Surgical Procedures to treat Enlarged Prostate or Prostate Cancer

Non cancerous enlargement of prostate gland (BPH- Benign Prostate Hyperplasia) may lead to urinary symptoms which can ease with certain lifestyle adaptations or in other cases with medicines. However, depending upon the severity of the symptoms and in-cases where lifestyle modification and medicine do not give sufficient relief, surgery may be recommended.

Other less common procedures which might be available in private healthcare or in clinical trials.

These are

• Photoselective Vaporisation of the Prostate 
• Minimally Invasive Surgery, such as Transurethral Needle Ablation or Transurethral Microwave  Therapy 
• Transurethral Vaporisation Resection of the Prostate. 

This is a fairly common procedure which removes the overgrown parts of prostate that press on the tube (urethra) through which urine passes out. Depending upon the aesthetic administered you may be awake (spinal anaesthetic) or asleep (general anaesthetic) during the surgery. The surgeon passes a thin tube into the urethra through your penis. The tube ending has a miniature camera so that the surgeon can see the prostate clearly. The second step involves removing tiny pieces of prostate tissue by passing an electrically-heated wire loop through the tube. Fluid is passed into the bladder to withdraw small pieces of prostate tissue that have been removed. After the surgery these removed pieces may be analysed to check for any abnormal cells. A catheter is used to remove urine from the bladder till two days after the surgery following which the nurse removes the catheter and checks if you are passing urine successfully.

Advantages:

Following the surgery one can urinate with greater ease
Effective in long run
Bladder stones if present can also be removed

Disadvantages:

The improvement in symptoms is not immediate rather it takes several weeks
In certain cases, a person maybe unable to pass urine once the catheter has been removed. If this happen a new catheter is put in place for a few more days.

This procedure is similar to TURP except instead of using electrically heated wire loop HoLEP uses high-powered laser to remove the parts of prostate tissue that press upon the urethra blocking urine flow. Prostate tissue which is removed during the procedure passes into the bladder and is removed using a different instrument. HoLEP requires specialist equipment and only a trained surgeon can carry out this procedure. Therefore, it may not be available everywhere. During surgery a person may be awake up unable to feel anything (spinal anaesthetic) or maybe asleep (general anaesthetic).  After surgery, a catheter is used to drain urine from the bladder for the next 12-24 hours. Before you are discharged, the nurse removes the catheter and checks if you are able to pass urine easily. Research studies have shown that HoLEP and TURP are equally effective in improving symptoms.

Advantages

Effective in case of men with very large prostate
More suitable than TURP in men who are on anti-coagulants (medicines that prevent blood clot)
Suitable also in treating bladder stones

Disadvantages

The treatment is relatively new and not easily available everywhere.
In case of a small percentage of men find they cannot pass urine at all after the catheter has been removed. In such cases a new catheter is put in place for a few more days

Similar to TURP but here parts of prostate tissue are burnt away by heating the prostate tissue rather than removing it. After the surgery a person is on the catheter to drain the urine for the next 9-24 hours. Depending on the anaesthetic administer you might be asleep (general anaesthetic) or awake (spinal anaesthetic )but unable feel anything during the surgery.

Disadvantage

The only disadvantage is that the tissue gets destroyed and cannot be sent for further lab examination. 
9-10 per cent men might feel that they are not able to pass urine after the surgery and may need to be on the catheter for a few more days. However, chances of this are seemingly higher in case of TURP.

Bladder neck incision is also called Transurethral Incision of the Prostate (TUIP). A doctor or a nurse may recommend this procedure in situations where a person has a small prostate and is still experiencing urinary symptoms. Although this is similar to TURP it has a shorter recovery time. Either a general or spinal anaesthetic is used. A thin tube is passed into the urethra through the penis  following which an instrument is passed which is used to make one or two small cuts in the neck of the bladder or prostate gland so that the bladder neck widens and urine can flow easily.

Advantages

Catheter is removed sooner than in case of TURP.

Disadvantages

In a small percentage of men are not able to pass urine once their catheter is removed. In such cases a new catheter is put in place for a few more days.

There is not much information about the long term effectiveness of this procedure.

The prostate tissue is not removed. Therefore cannot be analysed.

This procedure removes the inner part of the prostate gland through a cut in the stomach area. A general anaesthesia is administered during the procedure. The time a person spends in the hospital depends on the case, recovery and doctors advice. However, usually it takes up to four to six days although several months may be taken to fully recover.

Advantage

The tissue can be sent for further examination.
The treatment is as effective as HoLEP in men with very large prostate.

Other treatments

Photosensitive Vaporisation The prostate tissue with vaporised by a high energy laser. The recovery with this procedure is faster with a shorter hospital stay in comparison to TURP.
Minimally Invasive Surgery The procedures are carried out with tiny incision instead of one large incision leading to faster recovery time. 

Read More

Enlarged Prostate - Medicines for Treatment

The Treatment Options

There are primarily three treatment options for Enlarged Prostate.

