One of the most common problems faced by ageing men is benign prostatic hypertrophy. Prostate is the gland at the base of the urethra near the bladder and when it enlarges it can lead to symptoms, mostly related to urination.

1. Frequent urge to pass urine
2. Prolonged urination
3. Frequent nocturnal visits to the toilet
4. Intermittent urination
5. Difficulty to start urinating
6. Inability to completely empty the bladder
7. Urinary tract infections

There are medications available to manage this, but offer only temporary relief. Many men therefore prefer to have the surgery undergone to manage these bothersome symptoms. However, like any surgery, the risks and benefits need to be considered along with other conditions like age, overall health status, other comorbid conditions, etc.

Surgical removal of the enlarged prostate gland is a more definitive approach to manage these symptoms. In addition to providing a quick cure, it also is used in the following cases:

1. Patients who do not respond to medications
2. Presence of blood in the urine
3. Associated bladder stones
4. Frequent infections of the urinary tract
5. Associated damage to the kidneys

Procedure of Surgery
During the procedure, a tube is passed through the tip of the penis into the urethra towards the bladder neck. Once it is in the desired position, laser is passed through it to deliver energy that acts on the prostate to either completely or partially destroy it. There are two methods by which laser acts on the enlarged prostate and making way for free flow of the urine.

1. Ablation: Excess prostate tissue is melted away by the laser by using photosensitive vaporization of the prostate. This is also known as Greenlight laser therapy or KTP laser vaporization. Alternately, Holmium can be used as the source of laser energy to ablate the prostate tissue.

2. Enucleation: Excess prostate tissue is cut and teased out through the urethra. Holmium laser is used to resect the prostate into smaller pieces, which are then removed out through a resectoscope. Another technique uses a tissue morcellator which grinds the enlarged prostate into smaller pieces to enable easy retrieval.

More men now opt for laser prostate removal as it has the following advantages:

1. Reduced risk of bleeding: This becomes essentially important in patients who are on blood thinners.
2. No hospitalization: This can be done either as an outpatient or with minimal one day stay at the hospital
3. Immediate symptom relief: As compared to medications, the relief is felt almost immediately after the surgery
4. No catheter: With laser surgery, a catheter may be required for less than 24 hours unlike in open surgical cases.

As noted above, as with any surgery, once enlarged prostate symptoms set in, have a detailed discussion with your doctor to identify if you are a suitable candidate for laser surgery.

Know About Laser Prostate Surgery

Benign prostatic hyperplasia or BPH is a condition where the prostate gland gets enlarged. This is mostly common in men who are ageing. When the prostate gland gets enlarged, the flow of urine through the urethra gets blocked, and hence, several problems related to urination may occur. BPH occurs as a result of hormonal imbalance. If untreated, BPH can lead to severe bladder and urinary health conditions.
There are several symptoms and signs of benign prostatic hyperplasia. Here are 7 common symptoms:

1. A frequent need for urination: Men affected by BPH feel an increased need to urinate frequently. This gets enhanced during the night and is called nocturia. The patient may even need to urinate more than eight times a day. Due to the enlarged prostate gland, more pressure is put on the urethra, which leads to uncontrollable urination.
2. Urinating difficulties: The act of urination becomes difficult. Because of enhanced pressure on the urethra, the flow of urine to the penis from the bladder gets blocked. This makes a urine stream hard to start. The urine stream gets weak and interrupted, and more difficulty may be experienced during the end of urination.
3. Pain during urination and ejaculation: Due to pressure on the urinary tract and reproductive system, pain can accompany urination and ejaculation. Some patients tend to push urine out, which results in pain. The pain may also occur because of infection during BPH.
4. Blood in urine and an unusual color/smell: Urine may take a dark color and have an unusual smell due to urinary retention. Unpleasant urine smell signifies urinary tract infection. Blood in the urine may also result because of dilated veins present on the surface of the enlarged prostate.
5. Urinary retention: When a patient is unable to pass any urine, it is called urinary retention. Such a condition requires immediate treatment, and you need to consult a doctor immediately.
6. Urinary tract infections: Bacteria may start growing in the bladder when the bladder is not fully emptied of urine. This bacterial infection causes darkening of the urine, and emission of a foul odor.
7. Bladder stones: Bladder stones may develop because of the inability of the bladder to empty itself completely. This is a major symptom of BPH. Hard lumps of minerals or bladder stones are formed when the urine present in the bladder gets highly concentrated, which causes the crystallization of minerals. Bladder stones may cause infections, result in blood in urine, cause bladder irritation and may also block urine flow.

