What is prostate?
The prostate is a small but important gland (organ) in the male reproductive system. The main role of the prostate is to make fluid that protects and gives nutrients to sperm. The prostate makes about one third of the fluid that is ejaculated (released) from the penis at orgasm (sexual climax).
Where is prostate (location)?
In young men the prostate is about the size of a walnut, but it gets bigger with age. The prostate sits underneath the bladder, and surrounds the top part of the urethra. Urine passes through the urethra on its way from the bladder to the penis.
How does the prostate gland change with age?
The male sex hormone testosterone makes the prostate grow in size. As men get older, the prostate grows larger. At puberty, testosterone levels in boys start to increase and the prostate grows to about eight times of its size. It continues to grow, doubling in size between the ages of 21 and 50 years, and almost doubles again in size between the ages of 50 and 80 years. The reasons for this ongoing growth are not fully understood.
What is BPH?
BPH (benign prostatic hyperplasia) is the most common prostate disease. BPH is a non-cancerous enlargement or growth of the prostate gland. As the prostate surrounds the top part of the urethra, enlargement of the prostate makes the urethra narrower and puts pressure on the base of the bladder.
Narrowing of the urethra can affect the passing of urine in a number of ways. BPH is not usually life-threatening but symptoms can have a major effect on quality of life.
How common is BPH?
BPH is more common in older men, usually starting after 40 years of age; it affects nearly all men at some time in their lives. Some men do not have any symptoms even though their prostate has grown larger. BPH usually becomes more of a problem over time, with symptoms getting worse if they are not treated.
What causes BPH?
The causes of BPH are not well understood. There may be genetic links, as sons of men diagnosed with BPH are more likely to develop prostate disease. Older age and the male sex hormone testosterone are linked with BPH but may not be the cause. It is known that BPH only happens when testosterone, which is made in the testes, is present.
What are the symptoms of BPH?
Some men with BPH do not have many or any symptoms. Men who do have symptoms of BPH usually notice changes to their urination because BPH affects the part of the prostate that surrounds the top part of the urethra. LUTS (lower urinary tract symptoms) is a common term used to describe a range of urinary symptoms. LUTS linked to BPH can be obstructive or irritative, but other symptoms may also happen. Obstructive symptoms include a delay or straining when starting to urinate, and slow or dribbling flow of urine. Irritative symptoms include urgent or frequent urination during the day and night.
How is BPH diagnosed?
If you have urinary symptoms, a doctor may do a number of things to find the cause, including: taking a medical history and description of symptoms; a physical examination; blood or urine tests; and sometimes biopsy or ultrasound. These tests are used to find out the type of prostate disease (to check if it is BPH, prostate cancer or prostatitis). BPH is more likely to be the cause of urinary problems than prostate cancer.
What happens in a physical examination?
A digital rectal examination (DRE) is the main part of a physical examination when checking for prostate disease. The doctor places a gloved finger in the rectum (back passage) to check the size, shape and feel of the prostate.
Are blood tests needed to diagnose BPH?
A blood test to measure the level of prostate specific antigen (PSA) in the blood is often done for prostate disease. PSA is a protein made in the prostate gland and low levels of PSA are normally present in the blood. A high PSA level in the blood almost always means there is something happening in the prostate. A PSA test is mostly used as a marker of prostate cancer risk, but BPH can also raise PSA levels two to three times higher than normal.
Could it be prostate cancer?
If there is an abnormal PSA and/or DRE result, prostate cancer may be present. The only way to confirm whether prostate cancer is present is by prostate biopsy. The biopsy, to remove small samples of tissue from the prostate, is usually done by a urologist. The samples are sent to a pathologist to be looked at under a microscope to see if cancer is present.
How is BPH treated?
If you have LUTS linked with BPH, when deciding on the best treatment it’s important to think about how much the symptoms are bothersome or affect your quality of life. In some cases of BPH, when the symptoms are mild, no treatment may be the best option. Oral medicines (tablets) can help men with moderate symptoms. Surgery is an option for men whose BPH symptoms are severe.
Can I do anything to prevent BPH?
As there are no known causes of BPH there are no known ways to prevent it. However, lifestyle changes may help to stop the symptoms of BPH getting worse and may even help to improve symptoms. Reducing caffeine and alcohol intake (these can irritate the bladder), avoiding constipation (straining to pass stools can affect pelvic floor muscles, which are important for both bowel and bladder control), reducing body weight, and good control of diabetes and blood pressure may be helpful. Stopping smoking and increasing exercise levels may also help symptoms.
