Enlarged Prostate Treatment in Latur

Benign prostate hyperplasia (BPH) also called enlarged prostate is a condition in which the prostate appears bulky or enlarged causing difficulty in urinating. If left untreated, this condition can weaken the urinary tract causing a slow flow of urine and reduced kidney function. This condition often occurs in older men and can be caused due to other conditions like prostatitis, kidney stones, urethral stricture, and urinary tract infection. 

The prostate is a small muscular gland in the male reproductive system that is responsible for the production of fluid and semen during sexual climax. When the prostate becomes enlarged, it is called benign prostate hyperplasia (BPH) or enlarged prostate that causes frequent urination, difficulty in starting urination, dribbling at the end of urination, and inability to empty the bladder. 

The exact cause of prostate enlargement is still being studied. Since this condition affects most older men, it is believed to be linked to hormonal changes. 

However, here are some conditions that can lead to an enlarged prostate. 

• Inflammation of the prostate (prostatitis)
• Narrowing of the urethra (urethral stricture)
• Scarring in the bladder due to previous surgery
• Kidney stones
• Problems with nerves that control the bladder
• Prostate or bladder cancer
• Urinary tract infection (UTI)

The symptoms of an enlarged prostate can be initially mild but can worsen if left untreated. The size of the enlarged prostate does not determine whether the condition is severe or mild. For some men, a large swollen prostate could show minor symptoms while a small-sized enlarged prostate would show major symptoms. Here are signs that your prostate is enlarged.  

Mild Symptoms:

• Frequent urination
• Increased urge to pass urine at night
• Difficulty starting to urinate
• The urine stream feels blocked
• Feeling incomplete after urination

Severe Symptoms:

• Urinary tract infection
• Blood in urine
• Urge to urinate but unable to

Initially, a urologist will recommend you get a physical examination done. This includes a rectal examination that allows the doctor to have insight into the size and shape of the enlarged prostate. Moreover, a doctor will ask you to get the following tests to determine the next course of action. 

1. Cystoscopy: The urethra and bladder will be examined by inserting a tiny tube with high-intensity light through the urethra. 

2. Urinalysis: Urine is checked for blood and bacteria.

3. Urodynamic Test: Checks how well the parts of the lower urinary tract (bladder, sphincters & urethra) store and release urine. 

4. Prostate-Specific Antigen (PSA) Test: This blood test checks for cancer of the prostate. 

5. Post-Void Residual: This tests the amount of urine left in your bladder after urination.

6. Urine Flow Test: You urinate into a container attached to a machine that measures the strength and amount of your urine flow. This test helps determine if your condition is getting better or worse.

7. Transrectal Ultrasound: An ultrasound probe is inserted into your rectum to measure and evaluate your prostate.

For mild symptoms, an enlarged prostate requires no surgery and may require daily medication. For severe symptoms, a urologist will recommend a traditional surgical procedure or minimally invasive surgery for your BPH. 

1. Traditional Surgery Procedure

• Open Surgery: 

In open surgery, the surgeon makes an external incision and removes the enlarged tissue from inside the gland. The entire prostate is not removed, but rather the outer shell or capsule of the prostate remains similar to removing the core of an apple leaving its shell intact.

• Open OR Robot-Assisted Prostatectomy: 

A surgeon makes an incision in your lower abdomen to reach the prostate and remove tissue. Open prostatectomy is generally done if you have a very large prostate, bladder damage, or other complicating factors. This surgery requires a short hospital stay and is associated with a higher risk of needing a blood transfusion.

2. Minimally Invasive Procedure

• Laser Surgery: 

A high-energy laser is used to destroy or extract overgrown prostate tissue. This procedure relieves symptoms immediately and has low risks compared to traditional BPH surgery. A urologist will perform a laser surgery depending on the size of your prostate, overall health, and the type of laser which will best suit you. 

Types of Laser Procedures:

• Photoselective Vaporization of The Prostate (PVP): A laser using high-intensity heat is used to melt or vaporize excess prostate tissue and widen the urinary channel. 
• Holmium Laser Enucleation of The Prostate (HoLEP): A laser using high-intensity heat is used to cut/ remove the excess tissue that is blocking the urethra. 
•  Holmium Laser Ablation of The Prostate (HoLAP): Similar to PVP, a different type of laser is used to melt away (vaporize) the excess prostate tissue.
• Transurethral Resection of The Prostate (TURP): 

A minimally invasive surgical procedure involves inserting a lighted scope into the urethra to remove the outer part of the prostate. This procedure quickly relieves symptoms and you can feel a stronger free flow of urine. 

• Transurethral Needle Ablation (TUNA):

In this type of minimally invasive procedure, a scope is passed into your urethra thus allowing a doctor to place needles into the prostate gland. Radio waves are sent via these needles to heat and break excess prostate tissue blocking the flow of urine. 

• Transurethral Incision of The Prostate (TUIP):

A lighted scope is inserted into your urethra and the surgeon makes one or two tiny cuts in the prostate gland to make the urine flow easier through the urethra. 

• Transurethral Microwave Thermotherapy (TUMT): 

Your doctor inserts a particular electrode (conductor through which electricity is passed) through the urine pipe into your prostate area. Microwave energy is sent to the electrode thus shrinking it and easing urine flow. This surgery is often used on men with mild BPH symptoms. It is a painless procedure. 

• Prostatic Artery Embolization (PAE):

In this minimally invasive procedure, a catheter is inserted through the artery that is directed to the prostate gland. Tiny particles are injected into the artery to block the supply of blood to the prostate. This process of blocking the supply of blood to the prostate is called embolization. 

This process is repeated on the other side of the prostate through the same puncture causing the prostate to gradually decrease in size. It takes 1 to 4 hours depending on the size and location of the prostatic arteries. 

While an enlarged prostate may not always cause symptoms, in certain cases, it can lead to complications and pose certain risks, such as:

• Urinary Tract Infections (UTIs): BPH can cause urinary retention, where the bladder doesn't empty completely, increasing the risk of urinary tract infections.
• Bladder Stones: Urine that remains in the bladder for a prolonged period can lead to the formation of bladder stones, which can cause pain and other urinary symptoms.
• Kidney Damage: In severe cases, untreated BPH can cause damage to the kidneys, leading to kidney failure.
• Urinary Incontinence: BPH can cause urinary incontinence, where urine leaks out involuntarily.
• Acute Urinary Retention: A sudden inability to pass urine, known as acute urinary retention, can occur in some cases of BPH. This condition requires urgent medical attention.
• Hematuria: BPH can cause blood in the urine, a condition known as hematuria, which requires medical attention to identify the underlying cause.
• Erectile Dysfunction: BPH can cause erectile dysfunction, making it difficult for a man to achieve or maintain an erection.

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