So you see that benign prostatic hyperplasia involves the enlargement of the prostate gland, and results in several problems related to urination and different symptoms. Hence, immediate treatment is advisable.

7 Symptoms of Benign Prostatic Hyperplasia

Causes and symptoms of enlarged prostate

The problem of an enlarged prostate or benign prostate hyperplasia is a very common occurrence as you grow older. It's known to strike men above the age of 50, with more than 50% of men after the age of 60, having this complaint.

Causes of enlarged prostate

A non-cancerous condition, enlarged prostate makes the passing of urine from the bladder through the urethra difficult. The multiplication of the prostate cells causes an enlargement of the gland, leading to a buildup of pressure on the urethra, affecting the discharge of urine from the body. The narrowing of the urethra, due to this benign condition, forces the bladder to contract more vigorously so as to push urine out of the body.

As time passes, the muscles of the bladder get significantly affected, causing them to become extremely sensitive, thicker and stronger. As a consequence, the bladder begins to contract, even if the amount of urine in the organ is negligible, causing episodes of frequent urination. Gradually, the bladder fails to completely empty itself of urine due to the constriction of the urethra. This can give rise to a number of health problems including the formation of bladder stones, urinary tract infections, blood in the urine and so on.

How can you identify the signs of the condition?

Signs of enlarged prostate are very easy to identify and include:

- A slow or weak urine flow
- Difficulty in initiating urination
- Instances of frequent urination
- A feeling of not completely emptying one's bladder
- Frequent urination during the night
- Exerting a lot to urinate
- Instances of dribbling
- Urgency to pass urine
- A feeling of urinating again minutes after doing so
- Urination that starts and stops



What Leads to an Enlarged Prostate?

One of the most common issues with old age in men is the enlarged prostate. Any difficulty with urination (no constant stream, difficulty initiating, or incomplete emptying of the bladder for instance), and the first suspect is an enlarged prostate. These symptoms are followed by a digital rectal exam to check for an enlarged prostate. Once confirmed, the next step is to check for levels of prostate-specific antigen (PSA). If both the exam and the PSA are positive, it could mean prostate cancer. As with any cancer, it is believed that sooner it is diagnosed and the treatment is started, the better.

Historically, the best way to rule out the prostate cancer had been to do a prostate biopsy. This is a minor invasive procedure, wherein biopsies are taken from various regions of the prostate which are known to develop cancer (about 12). A disadvantage of this procedure includes missing out on the front part of the prostate which can also develop cancer. Secondly, it is not a very pleasant experience and given a chance, most men would not want to have it done.

There is good news for these men who would like to avoid prostate biopsies. The first is the multiparametric MRI which uses no x-rays and is considered very safe with extremely accurate results. This MRI exam requires about an hour, and once the images are obtained, the doctor will analyse these images and check for several parameters to assess for prostate cancer. The absence of cancer can be confirmed with up to 90% accuracy, which is far greater than with usual biopsies. If there is a possibility of cancer, then a biopsy can be done to confirm it. 

Also, these images indicate the exact region where cancer likely is, and this guides the doctor to biopsy only where absolutely essential. The chances of false positive and false negative results are reduced drastically. The one disadvantage here is that MRI detected biopsies usually tend to be of a higher grade which requires immediate treatment.

Another way to reduce chances of the biopsy by 30% to 50% is by the 4K test. It helps detect a variety of prostate issues including cancer. It can be used once higher levels of PSA is identified and before going for a biopsy. It combined 4 prostate-specific biomarkers with clinical information to accurately provide men with a risk of developing prostate cancer. It can be used even after negative biopsies to confirm the diagnosis of prostate cancer.

These two measures can drastically reduce the incidence of prostate biopsies, which is neither pleasant for the patient nor very effective for the doctor.

Prostate Biopsies - Ways You Can Avoid It!

The prostate gland in a man begins to grow in size on reaching 25 years of age quite naturally, and this is known as benign prostatic hyperplasia abbreviated as BPH. Now the problem arises when the enlargement of the prostate is more than normal.

In men, the urine flows through the urethra from the bladder. An abnormally enlarged prostate blocks the flow of urine through the urethra. The cells of the prostate slowly multiply to cause it to enlarge. This puts pressure on the urethra thereby giving rise to a number of problems, most of which manifest as symptoms.