1.    Lifestyle Changes

2.    Medicines

3.    Surgery

If lifestyle changes don't work and the symptoms are not severe enough then being on mediation can be source of great relief. However, a person has to be careful that you tell your doctor if you are already on any medication to avoid any harmful consequences of drug interference and mixing.  

 

The Medicines for Treatment 

Alpha Blockers

Medicine Type: Tablet

How it works :

Alpha-blockers loosen the prostate muscles also relaxing the muscles around the opening of the bladder. Although the medicine isn't a complete cure to the problem but it is quiet effect in relieving the problematic symptoms and discomforts. However, this isn't given in case a person has a very large prostate. 

Relief and effects:

Upon taking Alpha Blockers you may experience an improvement in your symptoms usually within a few hours to days but the medicine takes its full effect after a few weeks of consumption. This can be a successful option for every 3 in 5 men and can be effective for several years. In case the treatment doesn't show any sign of improvement then a higher dose may be recommended or another treatment option suggested.  

Side Effects:

Every medicine comes with certain side effects which may vary individual to individual. The side effects go away once the medicine is stopped and off course one may not experience all the side effects at the same time. To name a few

Nausea or headache upon standing up

Fatigue

Blocked nose

Erectile dysfunction (3 per cent chances)

Dry orgasm (2 per cent chances)  

5-alpha-reductase inhibitors (5ARIs)

Type : Tablet or Capsule

How It works:

This medicine works by shrinking the prostate preventing it as a result from pressing on the urethra so that a person can urinate with ease.
Relief and effects:
Usually the prostate can shrink up to a quarter after being on this medication for about 6-12 months. It might be possibility that the prostate might shrink further if the medicine is continued for a longer duration.  Although it may take up to six months for urinary symptoms to improve but the effects of the medicine improve the symptoms in the longer run. Studies evidence a continuous symptomatic improvement for up to four years after taking 5-alpha-reductase inhibitors. The drug is also shown to help prevent acute urine retention and requirements for surgery. This is usually the first course of treatment offered in cases where the prostate is very large and is found to work particularly well. 

Side Effects:

Erectile dysfunction (4 or 5 per cent chances)

A drop in libido (2 to 3 per cent chances)

Tenderness in chest (2 per cent chances)

Dry orgasms or retrograde ejaculation (1 per cent chances)

IMPORTANT: This drug drops the PSA levels in the blood therefore one has to make sure that your doctor is aware if you are on is medication and have been asked to undergo a PSA test.

Other Medicines:

Anticholinergics help with urinary symptoms like wanting to urinate with sudden urgency, feeling like the need to urinate again and again and even leaking urine on the way to toilet. This drug works in similar ways to an alpha-blockers and can lead to side effects like constipation, dry eyes and dry mouth.

  
Phosphodiesterase type 5 (PDE5) inhibitor makes it easy to urinate by relaxing muscles in the prostate and the opening of the bladder. it may cause side effects like rhinitis (swelling in nose), back pain, itchiness, indigestion and head ache. 

Mirabegron (Betmiga®)
These are given incase Anticholinergics are not effective in relieving urinary symptoms. This new type of drug can help in case of people having very sudden and frequent urgency to urinate. The drug may give side effects like headache, increase blood pressure and urine infections. 

Desmopressin
This drug taken at bed time is effective in case a person gets up a lot at night to urinate and has a disturbed sleep. This drug works by signalling the kidney to produce less urine for 6-8 hours. However, it is not recommended for use in people with chances for heart failure or who are above the age of 65. Regular blood tests are also accompanied to monitor kidney function. 

Loop diuretic
This capsule is generally taken during late afternoon and causes a person to urinate a lot by the time one goes to bed, therefore reducing the chances to get up frequently during the night. One can have a better sleep. 

Combination Treatment

 

In case of men it has sometimes been found that taking a combination of two medicines work better than taking one single drug. Therefore, one may be given the following combination treatments.

Read More

Worried about Enlarged Prostate? Get it checked right away

The Diagnosis.

Visit Best Kidney Hospital Punjab, Ludhiana for a thorough diagnosis of enlarged prostate. Before visiting a urologist or a kidney care and super specialty hospital you might want to consider the frequency of your symptoms and how they are affecting your daily life. Is the discomfort manageable or tending to increase.

For a proper diagnosis, it will be a good idea to maintain a written record of the type of fluid you are drinking and its quantity, how much urine you are passing and the time of urination.

The initial suspect would not straight away be a Benign Prostatic Cancer (BPE) or Benign Prostatic Hyperplasia (BPH). The doctor would first rule out other health issues that might be causing these symptoms. You might be asked if you are diabetic or on any form of medications like blood pressure, anti depressants etc. The symptoms sometimes can also be triggered in people with lifestyles involving a heavy intake of alcohol or drinks inclusive of caffeine. It is important that you proper self observation so that you can narrate with utmost clarity the symptom you are experiencing and how much are they bothering you. You will be asked to undergo some initial set of test.

The Tests

URINE TEST

The test is done to find out if the cause your symptoms is simply a urine infection. The test also identifies if there is any blood in the urine. The infection is treated with  a course of antibiotics.

