Prostate Disease

FREQUENTLY ASKED QUESTIONS What is the prostate gland? The prostate is a walnut-sized gland that is part of the male reproductive system. It is located below the bladder (the organ where urine is stored) and surrounds the upper portion of the urethra (the tube that carries urine out of the body). The gland is made of 2 main lobes, or regions, on either side of the urethra, enclosed by an outer layer of tissue (the capsule). The gland is made up of two main types of tissue: glands and smooth muscle.

What is its function? The seminal fluid discharged during ejaculation carries sperm cells. The prostate gland makes the fluid portion of the semen. This fluid energizes the sperm and makes the vaginal canal less acidic.

What is benign prostatic hyperplasia? The prostate gland begins to enlarge after the age to 40. The reason for the enlargement is not fully clear, and is likely to be due to subtle changes in the hormone levels with increasing age. This enlargement is not due to cancer. What are the consequences of this enlargement? The prostate tissue as it enlarges squeezes the urethra from all sides, creating a mechanical obstruction to emptying of the bladder. Initially the bladder respond by contracting more strongly so that the urine can be emptied and the patient has no symptoms apart from slight diminution of flow. Later the obstruction causes irritability of the bladder muscle causing urinary frequency and urgency. As the disease progresses, the bladder weakens, resulting in incomplete bladder emptying, eventually progressing to stoppage of urinary flow: retention of urine. Sometimes the high pressures generated in the bladder due to obstruction are transmitted back to the kidneys. This is a potentially dangerous situation, and can result in serious kidney damage, which may be permanent.

What are the symptoms of BPH? The most common symptoms of BPH are : A weak urine stream · Dribbling after voiding Feeling that the bladder has not emptied completely after urination Frequent urination, particularly at night (i.e., nocturia) and having to rush to the toilet to pass urine Hesitant, interrupted, or weak urine stream Leakage of urine (I. E., overflow incontinence) Pushing or straining to begin urination Blood in the urine (i. e., haematuria)

Does the size of the prostate determine severity of symptoms? The size of the prostate does not always determine how severe the obstruction or the symptoms will be. Some men with greatly enlarged glands have little obstruction and few symptoms while others, whose glands are less enlarged, have more blockage and greater problems. Sometimes a man may not know that he has any obstruction until he suddenly fiends himself unable to urinate at all, called acute urinary retention.

What causes acute urinary retention? When partial obstruction is present, severe constipation, alcohol, cold temperatures, or a long period of immobility can bring on urinary retention. Certain drugs like cough syrups and cold remedies may also precipitate urinary retention. Acute urinary retention causes severe pain and discomfort. Catheterisation may be necessary to drain urine from the bladder and obtain relief.

