, which is involved with prostate enlargement. Up to 20-30 % reduction in prostate size may be achieved with this agent in 6 months. Patients get symptomatic relief and risk of complications like acute urinary retention is reduced. It is important to realise that these drugs do not cure BPH: they only alleviate symptoms, so to be taken for life.

3) Anti-muscarinic agents- these drugs act on detrussor muscle of bladder and relieves storage symptoms

What are the surgical options?

In older days the surgical process involved "cutting & stiching" procedure (open surgery) with associated blood loss, higher complications, prolonged hospitalisation. Nowadays the technique of transurethral surgery (popularly known as "microsurgery") has made the surgery a lot simpler. This is a safe and effective operation performed in large numbers of patients with good results.

Transurethral surgery ( Transurethral resection of prostate : TURP )

This type of surgery is popularly known as microsurgery, it is the most common type of surgery done world wide for prostate enlargement. In this surgery there is no external cutting/incision or stiching. This operation is usually performed in spinal anaesthesia by giving one injection on back, that means patient is not fully anaesthetised, only lower half of his body is made senseless, patient can watch his surgery and even can talk with his doctor. Doctor introduces a fine instrument called resectoscope through patients urethral, reaches up to prostate and a wide channel for urinary passage is made under vision at the level of obstructing prostate. The resected prostatic tissues are removed through same opening. Hospital stay after this surgery is usually 2-3 days.

TURP is world wide “GOLD STANDARD” procedure for prostate surgery because of its very high success rate, minimal complication rate, quick procedure, short hospital stay and cost effectiveness.TURP can be performed in any age group patient after anaesthesia fitness, it can be performed in patients with hypertension, diabetes mellitus or kidney disease.

What lifestyle modifications are advised in a patient with BPH?

When symptoms of BPH are not severe, these lifestyle changes might be helpful.

  • Limit intake of tea, coffee, and alcohol. Alcohol increases urine production and may cause congestion in the prostate gland. Caffeine irritates the bladder.
  • Stay active, Urine is retained when you don't move around.
  • Stay warm, cold can precipitate retention of urine.
  • Avoid over-the-counter drugs of cold and cough. These drugs tighten the muscles that control urine flow, making it more difficult to urinate.
  • Restrict fluid intake after 6 p.m.
  • Each time you urinate, try to empty your bladder completely.
  • Avoid costipation