What does TURP procedure involve?
TURP better known as (Transurethral Resection of the Prostate) is the more commonly performed procedure. TURP involves telescopic removal of the obstructing, central part of the prostate with diathermy (electric current), creating a wide channel to allow urine to flow more easily.
We usually insert a temporary bladder catheter at the end of the operation. We normally remove your bladder catheter after two days.
What is a Laser Prostate surgery?
Lasers use concentrated light to generate precise and intense heat. There are several different types of prostate laser surgery, including:
Photoselective vaporization of the prostate (PVP). A laser is used to melt away (vaporize) excess prostate tissue and enlarge the urinary channel.
Holmium laser enucleation of the prostate (HoLEP). A laser is used to cut and remove the excess tissue that is blocking the urethra. Another instrument is then used to cut the prostate tissue into small pieces that are easily removed. HoLEP can be an option for men who have a severely enlarged prostate.
The type of laser surgery your doctor recommends will depend on several factors, including:
- The size of your prostate
- Your health
- The type of laser equipment available
Common laser prostatectomy procedure is HoLEP and it involves using the thin laser fibre which is passed through a working channel in the endoscopic instrument & the laser beam coming from this fibre cuts the obstructing prostatic tissue like a knife back to the level of the prostatic capsule. This removes any tissue causing obstruction of your urine flow.
Once all the tissue fragments have been removed, a three-way Foleys catheter (drainage tube that passes through the urethra into the bladder) is placed to drain your urine. Gentle irrigation is started as a precautionary measure for 24 hours to prevent formation of clots in the bladder to avoid discomfort to the patient.
What is the advantage of laser prostatectomy?
Laser surgery can offer several advantages over other methods of treating BPH, such as transurethral resection of the prostate (TURP) and open prostatectomy. The advantages can include:
- Lower risk of bleeding. Laser surgery can be a good option for men who take medication to thin their blood or who have a bleeding disorder that doesn’t allow their blood to clot normally.
- It can be easily done for very large size prostate glands ( >100 gms) for which TURP is unsuitable. For these large glands, open surgery was the only option in the past.
- Quicker recovery. Recovery from laser surgery generally takes less time than recovery from TURP or open surgery.
- More-immediate results. Improvements in urinary symptoms from laser surgery are noticeable right away. It can take several weeks to months to see noticeable improvement with medications.
How is the usual postoperative period after TURP / laser prostatectomy? What can I expect when I get home?
You will be given advice about your recovery at home. You will be given a copy of your discharge summary. You should drink twice as much fluid as you would normally for the first 24 to 48 hours, to flush your system through and reduce the risk of infection. You may return to work when you are comfortable enough.
One patient in five (20%) gets some bleeding 10 to 14 days after getting home, due to scabs separating from the cavity of the prostate. If this happens, you should increase your water intake; if it does not settle, you should contact your doctor. If you have severe bleeding, passing blood clots or have sudden difficulty passing urine, you should contact your doctor immediately; this may required readmission as an emergency.
Some loss of control of urine (Leakage) is common in the early days, so it is helpful to start pelvic floor exercises as soon as possible; these can improve your control when you get home.
Open prostatectomy/Robotic Simple Prostatectomy
Sometimes, in case of enlarged prostate which is not amenable to endoscopic procedure may require open/robotic approach to remove the prostate gland.
Does it affect my sexual life?
After prostate tissue removal, the semen can pass freely back into the bladder, this is called retrograde ejaculation. This is completely harmless and does not affect your health in anyway; however, it would be a concern to men wanting to father children in the future as they would have dry ejaculations. This surgery does not affect the orgasmic pleasure but the incidence of retrograde ejaculation after TURP ranges from 50% to 95%.
Are all the above-mentioned procedures being done here at Max Saket?
Yes, all above mentioned procedures are regularly being done here by experienced urologist with excellent results.
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Dr Anantkumar Urologist
Best Robotic Surgeon In Delhi
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Dr Anantkumar Urologist
Best Robotic Surgeon In Delhi
Location: Max Supper Speciality Hospital (A Unit of Devi Devki Foundation) 2, Press Enclave Road Saket, New Delhi – 110017
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