Dr. G.Thirumalai Ganesan

MS, M.Ch, FRCS(Glasg), FRCS (Urol)(UK)

Sarayu Medical Center, Q-39, 6th Avenue
Anna Nagar, Chennai-40 (Near K4 Police Station)
Tel: +91-44-45550367/68/69,
+91-97909-60550, +91-98412-33777
Email: endouro@gmail.com

Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH), or what is commonly known as an enlarged prostate gland, is a non-cancerous growth of prostate tissue.

Overviewurinary tract infections

The prostate gland is a walnut-sized organ located in front of the rectum and right below the bladder. Its function is to produce part of the seminal fluid, the solution that carries sperm. The prostate gland surrounds the urethra, the tube that carries urine and semen through the penis and out of the body. BPH affects the inner part of the prostate first, the part that encircles the urethra as it leaves the bladder. As the prostate grows, it may begin to squeeze the upper part of the urethra and restrict the flow of urine.

The chance of developing BPH increases with age. More than half of men over age 50 have BPH. By age 80, about 80 percent of men have enlarged prostates. However, only 40 to 50 percent of men actually develop any symptoms due to BPH. These symptoms may include a weak or intermittent urine flow, difficulty starting or stopping urination, a feeling of being unable to empty the bladder completely, or the need to urinate frequently, especially at night.

Diagnosis

The doctor will usually press on and manipulate (palpate) the abdomen and sides to detect signs of kidney or bladder abnormalities. The doctor will also check for signs of anemia or swelling in the legs and arms. Certain procedures that test reflexes, sensations, and motor response may be performed in the lower extremities to rule out possible neurologic causes of the bladder dysfunction.

There are several tools and examinations the doctor may use to diagnose or rate the severity of your condition, including:


Indexing Tool

An indexing tool called the International Prostate Symptoms Score (IPSS) can help evaluate the key lower urinary tract symptoms. Unlike laboratory tests or other objective tests, this scoring system measures the patient's own experience. The higher the score, the more severe is the condition. It is useful for many reasons:

  • The patient's score on this test gives a highly accurate assessment of the effect of lower urinary tract symptoms on the quality of a man's life.
  • It is a reasonable basis from which the patient and physician can discuss treatment options.
  • The index is also often used to gauge treatment outcomes and may be a better indicator of success than objective tests, such as the measurement of the prostate gland or the rate of urine flow.

It should be noted that the IPPS is useful only as a gauge of symptom severity, and has the following limitations:

  • Other conditions can produce similar scores, so the test is not used as a diagnostic tool for BPH.
  • The index does not include other urinary symptoms, such as dribbling and incontinence or sexual health, which are important for the quality of life. At the very least, the patient should have a frank discussion with his physician if such symptoms are present and affect his life.
  • It also does not reflect regional or ethnic differences that can vary the responses to these symptoms.

urinary tract infectionsDigitial Rectal Exam

A finger is placed into the rectum to assess the size of the prostate and to detect any abnormal nodules (lumps) that may require further investigation.

Urianalysis

A urinalysis may be performed to detect signs of bleeding or infection. A urinalysis involves a physical and chemical examination of urine. In addition, the urine is spun in a centrifuge to allow sediments containing blood cells, bacteria, and other particles to collect. This sediment is then examined under a microscope. Although urinary infection is uncommon in younger men, it occurs more frequently in older men, particularly those with BPH.


Blood Tests

In men with symptoms, blood tests are performed to measure a substance called serum creatinine, which is a marker for kidney trouble. Kidney problems exist in an average of 13.6 percent of BPH patients. Studies have reported rates as high as 30 percent and as low as 0.3 percent.


PSA Tests for BPH and Prostate Cancer

A PSA test measures the level of prostate-specific antigen (PSA) in the patient's blood. It is the standard screening test for prostate cancer. A PSA is recommended annually for all men over 50 years old and for men over 40 who are at high risk for prostate cancer.


Postvoid Residual Urine

One of the important subjects of tests for urinary incontinence is the postvoid residual urine volume (PVR), the amount of urine left after urination. Normally, about 50 mL or less of urine is left; more than 200 mL is a definite sign of abnormalities. Measurements in between require further tests. PVR can be measured using transabdominal ultrasonography.


  • Transrectal ultrasonography (TRUS) uses a rectal probe for assessing the prostate. TRUS is significantly the most accurate method for determining prostate volume. It can sometimes detect cancer.
  • Transabdominal ultrasonography uses a device placed over the abdomen. It can give an accurate measure of postvoid residual urine and is less invasive and expensive than TRUS.

Urethrocystoscopyurinary tract infections

A urethrocystoscopy, also called cystourethroscopy, may be performed in men diagnosed with BPH, particularly if they are surgical candidates or if other urinary tract problems are suspected. Such problems include blood in the urine, infection, bladder cancer, or prior surgery or injury. The physician can determine the presence of a number of problems, including enlargement of the prostate, obstruction of the urethra or neck of the bladder, anatomical abnormalities, or the presence of stones. In this procedure, a flexible or rigid fiberoptic tube (an endoscope) is inserted into the urethra to allow doctors to view the lower urinary tract. The procedure is not without risks. Complications are uncommon but can include allergic response to anesthetic, urinary tract infection, bleeding, and urine retention.

 

Treatment Options

Mild cases of BPH usually require no treatment. A variety of treatments are available for moderate to severe cases, including medications, minimally invasive therapy, and conventional surgical therapy. urinary tract infections

  • Transurethral resection of the prostate (TURP) is the most common surgical procedure for treating BPH. The operation involves the removal of part of the prostate gland surrounding and constricting the urethra. The urologic surgeon passes a narrow tool with a wire loop on the end into the penis and through the urethra to the prostate gland. Electricity is then passed through the wire to heat it and cut the obstructing prostate tissue.
  • Laser vaporisation is performed with Thulium laser in high risk patients who are on anti-coagulants (Blood thinning agents)