Common Symptoms of an Enlarged Prostate Gland
The condition of enlarged prostate gives rise to some noticeable symptoms which provide the signs that you need to visit a doctor to get it treated. A weak or slow urinary system is one of the most common symptoms of being affected with an enlarged prostate. This includes urinating more often, an increase in the urgency to urinate, difficulty in starting urination and a feeling of incomplete bladder emptying immediately after urinating. At times, it is seen that passing urine becomes very strenuous. All these above symptoms indicate that there is an enlargement of the prostate gland and medical help should be sought immediately to prevent the condition from worsening.

Steps to Manage an Enlarged Prostrate

Effective medication is usually the first step in the management of an enlarged prostate gland. Alpha blockers are the drugs that are most commonly used in this situation. These drugs do not reduce the size of the prostate, but they are great in relieving the symptoms to allow free and painless passage of urine. Another group of drugs known as 5-alpha reductase inhibitors can help in shrinking an enlarged prostate. The drugs work by the reducing the levels of the male hormone called dihydrotestosterone.
In some advanced stages of prostate enlargement, minimally invasive treatments are used for the effective management of the condition. Transurethral Microwave Thermotherapy or TUMT is used to treat mild blockages that reduce the frequency of urination, the urgency, and straining. However, it is not able to correct the bladder emptying issues. Transurethral Radio Frequency Needle Ablation or TUNA helps in the destruction of the prostate tissues resulting in an improvement in the flow of urine.
Prostatic stents are also sometimes used for the management of the condition of an enlarged prostate. In this treatment procedure, a small metal coil is inserted into the urethra for widening it and keeping it open. In most severe case of prostate enlargement, only surgical methods remain as the opted method of treatment. Laser surgeries are performed to destroy the tissues of the prostate for easing of the condition. Ultimately, an open prostate surgery is performed when the transurethral procedure cannot be used. In this surgery, the tissues of the prostate are removed by the surgeon in case of great enlargement.
The condition of an enlarged prostate gland requires medical attention and treatment for the most effective management, and it is best that a medical professional is consulted as soon as any of the symptoms surface.
Enlargement starts usually after 50 years. Surgery 'Transurethral resection of prostate (TURP)' either by monopolar or bipolar electrocautery. Enucleation of prostate by laser is also an option.

Enlarged Prostate - How Can It Be Managed?

As men enter their middle age, many of them develop issues with their prostate gland. There are certain symptoms that would tell you that your prostate glands have stopped functioning smoothly. It is recommended that you opt for a thorough check up when you suspect something wrong. This is because untreated prostate issues can lead to prostate cancer later in life. To avoid such a situation, it is best to get it treated as soon as possible.

Here are certain common symptoms which would make you aware of the issues that might affect your prostate gland.

Bladder Discomfort: When you frequently start experiencing the feeling of your bladder not emptying completely, then it is time to consult an urologist for the problem. Such bladder discomforts are linked to prostate gland malfunctioning.
Increased frequency of urination: Ideally a person urinates around six to eight times a day. Depending on the intake of liquid or water it can even rise up to ten times. But if you are urinating more than ten to twelve times, then it is definitely a matter of concern and you should approach medical help for it.
Dribbling of urine: when you notice that the flow of urine is not stable and it starts dribbling for a long time, then you must understand that the prostate gland is not functioning properly. This is one of the earliest signs of prostate disorders.
Waking up frequently at night to use the washroom: It is not very normal to wake up frequently at night to use the washroom. But when you notice an increase in your trips to the washroom at night, it can be a sign of prostate malfunctioning.
Pain in penis or blood in the flow of urine: If you feel pain when you are trying to empty your bladder or anytime during the day, then it is a matter of concern. Similarly, if there is a flow of blood, even in the slightest, in your urine, then it is time to opt for a check up with your medical practitioner.
Hence, these are the major symptoms which reflect that the functioning of your prostate gland is not as smooth as it is supposed to be. If you can relate with any of these symptoms, ideally you must immediately consult your medical practitioner and take an expert opinion. Medical science has progressed a lot in contemporary times and prostate disorders are very much treated by medicines and procedures. It is a very much curable problem provided you get the right help at the right time.

Prostate Enlargement - 5 Signs You Are Suffering From it!

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