I am Dr. Tanuj Paul Bhatia, urologist at Sarvodaya Hospital, Faridabad. Today we will talk about benign enlargement of prostate which is affecting at old age. Prostate gland is a walnut-shaped gland which is in our body and we pass urine through prostate which comes out through urethra. When prostate gland increases in size with age, it causes some sort of infection to the flow of urine and that is when the patient develops the symptoms of prostate enlargement. Some patient also feels the urgency to urine. The most common symptoms of the disease are poor flow of urine. They also develop intermittency i.e. urine does not pass out in one stream. The patient wants to pass urine but he is not able to pass the same and he has to wait. When patient feels to urinate, they have to rush to the bathroom and if they ignore or hold it back they may develop urine incontinence. Patient may also suffer from the increased flow in urination. Patient may also suffer from the problem of blood in urine i.e. called hematuria. It should trigger complete evaluation of the patient. When the patient comes to us with these symptoms, we examine the patient with these symptoms.
Urinary symptoms also referred to as lower urinary tract symptoms. After complete history and examination, we move on to investigation. So, we start the treatment with ultrasound. Some diabetic patients may not know that they are holding urine back in the bladder. Blood test for prostate enlargement is kidney function test, prostate-specific antigen (PSA) test. This includes infection of prostate or prostatitis, prostate cancer. So, PSA is used as a screening test. There is a test in which patient is asked to pass urine in a special commode which is connected with the computer through which we can check the flow of the urine. Other than that we also get a urine routine and urine culture test done for all those patients who come to use with urinary symptoms.
At times we see that patient does not have any symptoms but when ultrasound is done, we see a problem in the prostate. When symptoms are bothersome, that is when you require treatment for prostatic enlargement. Few patient require surgery for the same. We use different types of drugs to treat this problem. Patient develops prostate as well as erectile dysfunction problem. When we talk about the surgery so, those days are gone when big surgeries where happening. Now the prostate is operated with endoscopically through the urinary tract. Any size of the prostate can be taken out with this procedure. 2 main techniques are used fo this procedure. One is electrocautery and it is referred to as TURP (transurethral resection of the prostate) and another method is used called laser (laser prostatectomy).
How to know you require surgery or not? If you are not responding to the medications at all, you require surgery. If you are responding to the medicines and not having satisfactory result, you need surgery. If you develop recurrent urinary tract infection because of prostatomegaly than you require surgery. If you develop recurrent bleeding in urine i.e. hematuria, you do require surgery. In addition to these, some patient develops stones in bladder because of blockage in urine due to prostate, those patients are straight away the indications of surgery. If the disease is neglected for a very long time, the patient may develop kidney disease i.e. a renal failure. So, 2 types of surgeries are there. Both are done through endoscopy without any cuts. Most common surgery is TURP. In this technique, electrocautery is used and with the small cuts we push into the bladder and then they are taken out. It is a technique which is there for very long.
It is a time tested technique. It has very good results. However, if the prostate is very large and patient is taking medicines for blood thinner which is very common and used for coronary artery diseases so, these patients have the risk of bleeding. They have the risk of excessive bleeding during the treatment. That is why they benefit from laser prostatectomy. Also, with TURP there used to be a risk of dilutional hyponatremia which is referred to as TORRE syndrome. With the laser treatment, the risk of TORRE syndrome is very less. So, the advantage of laser prostatectomy is in the patient with large prostate, in patients who are on blood thinner and in patients with chronic disease.