Diagnosis of Benign prostatic hyperplasia (BPH):
The diagnosis for an enlarged prostate involves a combination of physical examination and diagnostic tests to confirm BPH. Since heredity is a risk factor for BPH, the doctor will analyze your family history report. The doctor recommends the following tests to rule out the possibility of enlarged prostate due to other conditions. Some of the diagnostic tests include –
- Ultrasound – Doctors generally recommend an ultrasound of the prostate gland to detect any abnormal growth within the prostate using 3D imaging. This test helps determine the amount of enlargement around the prostate.
- Prostate-specific antigen (PSA) blood test – Doctors usually recommend a PSA blood test to check for any increased PSA levels in case of enlarged prostate. This helps the urologists to detect signs of prostate cancer.
- Urinary flow test – This test is done to measure the strength and amount of your urine flow and determine if the condition is stable or getting worse with time.
- Postvoid residual volume test – Sometimes, when the patient is unable to empty the bladder completely, this test is recommended to measure the amount of urine left in your bladder after the urination. This is done via ultrasound or inserting a catheter into the bladder.
- 24-hour voiding diary – The doctors recommend this test to record the frequency and amount of urine expelled, especially if more than one-third of your daily urinary output occurs at night.
- Urine test – The doctor analyzes a sample of your urine to rule out any signs of infection or other conditions that can lead to similar symptoms.
- Blood tests – Blood tests indicate any infections in the kidneys and indicate abnormal functioning.
In case of moderate or complex cases, the doctor may recommend the following diagnostic tests –
- Digital rectal exam – The doctor inserts a finger into your rectum to check for any signs of prostate enlargement.
- Cystoscopy – A light, flexible scope called a cystoscope is inserted into your urethra to allow the doctor to see inside your bladder.
- Prostate biopsy – The doctor uses needles guided by a transrectal ultrasound to take a tissue sample of the prostate and analyze the tissue to rule out the chances of prostate cancer.
- Urodynamic and pressure-flow studies – This test measures the bladder pressure and determines how well your bladder muscles work using a catheter that is inserted through your urethra.
Enlarged Prostate Surgery
There are several surgical as well as non-surgical methods for BPH treatment which include various medications, dietary changes, and lifestyle modifications. However, non-surgical methods such as medications, home remedies, etc are effective to manage the symptoms of BPH and surgical treatment is the only method to treat enlarged prostate.
Minimally invasive surgeries – These surgical techniques involve minimal invasion that can often be done as outpatient surgery, meaning the patient may not require a hospital stay. Recovery is generally quicker, but it depends on the medical condition of the patient and the surgical expertise of the surgeon. Minimally invasive techniques such as TURP, TUIP, etc., help the patients relieve symptoms quickly and may nullify the need for medications. Minimally invasive procedures are recommended in case of the following situations-
- Your symptoms are moderate to severe
- Medications are ineffective
- Chronic urinary tract obstruction, bladder stones, or blood in your urine
- Preference of the patient
Based on these conditions, there are different techniques to perform minimally invasive procedures-
- Transurethral Resection of the Prostate (TURP)- This technique uses a light scope called a resectoscope. It is inserted into the urethra through the penis. TURP uses electric current or laser light to remove the outer tissue of the prostate. The patient is generally under the influence of anesthesia to ensure a painless procedure. The resectoscope provides light, irrigating fluid, and an electrical loop that cuts the tissues and seals the blood vessels. Finally, the removed tissue is expelled out of the body through a catheter.
- Transurethral Incision of the Prostate (TUIP)- TUIP is used to widen the urethra in case the size of the prostate is not significant but causes blockage. After the patient is administered with general anesthesia, the surgeon inserts a light scope to cut the tissues around the prostate gland to release the pressure of the prostate on the urethra. The patient generally finds it easier to urinate after the procedure. The surgeon may choose to leave the catheter in the bladder for a day or two after the surgery to drain the bladder.
- Transurethral microwave thermotherapy (TUMT)- In this procedure, the urologist inserts a catheter through the urethra to reach the prostate. An ‘antenna’ then sends microwaves through the catheter to heat the parts of the prostate that destroys the enlarged tissues to ease the flow of the urine. The surgeon uses a cooling system around the urinary tract that protects it from heat damage. TUMT is a low-risk procedure that may take time before the patient notices any results.
- Prostatectomy- This surgery aims to remove the entire prostate gland with either laparoscopic or robot-assisted technique. The surgeon makes an incision in your lower abdomen to reach the prostate and remove the surrounding tissues. It is generally done for very large prostate or other complicating factors. However, it has long-term benefits that may require a few days hospital stay after the surgery depending on the medical condition of the patient.
Laser surgeries – These are advanced surgeries that use high-energy lasers to destroy or remove the tissues around the enlarged prostate. Patients who undergo laser therapy procedures often feel instant relief. Moreover, laser surgeries have a lower risk of side effects than minimally invasive surgeries. Some of the advanced laser techniques for laser BPH procedures are-
- Photoselective Vaporization (PVP) – PVP is an advanced method to vapourize prostate tissues using a high-powered laser. It is an outpatient procedure which means the patient can go home on the same day of surgery after consulting with the doctor. This method causes minimal blood loss and the patient can recover quickly to resume his daily routine.
- Holmium Laser Enucleation of Prostate (HOLEP) – In this procedure, the urologist inserts a thin, tube-like instrument called a resectoscope through the penis and into the urethra. A laser is used to destroy the excess prostate tissue without the need for any incision or cuts. The patient is administered with general anesthesia for a painless procedure. The surgeon may choose to use a catheter which is usually removed the next day of the surgery.
- Thulium Laser Enucleation of the Prostate (ThuLEP) – This is a similar procedure to HOLEP, except for the difference in the type of laser used. The surgeon inserts a resectoscope through the penis and into the urethra. A laser inserted into the resectoscope that destroys the enlarged prostate to reduce the pressure on the urethra. There are no incisions and the patient is administered with general anesthesia before the surgery for a painless procedure.
Medication for Prostate Enlargement:
- BPH Medications – Doctors generally prescribe medications to treat men with mild to moderate symptoms of BPH. These medicines ease the symptoms by calming the muscles in the prostate and bladder. However, there may be some side effects related to corresponding medications depending on the condition and severity of the disease. Some categories of medications prescribed by the doctor for BPH include-
- 5-Alpha Reductase Inhibitors [5-ARIs]
- Tadalafil (Cialis)
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