Enlarged Prostate (Benign Prostatic Hyperplasia – BPH)

The prostate is a walnut-sized gland located between the bladder and the penis.

The prostate is just in front of the rectum. The urethra runs through the center of the prostate, from the bladder to the penis, letting urine flow out of the body.

The prostate secretes fluid that nourishes and protects sperm. During ejaculation, the prostate squeezes this fluid into the urethra and it’s expelled with sperm as semen.

The vasa deferential (singular: vas deferens) bring sperm from the testes to the duct of seminal vesicles. The seminal vesicles contribute fluid to semen during ejaculation.

As a man ages, there is a good chance that he will develop an enlarged prostate or benign prostatic hyperplasia (BPH). In fact, it is estimated that close to 80% of men will develop BPH. More than 40% of men who develop an enlarged prostate will need treatment to correct symptoms from this enlarged prostate.

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Symptoms & Causes of Enlarged Prostate (BPH)

• A weak or slow urinary stream
• A feeling of incomplete bladder emptying
• Difficulty in starting urination
• Frequent urination
• Urgency to urinate
• Getting up frequently at night to urinate
• A urinary stream that starts and stops
• Straining to urinate
• Continued dribbling of urine
• Returning to urinate again minutes after finishing

When the bladder does not empty completely, you become at risk for developing urinary tract infections. Other serious problems can also develop over time, including bladder stones, blood in the urine, incontinence, and acute urinary retention (inability to urinate). A sudden and complete inability to urinate is a medical emergency; you should see your doctor immediately. In rare cases, bladder and/or kidney damage can develop from BPH.

Most men have continued prostate growth throughout life. In many men, this continued growth enlarges the prostate enough to cause urinary symptoms or to significantly block urine flow. Doctors aren’t sure exactly what causes the prostate to enlarge. It may be due to changes in the balance of sex hormones as men grow older.

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Risk factor of Enlarged Prostate (BPH)

• Aging Prostate gland enlargement rarely causes signs and symptoms in men younger than 40. By 55, about 1 in 4 men have some signs and symptoms. By 75, about half of men report some symptoms.
• Family history. Having a blood relative such as a father or brother with prostate problems means you’re more likely to have problems as well.
• Where you’re from. Prostate enlargement is more common in American and Australian men. It’s less common in Chinese, Indian and Japanese men.

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Test diagnosis of Enlarged Prostate (BPH)

• Detailed questions about your symptoms.
• Digital rectal exam. This exam can determine whether your prostate is enlarged or not.
• Urine test (urinalysis). It can help rule out an infection or other conditions that can cause similar symptoms.
• Prostate-specific antigen (PSA) blood test. It’s normal for your prostate gland to produce PSA, which helps liquefy semen. When you have an enlarged prostate, PSA levels increase. However, PSA levels can also be elevated due to prostate cancer, recent tests, surgery or infection (prostatitis).
• Urinary flow test. This test measures the strength and amount of your urine flow.
• Post-void residual volume test. This test measures whether you can empty your bladder completely. This is often done by using an ultrasound test to measure urine left in your bladder.
• Transrectal ultrasound. An ultrasound test provides measurements of your prostate and also reveals the particular anatomy of your prostate.
• Prostate biopsy. With this procedure, a transrectal ultrasound guides needle to take tissue samples of the prostate. Examining tissues from a biopsy under a microscope can help diagnose or rule out prostate cancer.
• Urodynamic studies and pressure flow studies. With these procedures, a catheter is threaded through your urethra into your bladder. Water (or less commonly air) is slowly injected into your bladder. This allows your doctor to measure bladder pressures and to determine how well your bladder muscles are working.

Prostate cancer is entirely different than prostate gland enlargement, even though they can cause some similar symptoms and may be detected by some of the same tests. Having an enlarged prostate doesn’t reduce or increase the risk of prostate cancer. Even if you’re being treated for an enlarged prostate gland, you still need to continue regular prostate exams to screen for cancer.

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Surgical Treatment Options for Benign Prostatic Hyperplasia (BPH)

There are many treatment options. Many men experience no signs or symptoms with enlarged prostate. If that’s the case for you, watchful waiting could be the best option. Enlarged prostate aren’t cancerous.

• Transurethral resection of the prostate (TURP)
• Open prostatectomy
• Laser surgery

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Transurethral Resection of the Prostate (TURP)

TURP has been a common procedure for enlarged prostate for many years, and it is the surgery with which other treatments are compared. With TURP, a surgeon places a special lighted scope (resectoscope) into your urethra and uses small cutting tools to remove all but the outer part of the prostate (prostate resection). TURP generally relieves symptoms quickly, and most men have a stronger urine flow soon after the procedure.

