| What is a Prostate Gland? |
The prostate is a walnut-sized gland that forms part of the male reproductive system. The gland is made of two lobes, or regions enclosed by an outer layer of tissue. The Prostate is located in front of the rectum and just below the bladder, where urine is stored. The prostate also surrounds the urethra, the canal through which urine passes out of the body. |
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| What is Benign Prostatic Hyperplasia? |
Benign Prostatic Hyperplasia is nonmalignant (noncancerous) enlargement of the prostate gland, a common occurrence in older men. It is also known as Benign Prostatic Hyperplasia and abbreviated as BPH. |
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| What is Benign Prostatic Hyperplasia? |
During puberty, the prostate goes through a phase of very rapid enlargement, but this levels off once puberty is completed. Starting in mid-life, the prostate begins growing again, but very slowly this time. It is thought that these periods of growth result from increased levels of male hormones such as testosterone. Testosterone is produced throughout a man's life and subsequently, the prostate grows throughout a man's life. Due to the slow progression of this growth, most men do not notice any symptoms of BHP until they are older and the Prostate has grown to such a size that it impinges on the out flow of urine from the bladder. |
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| What are the symptoms of BPH? |
Due to the location of prostate, BPH causes a number of urinary symptoms. The prostate is located just below where the bladder empties into the urethra (which is a thin tube that carries urine from the bladder, through the penis, to outside the body). As the prostate enlarges, it impinges the flow of urine through the urethra. |
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| The most common symptoms are: |
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Straining to void |
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Dribbling after voiding |
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Feeling that the bladder has not emptied completely after urination |
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Frequent urination, particularly at night (i.e., nocturia) |
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Hesitant, interrupted, or weak urine stream caused by decreased force |
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Leakages of urine (i.e., overflow incontinence) |
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Pushing or straining to begin urination |
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Recurrent, sudden, urgent need to urinate. |
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| Diagnosis |
Clinical symptoms and physical examination provide the basis for diagnosis of Benign Prostatic Hyperplasia. The physical examination includes a digital rectal examination (DRE). Symptom evaluation is obtained from the results of the AUA Symptom Index. |
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| Digital Rectal Examination (DRE) |
DRE typically takes less than a minute to perform. The doctor inserts a lubricated, gloved finger into the patient's rectum to feel the surface of the prostate gland through the rectal wall to assess its size, shape and consistency. Healthy prostate tissue is soft, like the fleshy tissue of the hand where the thumb joins the palm. Malignant tissue is firm, hard and often asymmetrical or stony like the bridge of the nose. If the examination reveals the presence of unhealthy tissue, additional tests are performed to determine the nature of the abnormality. |
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| AUA Symptom Index |
American Urological Association (AUA) Symptom Index is a questionnaire designed to determine the seriousness of a man's urinary problems and to help diagnose BPH. The patient answers seven questions related to common symptoms of benign prostatic hyperplasia. How frequently the patient experiences each symptom is rated on a scale of 1 to 5. These numbers added together provide a score that is used to evaluate the condition. An AUA score of 0 to 7 means the condition is mild; 8 to 19, moderate; and 20 to 35, severe. |
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| PSA Test |
Blood test to check the levels of prostate specific antigen (PSA) in a patient who may have BPH helps the doctor to eliminate the diagnosis of prostate cancer. |
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| Uroflowmetry Test |
This is a simple test which records the urine flow to determine how quickly and completely the bladder can be emptied. With a full bladder, the patient urinates into a device that measures the amount of urine, the time taken, and the rate of urine flow. Patients with stress or urge incontinence usually have a normal or increased urinary flow rate, unless there is an obstruction in the urinary tract. A reduced flow rate may indicate BPH. |
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| Post-Void Residual (PVR) |
This test measures the amount of urine that remains in the bladder even after urination. The patient is asked to urinate immediately prior to the test and the residual urine is determined by ultrasound. PVR less than 50 ml. generally indicates adequate bladder emptying and measurements of 100 to 200 ml or higher often indicates blockage. |
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| Treatment Options |
Your doctor may recommend a variety of treatment options depending on what disease you are suffering from. These options may range from 'wait and see', drug therapies, radiation, surgery, or some combination. Your doctor will recommend a treatment course that best fits with your individual situation and disease. |
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| My Doctor Recommends Surgery... |
There are different surgical procedures available and your doctor will be happy to explain the procedure he or she has chosen and risks associated. For example, if you have BPH, he or she may recommend Holmium laser procedure called Holmium Laser Enucleation or Prostate (HoLEP) or Transurethral Resection of the Prostate (TURP), these are two highly effective procedures that remove the enlarged prostate gland tissue. |
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| Holmium Laser Enucleation of Prostate |
Holmium Laser Enucleation of Prostate (HoLEP) has emerged as a safe and effective BPH treatment option. HoLEP involves Enucleation o the median lobe, followed by the lateral lobes. The lobes are placed into the bladder for removal by morcellation. Prostate size is not a limitation for this technique. Minimal blood loss, less catheter time, lesser hospital stay are some advantage of this procedure. |
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| Laser Treatment |
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| Holmium Laser Enucleation of Prostate (HoLEP): |
It is the latest modality used in the management of Enlarged Prostate. In this procedure, a 550 Micron Fibre attached to a 100-Watts Holmium Laser machine is used to remove obstructive prostatic tissue and seal blood vessels. The enucleated gland is then pushed into the bladder, which is later sucked out with the help of an equipment called Morcellator. The whole procedure takes around 45-90 minutes, depending on the size of the gland. This procedure is nearly bloodless as the laser beam when cuts the gland also seals the blood vessels. In most of the cases there is no need for blood transfusion. At the end of surgery, a catheter is inserted to keep the bladder in place. It continuously drains the urine into a sterile collection bag. The catheter is usually kept for 24 to 48 hrs and the patient is discharged without catheter after giving a catheter free trial. |
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| Advantages Of HOLEP Over TURP: |
| Advantages of Holmium Laser Surgery |
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OPEN SURGERY |
TURP |
HOLEP |
Prostate Size |
Any size |
< 80 grams |
Any size |
Catheterization |
5-7 days |
3-5 days |
2 days |
Blood Transfusion |
Usually required |
10-15 in 100 cases |
0-1 in 10,000 patients |
Bladder Irrigation |
Required |
Required |
Rarely required |
Hospital Stay |
5-7 days |
3-5 days |
2-3 days |
Patients with high blood sugar & high blood pressure |
High risk |
High risk |
Treatment Possible |
Patients with poor cardiac status |
High risk |
High risk |
Treatment Possible |
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| Transurethral Resection of the Prostate (TURP) |
A surgeon inserts a narrow instrument (resectoscope) into the urethra and uses small cutting loops to scrape away excess prostate tissue. Patients can be expected to stay in the hospital up to three days after surgery. Blood loss and catheter time are more in TURP than HOLEP. |
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