How is BPH diagnosed? Symptoms are the first indications of prostate trouble. However, there are several tests, which may be employed by a doctor to arrive at a diagnosis. Some of these include: A digital rectal examination. The doctor inserts a gloved finger into the rectum and feels the part of the prostate next to the rectum. This exam allows the doctor to feel the prostate gland and get a general idea of the size and condition of the gland. A urine test can help detect infection, which causes inflammation (prostatitis) that can lead to similar symptoms. A prostate-specific antigen (PSA) test is sometimes used in order to rule out cancer as a cause of urinary symptoms. An ultrasound examination is usually performed Sometimes, a urine flow study, which measures how quickly the urine is flowing, may be done. A reduced flow often suggests BPH. What can happen as a consequence of BPH? Severe BPH can cause serious problems over time. Urine retention and strain on the bladder can lead to urinary tract infections, bladder or kidney damage, bladder stones and incontinence. If the bladder is permanently damaged, treatment for BPH may be ineffective. When BPH is found in its earlier stages, there is a lower risk of developing such complications. Does BPH cause cancer? BPH does not cause cancer. However, cancer does occur more often as men get older. Therefore, it is important that the prostate gland is checked regularly. All men over age 50 should have an annual prostate examination and those who have a higher risk because of a family history should be examined yearly starting at age 40. Is there any treatment? Many men have only minimal urinary symptoms, and tests exclude the presence of severe urinary obstruction. They can simply be followed up expectantly: this is known as watchful waiting. In patients with more severe symptoms active treatment has to be considered. This may involve the use of drugs, surgery, or certain other non-surgical interventions. What are the oral medications available? The prostate gland is made up of muscles and glands and drugs are available that work on these tissues. Alpha-blocking drugs, such as terazosin, relax the muscles surrounding the urethra as it passes through the prostate, making it easier to urinate. These drugs have certain side effects like dizziness and tiredness, as they tend to lower blood pressure. They have to be prescribed with care in patients with high blood pressure or other cardiac complaints. Drugs like finasteride inhibit production of the hormone DHT, which is involved with prostate enlargement. Up to 20-30 % reduction in prostate size may be achieved with this agent. Patients get symptomatic relief and risk of complications like acute urinary retention is reduced. However this drug has side effects as well, though uncommon: tenderness of the nipples, and difficulties with sexual function. It is important to realise that these drugs do not cure BPH: they only alleviate symptoms and have consequently to be taken for life. Judiciously used these drugs give relief to a large number of patients, and are particularly useful in patients with mild symptoms, and those who want to defer surgery temporarily. What are the non-surgical options? Various forms of heat treatment have been applied to the prostate : transurethral thermotherapy (microwave) and TUNA (radio-frequency). None of these treatments are curative, and it becomes difficult to justify the expense of these methods in an Indian population. What are the surgical options? The main cause of symptoms in patients with prostatic enlargement is the physical presence of the swollen tissue and clearly, for cure, the tissue has to be removed. The process of removal has to be safe, effective and economical. There should be long lasting benefit from surgery. In olden days the surgical process involved a "cutting" procedure with associated with blood loss, complications, prolonged hospitalisation. Nowadays the technique of transurethral surgery (popularly known as "microsurgery") has made the surgery a lot simpler. This is a safe and effective operation performed in large numbers of patients with good results. Transurethral surgery ( Transurethral resection of prostate : TURP ) In this type of surgery, no external incision is needed. Usually full general anaesthesia is not required and the entire operation is performed under a spinal anaesthetic with a small injection in the back. The patient is fully awake during the operation and may actually watch his own operation on a TV monitor! The surgeon reaches the prostate by inserting an instrument through the urethra called a resectoscope. The resectoscope, which is about 12 inches long and 1/3 inch in diameter, contains a light, valves for controlling irrigating fluid and an electrical loop that cuts tissue and seals blood vessels. The surgeon views the operation field on a television screen and cores away the prostate tissue using the resectoscope wire loop. The pieces of tissue are carried by the fluid into the bladder and then flushed out at the end of the operation. Usually the operation takes about 30-60 minutes to perform. These days blood transfusion is required only in a minority of patients. Open surgery Open surgery is performed when the gland is greatly enlarged, when there are complicating factors, or when the bladder has been damaged and needs to be repaired. Laser surgery The laser (Holmium Laser) can be used to enucleate the prostate through the urethra. This is a bloodless procedure, and when the technique is refined may well become a treatment of choice. For the moment laser prostatectomy is undergoing clinical trials and is not a regular option. Know more details. How can symptoms of BPH be controlled? When symptoms of BPH are not severe, these lifestyle changes might prove helpful. Limit intake of tea, coffee, and alcohol. Alcohol increases urine production and may cause congestion in the prostate gland. Caffeine irritates the bladder. Stay active. Urine is retained when you don't move around. Even a little increase in activity can make a difference. Stay warm. Being cold can lead to retention of urine. Avoid over-the-counter antihistamines and decongestants. These drugs tighten the muscles that control urine flow, making it more difficult to urinate. Don't drink any liquids after 7 p.m. Each time you urinate, try to empty your bladder completely.