Limitations: TURP could only be performed on prostates that are 60 cubic centimeters in size or less.

Complications

• Risk of heavy bleeding even few days after surgery.
• Infection
• You may temporarily require a catheter to drain your bladder after the procedure.
• You’ll be able to do only light activity until you’re healed to reduce the chances of bleeding.
• Erectile dysfunction.
• Water intoxication.
• Urinary incontinence.

Open Prostatectomy

This type of surgery is generally done if you have a very large prostate, bladder damage or other complicating factors, such as bladder stones. It’s called open because the surgeon makes an incision in your lower abdomen to reach the prostate. Open prostatectomy is the most effective treatment for men with severe prostate enlargement, but it has a high risk of side effects and complications. It generally requires a few days stay in the hospital and is associated with a higher risk of blood transfusion.

Laser Surgery

Laser surgery (also called laser therapy) uses high-energy laser to destroy or remove overgrown prostatic tissue. Laser surgery generally relieve symptoms right away and have a lower risk of side effects than does TURP. Laser surgery is also used in men who can’t have other prostate procedures because they are taking blood-thinning medications.

Side effects are common in any of these prostate surgeries, such as semen flowing backward into the bladder instead of out through the penis during ejaculation (retrograde ejaculation), loss of bladder control (incontinence) and impotence (erectile dysfunction).

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Non-surgical treatment –  Prostatic Artery Embolization(PAE)

Now a new procedure has been developed that is comparable to TURP in recovery of the symptoms with no side effect. It is called Prostatic Artery Embolization or PAE.

The patients are admitted to the hospital on the day of the procedure after all basic investigations. During embolization procedure, pain medication, anti-inflammatory drugs and antibiotic are given.

Embolization is performed under local anesthesia by unilateral approach, usually the right femoral artery. Initially, pelvic angiography is performed to evaluate the prostatic arteries. Then, a 4 or 5-F angiography catheter is introduced to reach in prostatic artery and a 3-F coaxial microcatheter advance in the ostium of the prostatic artery. For embolization, nonspherical PVA particles are used. The endpoint chosen for embolization is slow flow or near-stasis in the prostatic vessels with interruption of the arterial flow and prostatic gland opacification.

When embolization of the both prostatic arteries is finished, the catheter is removed. After 4-6 hrs patients can start walking around in room without a urinary catheter. Same day he can resume the normal activities.

 

Advantages of Prostatic Artery Embolization ( PAE)

• PAE can be performed on any size of enlarged prostate.
• It does not produce the side effects/complications that TURP does.
• No blood loss or risk of blood transfusion.
• No ugly surgical scars. Whole procedure is done through a small nick around the skin in the groin region.
• Makes for faster recovery and early activity
• No Need of hospital stay. it is done on day care basis or one-day hospitalization.
• Most men experience no pain to light pain and leave the hospital in a day after intervention.
• No Side effect of loss of bladder control (incontinence)
• No sexual dysfunction following prostatic artery embolization like retrograde ejaculation and impotence (erectile dysfunction). Quarter of patient report that sexual function improved after the procedure.
• PAE procedure need no general anesthesia. It needs just mild sedation.
• It is cheaper than surgery.
• Overall success rate is about more than 98%.

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Best Treatment Solution – Non surgical treatment – Prostatic Artery Embolization

Prostatic artery embolization (PAE) is a procedure where an interventional radiologist uses a catheter to deliver small particles that block the blood supply to the enlarged prostate. The procedure is not a surgical intervention and allows all the functions of prostate to be kept in place. After embolization the shrinkage of an enlarged prostate occurs in 2-3 weeks time.

Why PAE is the best option

• PAE can be performed on any size of enlarged prostate.
• It does not produce the side effects/complications that TURP does.
• Whole procedure is done through a small nick around the skin in the groin region.
• Most men experience no pain to light pain and leave the hospital in a day after intervention.
• No sexual dysfunction following prostatic artery embolization.
• Quarter of patient report that sexual function improved after the procedure.
• PAE procedure need no general anesthesia It needs just mild sedation,
• No blood loss or risk of blood transfusion.
• No surgical ugly scars and makes for faster recovery.
• It is cheaper than surgery.
• Overall success rate is about more than 98%.