BLOOD WORK

A simple blood test is performed to check if the kidneys are working correctly. A specific blood test like a prostate specific antigen (PSA) may also be performed to examine the PSA levels in the blood. PSA is a protein which is produced by cells in the prostate. If you are having an enlarged prostate then the PSA levels will rise in your blood. However, there are other causes that may lead to an increase in the PSA levels like age, infection, inflammation and prostate cancer.

PHYSICAL EXAMINATION

The doctor may examine your abdomen and penis and might also do a digital rectum scan (DRE) to check for any hard or irregular areas in your prostate and well as get an idea of its size being in the normal range as per your age.

SYMPTOM QUESTIONNAIRE

You will be asked to fill out a standardized questionnaire to check the severity of your symptoms and how much are they affecting your lifestyle.

URINE FLOW TEST

This test is carried out to assess the flow rate or speed of the urine. A person with enlarged prostate has slower urine flow rate compared to a healthy person. A full bladder is needed for the test.

ULTRASOUND SCAN

This test is to reveal how much urine can your bladder hold and also checks if the bladder is emptying properly. This test can also assist for checking up for any abnormalities in the kidney.

FURTHER TESTS

If the above set of initial test signify the possibility of having Benign Prostatic Cancer (BPE) or Benign Prostatic Hyperplasia (BPH) then you will be asked to undergo further test to identify exactly what is causing your symptoms.

BLADDER PRESSURE (URODYNAMIC) TEST

This test is to assess how well is the bladder working. It is carried out with the doctor inserting a thin tube up the penis and filling the bladder with a clear liquid. Thin tubes are also placed in the rectum. These tubes measure the pressure in the urethra, bladder and rectum. The patient is then asked to urinate with the tubes measuring the pressure simultaneously. This test is generally performed if a person wants to undergo surgery to treat an enlarged prostate or if the symptoms haven't improved and are getting worse after the surgery. 

FLEXIBLE CYSTOSCOPY

This test identifies for any abnormality like the presence of a blockage or anomalous  tissue in the bladder or urethra. The doctors introduced a thin tube into the bladder through the penis. An anesthetic gel is applied for comfort. The end of the tube has a light so the doctors can see inside the bladder. It may have an eye piece for the doctor to see or a camera so that the inside of the bladder and urethra are visible on the screen. This test is carried out in case of severe urinary symptoms, pain and blood in the urine or repeated urinary infections. The doctor may also carry out this test in-case he/she feels that the opening of your bladder is too small or narrow, also referred to as a stricture.

PAD TEST

This test works out the amount of urine being leaked. The doctor or a nurse will give you an incontinence pad to wear for a certain amount of time. The pad will then be weighed to check how much urine is leaked. This test is carried out if a person is leaking urine occasionally.

Read More

The MYTH: Enlarged prostate is caused by cancer

Aastha Kidney Hospital Ludhiana
Increase in the size of prostate or an enlarged prostate isn't caused by cancer, rather it simply as a result of increase in the number of cells in the prostate gland. Medically this condition is referred to as Benign Prostatic Cancer (BPE) or Benign Prostatic Hyperplasia (BPH).

The intense medical terms simply mean the following:

Benign - meaning non cancer causing

Prostatic - referring to prostate gland

Enlargement or Hyperplasia- increase in size or number of cells.

Prostate cancer and enlarged prostate are medical conditions that begin in different parts of the prostate. Prostate cancer may be present without any symptoms. A person however can have both prostate cancer as well as an enlarged prostate problems at the same time.

Exact Cause

Although the exact causes cannot be pin pointed but factors like age, hormone imbalance, hereditary and conditions like diabetes, obesity are certain reasons that may possibly cause the prostate to enlarge. However, further studies are required to identify the exact cause.

Affected AGE GROUP

Men above 50 years of age

When does an ENLARGED PROSTATE become a problem?

An increased prostate is quiet common among men as they get older. Although most men do not have severe symptoms that need treatment and can go on with daily lives experiencing mild discomfort and difficulties like wanting to frequently urinate or stay near the toilet. Working, driving or being a part of social gatherings is difficult but manageable.

Also, waking up a lot at night to use the toilet means experiencing fatigue and not feeling fresh during the day. While the symptoms in certain cases improved over time, for most men these tend to grow with age.

The Complications

Chronic Urine Retention

The person is not able to empty the bladder completely upon urination. This situation develops slowly over time. Initially, a person may experience mild symptoms like reduced flow of urine or possibly leaking urine at night. The person may experience swelling in the abdomen or have a feeling that urine hasn't been passed completely. Although retaining the urine doesn't cause pain but the constant pressure because of urine retention can slowly stretch the bladder muscle making it weaker. Not being able to pass the urine completely also put the person in the risk of contact frequent urine infections or even developing painful bladder stones along with mild symptoms mentioned earlier. There may be a possibility of having blood in the urine. Also, this condition can lead to severe damage being cause to kidney and bladder.

Acute Urine Retention

This abruptly lead to excruciating pain with an inability to urinate requiring immediate medical assistance. The bladder may have to be drained immediately and an alpha blocker administered to prevent the re-occurrence of this condition. 

Read More