BPH

The prostate gland is located below the bladder and in front of the rectum and surrounds the urethra, which carries urine from the bladder out through the penis. The main function of the prostate is to produce ejaculatory fluid. Prostatism, a.k.a. benign prostatic hyperplasia (BPH), is a common urological condition caused by non-cancerous enlargement of the prostate gland in aging men. It will affect approximately 50 percent of men between the ages of 51 and 60 and up to 90 percent of men over the age of 80.

Symptoms of BPH:

These can be either irritative or obstructive. Irritative symptoms are frequency, urgency, nocturia and dysuria. Obstructive symptoms are difficulty in starting the urine flow or dribbling after urination ends, decrease in force and caliber of the urine stream & feeling of incomplete voiding.

Diagnosis of BPH:

This may involve assessment of severity of symptoms by the International Prostate Symptom Score (IPSS), digital rectal exam (DRE), Uroflowmetry, Ultrasound, PSA test and renal function tests.
Methods of Treatment: 1) Observation alone 2) Medical management with drugs like alpha-1 blockers (prazosin, terazosin, tamsulosin) and 5-alpha-reductase inhibitors (finasteride) 3) Surgical treatment: Indications for surgical treatment: When medical therapy fails, surgery is required to remove the obstructing tissue. Surgery is always recommended for men who are unable to urinate, have kidney damage, frequent urinary tract infections, significant urethral bleeding or stones in the bladder.

Options for Surgical Treatment:

Transurethral Resection Of The Prostate (TURP): Under regional anesthesia, the surgeon inserts an instrument called a resectoscope through the tip of the penis into the urethra. With this instrument, obstructive prostate tissue is removed one piece at a time and bleeding vessels coagulated. The removed tissue pieces are sent to a pathologist. At the end of the procedure, a catheter is placed in the bladder through the penis and the bladder is continuously irrigated with fluid through the catheter in order to monitor bleeding and prevent blood from clotting and obstructing the catheter. Since there are no surgical incisions with this procedure, patients normally stay in the hospital only one to three days.

Transurthral Incision Of The Prostate (TUIP): Transurethral incision is used for men with smaller prostate glands who suffer from significant obstructive symptoms. Instead of cutting and removing tissue to relieve the obstructed bladder, this procedure widens the urethra by making small cuts in the bladder neck where the urethra joins the bladder. Patients normally stay in the hospital one to two days. A catheter is left in the bladder for one to two days after surgery.

 

 Laser Prostatectomy:

This is an endoscopic treatment usually performed these days with the Holmium:YAG laser or the Green Light KTP 

 Laser. The amount of bleeding may be less with laser as compared with TURP, and complications due to fluid absorption are also minimal. 

 However, the choice of treatment depends on an individual patient’s condition and the laser is not necessarily better than TURP in all 

 patients.

 

Open prostatectomy: Open prostatectomy (through a lower abdominal incision) for BPH is performed for a prostate that is too large or associated with large bladder diverticula, large bladder stones and who cannot tolerate having their legs placed in stirrups for TURP/TUIP surgery. Patients usually stay in the hospital for several days.

 

Possible complications:

Postoperatively, patients typically experience significant improvement in their symptoms. As with any operative procedure, complications do exist. Overall mortality rates are 0.1% and morbidity rates are 10-15%. Complications include bleeding, retrograde ejaculation, incontinence, impotence, urethral stricture, recurrent symptoms, and erectile dysfunction. Remember, that this is only a brief guide and does not cover all aspects and eventualities.