Prostate is a walnut shaped gland, located immediately below the neck of the urinary bladder, surrounding the urethra. Normal size of prostate is less than 20 gms. The prostate size increases with age. BPH is characterized by the benign (non-cancerous) overgrowth of prostate cells. Nearly half of men over the age of 65 have BPH or Enlarged Prostate. This enlargement causes bladder outlet obstruction and reduces the urinary flow and the man finds that his urine stream becomes weaker and it is more difficult to empty his bladder.
These symptoms may significantly impair quality of life.
As the condition increases in severity, the symptoms begin to affect daily activities.
Symptoms of BPH are:
- Urinary Frequency, especially at night
- Urgency – the need to urinate immediately
- Hesitancy – flow doesn’t start right away
- Intermittency – flow stops and goes
- Flow of urine is slow
- Blood in the urine
- A Feeling the bladder isn’t empty
- Dribbling after urination
- Pain or burning during or after urination
- Painful orgasms
While symptoms of BPH and Prostate Cancer can be similar, BPH has never been shown to be a precursor to developing prostate cancer.
Once a diagnosis of BPH is confirmed, a treatment is recommended. There is no cure for this condition so finding relief from the symptoms is the goal of the treatment.
The spectrum of symptoms that are associated with BPH are known collectively as lower urinary tract symptoms (LUTS).
The severity of symptoms and the degree of Bother to the patient have to be assessed as per the AUA Symptom score.
|The AUA Symptom Score|
The symptoms of BPH overlap with those of other conditions, so your initial examination should be thorough. Your doctor will question you about your general health and symptoms. You will be asked about other conditions, such as diabetes and hypertension, and what medications you are taking.
Physical examination and Digital Rectal examination
A digital rectal examination will be performed to give the doctor an idea of the size and consistency of your prostate. He will also feel your abdomen to check whether your bladder is distended so that it can be felt (if it can, this is a sign that you may be retaining urine). Your doctor may also make an assessment of your nervous system, such as testing the muscle tone and sensation in the area around and between the scrotum and anus, as some disorders of the nervous system, such as Parkinson’s disease or spinal cord problems, can give rise to urinary symptoms similar to those of BPH. Since high blood pressure (hypertension) is common, blood pressure may also be measured as part of a general health check.
An urinary tract infection ( UTI ) can cause symptoms like increased urinary frequency or urgency, a urine sample will be checked for signs of bacterial infection or blood. The urine may also be tested routinely for the presence of sugar, which is a sign of diabetes. The urine may also be checked for malignant cells resulting from a bladder, ureteric or kidney cancer.
Few men have kidney problems due to their BPH. Kidneys are affected by back pressure of urine due to urinary retention in the bladder. This will result in deranged Kidney function tests. This can be assessed by Kidney Function Tests. Your blood sugar level may also be tested to check that you do not have diabetes, as this can be a cause of frequent urination.
The amount of PSA may also be measured. (mentioned in detail in the prostate Cancer section. ) PSA is a marker of prostate cancer, but sometimes as a result of BPH. In fact, the larger your prostate, the higher your PSA tends to be.
If your PSA level is raised, it may be recommended that you have a prostate biopsy so that prostate cancer can be excluded.
Urine Flow test (or Uroflowmetry)
By measuring the speed of your urine output over time, your urologist can get some useful information about your urine flow. For this test you will have to urinate (privately) into a machine that measures the speed of urination and more information.
Ultrasound to measure the residual urine left in the bladder
Ultrasound can give your doctor an idea of how severe the obstruction is and how well you might respond to certain types of treatment.
TURP – Transurethral Resection of the Prostate
Historically, BPH was surgically treated by an operation called Open Prostatectomy which is a major abdominal surgery. Performed in a hospital under general anesthesia, the surgeon opens the patient’s abdomen and either removes the gland or cuts off the overgrowth. The patient leaves the operating room with two catheters which stay in for up to a week. This procedure requires a long-term rehabilitation period.
Less invasive than Open Prostatectomy is the more commonly performed Trans urethral Resection of Prostate (TURP).
This procedure is done in as short hospital stay using Spinal Anaesthesia. Using a resectoscope, the surgeon enters the urethra through the natural passage in penis and cuts away pieces of the overgrown gland using electro-cautery. At the end of the procedure, a urinary catheter is put in the patient and is removed after 3-5 days. This procedure takes about 90 minutes and the patient may be discharged on the day after surgery. The patient can return to daily activities in about 1 week, and can start strenuous activity after 1 month of surgery. The benefit of this procedure is its safety and effectiveness in opening the bladder outlet and improving the urinary flow.
Possible side-effects directly after the procedure include some burning in urination and blood in the urine. There is a possibility of long-term recovery issues, including retrograde ejaculation.
TURP is considered to be the optimum treatment for BPH today.
What is Transurethral Resection of the Prostate (TURP)?
Transurethral Resection of the Prostate (TURP) is a procedure to remove excessive growth of the prostate gland, resulting from Benign Prostatic Hyperplasia (BPH).
TURP is a minimally invasive procedure to remove the overgrowth of prostate tissue. TURP is still considered the “gold standard” of prostate surgery optionsand the preferred treatment for BPH. It is performed by a urologist in a hospital under spinal anaesthesia. A resectoscope (an instrument much like a cystoscope with the advantages of a microscope, light, irrigation capability, and a wire loop) or a spring-action cutting tool, is inserted into the urethra to access the enlarged prostate gland. The electric current generated through the cutting tool removes small pieces of tissue until the bladder outlet is opened up. To control bleeding, the vessels are cauterized by the wire loop and the bladder and urethra are irrigated with a saline solution. A urinary catheter is put in for the purpose of resting the bladder, keeping the urethra open if swelling develops, and to wash the blood clots from the bladder. The procedure takes about 90 minutes.
Benefits of TURP
TURP has several advantages over the newer technologies. For men with other health problems that make the newer procedures inadvisable, TURP is the best option for treatment of BPH. If the prostate has grown too large, newer procedures they may not be effective, and some may feel more comfortable with surgery than an unfamiliar technology.
Additional Advantages include:
- Visual, hands-on access to the prostate
- Immediate removal of excess tissue
- Can be coupled with other procedures, e.g., removing small bladder stones
- Longevity of use with supportive data on overall efficiency, safety, and success rates
- Traditionally taught in medical schools so doctors have extensive experience
Recovery after TURP
Commonly, there is a one-night hospital stay for observation and flushing of the catheter. Light bleeding will continue, presented in the urine and when the catheter is flushed out. The catheter will remain in for two to five days and must be flushed regularly by the patient after discharge; instructions on how to do this are given while in the hospital.
After discharge, precautions are recommended for the purpose of healing, comfort, and preventing damage to the treated area. Patients will require rest and should drink large quantities of water to flush out the bladder to prevent a urinary tract infection. No straining, lifting or pushing heavy items should occur. A significant improvement in recovery is seen after the catheter has been removed and, while some of the pre-operative symptoms may continue, they will slowly decrease over a period of two to four weeks. Complete reversal of all prior symptoms may take several months.
Sex after TURP Prostate Surgery
Sexual function returns for most men, but the doctor may advise against ejaculation for up to two months. While the ability to orgasm is unaffected by TURP, your ejaculate may no longer exit through the penis. This occurs if the valve to the bladder, which controls the direction of semen, is damaged during the procedure.