Enlarged Prostate (BPH)

The symptoms of prostate enlargement vary, but the most common ones involve changes or problems with urination, such as:

• Having to urinate more often (frequency)
• Getting up several times at night to urinate (nocturia)
• Need to rush to the toilet (urgency)
• Difficulty in starting to urinate (hesitancy)
• A weak stream
• Interrupted flow of urine (intermittency)
• Dribbling on underwear
• Discomfort or burning sensation when urinating
• Urinary incontinence (Lack of control)
• Feeling that bladder has not emptied properly
• Having to strain while passing urine

These symptoms are analysed based on a symptom score, and the result of this score classifies the symptoms into mild, moderate and severe. The size of the prostate does not always determine the severity of the obstruction or symptoms. Some men with greatly enlarged glands have little obstruction and few symptoms while others, whose glands are less enlarged, have more blockage and more significant problems.

At Max Healthcare, we offer comprehensive treatment for various urological conditions. Our state-of-the-art facilities, we specialize in providing services in the areas of urology, uro-oncology, reconstructive urology, robotic surgery, kidney transplantation & laparoscopic andrology services, among others. Some of our exceptional services include laparoscopic urological surgery, ABO-incompatible kidney transplantation, renal transplantation, uro-oncology, reconstructive surgery of the urinary tract, and laser urological procedures. Additionally, we have the intuitive surgical Da Vinci XI Robotic System to perform highly complex urological procedures like radical cystectomy, radical prostatectomy, partial nephrectomy, etc. All urological surgeries are performed laparoscopically to ensure great precision for improved patient outcomes.

Our dedicated team of leading urologists provides the most advanced treatments using cutting edge technology, based on international standards. They have years of experience under the belt, including international level experience and exposure.

Prostate enlargement is a common part of ageing and doctors call this condition ‘Benign Prostatic Hyperplasia’ (BPH). BPH is not cancer. But some of the symptoms of an enlarged prostate and prostate cancer are similar. In 8 out of 10 cases, these symptoms suggest prostate enlargement, but they may also be due to prostate cancer. Hence, diagnosis plays the most important part in the treatment approach for enlarged Prostate.

The diagnosis tests vary from patient to patient, but the following are the most common tests performed:

• Digital Rectal Examination (DRE): This examination is usually the first test done. The doctor inserts a gloved finger into the rectum and feels the part of the prostate next to the rectum. This examination gives the doctor a general idea of the size and condition of the gland.
• Ultrasound: It involves generating echo patterns of the sound waves, which form an image of the Prostate gland on a display screen.
• Urine Flow Study: The patient will be asked to urinate into a special device that measures how quickly the urine is flowing.
• CMG (Urodynamics): It involves the use of a series of investigations that can identify the cause of urinary bladder control problems. These investigations are required in patients with prostate enlargement with urine outflow obstruction.

When prostate enlargement is suspected, you may be referred to a urologist, a doctor who specializes in problems of the urinary tract and male reproductive system. Your doctor can rule out cancer with the help of a detailed examination and certain investigations. You may be recommended a PSA blood test. PSA, a protein produced by prostate cells, is frequently present at elevated levels in the blood of men who have Prostate cancer. Such tests also help decide whether surgery is needed.

Follow-up

Following surgery, you will stay in the hospital from 2-4 days depending on the type of surgery you had and how quickly you recover (after TURP, the average hospital stay is 36 to 48 hours). Open surgery requires almost 7-8 days of hospital stay.

The Urologist at Max Healthcare decides the modality of treatment for a particular patient after detailed examinations and investigations. There are two main ways of treatment:

a) Non-surgical Treatment

Over the years, researchers have tried to find a way to shrink or at least stop the growth of the prostate without using surgery. FDA has approved some drugs to relieve common symptoms associated with an enlarged prostate. These medications act by relaxing the smooth muscle of the prostate and bladder neck to improve urine flow and to reduce bladder outlet obstruction.

b) Surgical Treatment

Most doctors recommended removal of the enlarged part of the prostate as the best long-term solution for patients with prostate enlargement. With surgery for prostate enlargement, only the enlarged tissue that is pressing against the urethra is removed. Surgery usually relieves the obstruction and incomplete emptying caused by prostate enlargement. The types of surgery that are used are as follows:-

• TURP (Transurethral Resection of Prostate)

In this type of surgery, no external incision is needed. After giving regional anaesthesia, the surgeon reaches the prostate by inserting an instrument called a resectoscope through the penis. The surgeon uses the resectoscope’s wire loop to remove the obstruction tissue one piece at a time.

• Other Endoscopic procedures

TUIP (Transurethral Incision of Prostate) and TUEVP (Transurethral Electrovaporization of Prostate) are endoscopic surgical procedures for patients with smaller Prostates. TUEVP is equivalent to laser surgery.

• LASER Surgery

HO Laser (Holmium Laser) enucleation of the prostate is done to remove the gland through the endoscopic method as done in open surgery. Like TURP, it requires anaesthesia and a hospital stay. At Max Healthcare, we perform the world’s most advanced Holmium Laser (HoLEP) Surgery which is done to remove the enlarged prostate gland tissue. The VersaPulse® is a unique device that allows the doctor to perform certain surgical procedures with increased precision, smaller or no incisions, and little or no bleeding.

• Open Surgery

In a few cases when a transurethral procedure cannot be used, open surgery, which requires an incision, may be used. It is done when the gland is greatly enlarged, when there are complicating factors, or when the bladder has been damaged and needs to be repaired.