Prostate Enlargement (Benign prostatic hyperplasia or BPH)
This is a non-cancerous enlargement of the prostate gland. The prostate gland increases in size as men get older, because of the presence of the male hormone testosterone. Prostate enlargement affects almost all men to some extent. In some men, the enlargement causes symptoms due to obstruction of urine flow. Up to 50% of men above 50 years of age will have symptoms due to prostate enlargement.
What are the symptoms of prostate enlargement?
Prostate enlargement may cause the following symptoms:
Difficulty in initiating urination
Weak urine stream
Urine stream stops and starts
Unable to empty bladder completely
Urgent need to urinate
Leakage of urine
When the problem is untreated, it can cause serious problems such as:
How is BPH diagnosed?
Based on the symptoms, the doctor will know that the problem is likely to be BPH. He will go on to perform a rectal examination to feel the prostate, to make sure that the prostate does not have cancer. Other tests to be done may include:
Urine test to check for blood in the urine
PSA blood test to check for prostate cancer
Ultrasound of the prostate to check prostate size and shape
Ultrasound of the bladder and kidneys to check for stones and obstruction
Uroflow test to assess the urinary flow rate
Flexible cystoscopy to check the urethra and bladder
Ultrasound of the prostate
What is the best treatment for BPH?
Patients with mild symptoms of BPH are initially treated with medication. There are two main types of medication, one that relaxes the prostate and gives quick relief of symptoms, the other to shrink the prostate and prevent further worsening of the condition.
Patients with severe symptoms of BPH may require surgery. Nowadays, the surgery is minimally invasive and there is no incision needed.
Transurethral resection of prostate (TURP)
TURP is the most established minimally invasive treatment for BPH. The prostate gland is cut from within by a special cystoscope with a loop attachment. A urinary catheter is inserted afterwards to allow recovery and is removed after one or two days. As it is minimally invasive, there is minimal pain and the recovery is quick.
The prostate being cut by the loop during TURP
Greenlight laser prostatectomy
Greenlight laser prostatectomy is a newer surgical procedure for BPH. The prostate gland is vaporised from within using laser. It is also a minmally invasive procedure.
The prostate is vaporised during laser prostatectomy
What is the difference between TURP and Greenlight laser?
TURP is suitable for treatment of prostate glands of all sizes. Greenlight laser prostatectomy is suitable only for smaller prostates. The advantage of Greenlight laser is that postoperative bleeding is less.