Enlarged Prostate – Neo trends in the management of BPH

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The medical term for an enlarged prostate is called benign prostatic hyperplasia (BPH). It is quite common in men over the age of 50. BPH is a disease that causes lower urinary tract symptoms (LUTS) and is one of the most common diseases associated with aging.

What is the main cause of prostate enlargement?

Enlargement of the prostate gland occurs when the cells of the prostate start to multiply inadequately. The enlarged prostate causes are still untold but it is assumed that it happens due to the change in the sex hormone.

As the medical term suggests, it is not cancerous or severely critical for health but it does lead to various discomfort and change in your life.

Symptoms: How to know about enlargement prostate?

The enlarged prostate symptoms can vary for every individual. Some of these symptoms are usually mild and harmless while others can be extremely painful to put up with. The common symptoms of an enlarged prostate include:

  • Difficult in peeing completely
  • Frequent urge to pee
  • Sudden urge to urinate
  • Dribble at the end of Urination
  • Painful Urination

If you experience such symptoms in your body then consult a doctor immediately. If ignored in the initial stage, the problem can grow out to be immensely hard to bear.

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Diagnosis of Enlarged Prostate

The most common diagnosis of an enlarged prostate is performing a rectal examination which involves inspecting the size and shape of the prostate gland. In addition, there are some of the most common Prostate enlargement tests that help with diagnosis:

  • Urinalysis
  • PSA (Prostate-specific Antigen) Test
  • Urodynamic Test
  • Post-Void Residual
  • Ultrasonography
  • Cystoscopy
  • Prostatic Biopsy

What is the best treatment for Enlarged Prostate?

Enlarged Prostate treatment depends on the severity of the symptoms. Mildly enlarged prostate symptoms can be resolved with making some lifestyle changes including yoga, exercises, home remedies etc. However, if the symptoms are grievous then surgical operations are advised. The objective of treatment for BPH is to improve quality of life and to treat Urinary symptoms as mentioned above.

Treatment with medication

Here are some of the usually recommended enlarged prostate medication by Urologists:

  • Alpha-1 Blockers
  • Antibiotics
  • Hormone reduction medications

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Surgical treatment options

Treatment options for men with prostate obstruction have existed for years. But what is new in 2020? What is making this branch of medicine such an exciting area to be working in? Much of it is to do with the medical technology revolution as the new technology making treatments less invasive.

Surgical management is indicated when patients have moderate to severe symptoms accompanied by complications such as infection, hematuria and upper urinary tract obstruction, or when they do not respond to medical management.

There are various surgical operations for the treatment of enlarged prostate:

Transurethral incision of the prostate (TUIP):

It is a surgical operation that employs an instrument inserted into the urethra that induces an electric current to create an incision in the prostate.

Simple Prostatectomy:

It is a procedure that involves the removal of the inner part of the prostate gland. This surgery involves making an incision in the lower belly.

TURP (Transurethral resection of the prostate):

It is a surgical procedure that involves the removal of a selective portion of the prostate.

TURP has long been the standard of care for the surgery of BPH unless the prostate was very large and, in that case, an open operation was performed with the goal to improve upon these techniques to provide better outcomes with less morbidity.

 HOLEP (Holmium laser enucleation of the prostate):

With the advancement in technology, laser treatment has challenged TURP as the surgical treatment of choice.

This procedure can be an option for men who have a severely enlarged prostate. In this procedure, a laser is used to cut and remove the excess tissue that is blocking the urethra breaking the enlarged prostate tissue into small pieces that are easily removed afterward.

Benefits of LASER prostate surgery over other methods of treating Benign prostate enlargement, such as transurethral resection of the prostate (TURP) and open prostatectomy are:

  • It has lower risk of bleeding.
  • It can be viable for any size of prostate.
  • Shorter or no hospital stay.
  • Quicker recovery when compared with recovery from open surgery.
  • With laser surgery, a catheter is generally required for less than 24 hours.
  • Improvements in urinary symptoms from laser surgery are noticeable with immediate effect after laser surgery.
  • The risk of sexual dysfunction after Laser Prostate Surgery is generally lower than with traditional surgery.

Robotic Surgery:

Robotic surgery is a minimally invasive technique for performing prostate removal surgery. Robotic prostatectomy is used to treat patients who have prostate cancer.

The radical prostatectomy is a surgical treatment for prostate cancer, that removes the entire prostate gland.

Robotic prostate cancer surgery using the offers several advantages over the traditional laparoscopic surgical method of treating prostate cancer focusing on the following areas:

  • Patients experience significantly less blood loss.
  • The Robotic prostate surgery system provides the surgeon with a revolutionary, three-dimensional, multi-level magnification spectrum allowing the surgeon to make highly precise movements inside the incision during robotic prostate cancer surgery removing the malignant tissue efficiently.
  • It helps the Uro-surgeon to avoid damaging healthy prostate tissue thus improving clinical results
  • Reduces risk of complications and infections
  • Robotic prostatectomy uses small incisions hence minimizes scar tissue build-up
  • The risk of incontinence is low after surgery
  • The surgical technique is continuously refined to improve potency.
  • Reduced hospital stay and faster recovery
  • Less pain after surgery

Despite all the new medical and surgical options available, the key message remains that there is not a one-size-fits-all approach. An adult with a largely sized prostate who ends up in urinary retention with a catheter would have different requirements than a young sexually active man with worsening of his symptoms over time causing significant social impact. Both are affected by clinical BPH, but it is up to the Urologist, in discussion with the patient, to come up with an individual treatment plan suited to their needs.

It is of utmost importance that the patients understand the full range of available treatment options to make an informed decision and pursue the treatment best for their individual medical situation.