The prostate is a single gland, which is located in men below the bladder. It is a part of an internal sphincter of the urethra (which allows to keep the urine inside the bladder when we don’t think about it). Also produces a discharge, which is a part of men’s sperm.
Benign Prostatic Hyperplasia is a disease, which affects about 50% of men over 50 Yrs. It is characterized by enlargement of prostatic cells, resulting in the formation of large, fairly discrete nodules in the periurethral region of the prostate. When sufficiently large, the nodules compress the urethral canal to cause partial, or sometimes virtually complete, obstruction of the urethra which interferes the normal flow of urine. It leads to symptoms of urinary hesitancy, frequent urination, increased risk of urinary tract infections and urinary retention.
Benign prostatic hyperplasia symptoms are classified as obstructive or irritative. Obstructive symptoms include hesitancy, intermittency, incomplete voiding, weak urinary stream, and straining.
Irritative symptoms include frequency of urination, which is called nocturia when occurring at night time, and urgency (compelling need to void that cannot be deferred). These obstructive and irritative symptoms are evaluated using the International Prostate Symptom Score (IPSS) questionnaire, designed to assess the severity of BPH.
BPH can be a progressive disease, especially if left untreated. Incomplete voiding results in stasis of bacteria in the bladder residue and an increased risk of urinary tract infections. Urinary bladder stones are formed from the crystallisation of salts in the residual urine. Urinary retention, termed acute or chronic, is another form of progression. Acute urinary retention is the inability to void, while in chronic urinary retention the residual urinary volume gradually increases, and the bladder distends. Some patients who suffer from chronic urinary retention may eventually progress to renal failure, a condition termed obstructive uropathy.
To diagnose BPH I evaluate the IPSS questionnaire, ask about other symptoms, take the medical history of the patient and perform examinations. These include DRE (digital rectal examination, which allows me to estimate the size of the gland and helps to rule out other conditions as inflammation of prostate or advanced prostate cancer), lab tests (renal function panel, PSA to rule out prostate cancer, urine test to rule out infection), radiology tests (USG to assess the kidneys and bladder, see the shape and volume of the prostate and measure the residual volume of the bladder after passing urine) and Uroflowmetry (to confirm weak urine stream).
After all these procedures it’s time to discuss with the patient about possible ways of treatment.
Currently, we have many effective drugs to lower the intensivity of symptoms and improve the quality of life of our patients. Two main groups of them include alpha-blockers, like tamsulosine or alfuzosine (which relax the smooth muscles of the prostate gland that makes the urethra wider during passing urine) and 5-alpha reductase inhibitors, like dutasteride (which lower the volume of prostate and gradually improve the power of urine stream). Medicaments have also their side effects, that’s why should be always advised by Urologist, who can select the treatment individually to each patient.
If medical treatment fails, transurethral resection of prostate (TURP) surgery may need to be performed. This involves removing part of the prostate through the urethra. There are also a number of new methods for reducing the size of an enlarged prostate, like vaporization of the prostate using laser fiber. This method of treatment is also available in Saudi German Hospital and is in my scope of work.
A technology called Photoselective Vaporization of the Prostate (PVP) with the GreenLight (KTP) laser have emerged in last 10 years. This procedure involves a high powered 180 Watt KTP laser with a laser fiber inserted into the prostate. This fiber is used to vaporize the tissue to the prostatic capsule. KTP lasers have a penetration depth of 2.0mm, cause minimal bleeding which is safe to the patient. Usually, vaporization of the prostate using KTP laser may be performed as a one-day treatment.
If the volume of the prostate is too high, an open, not endoscopic surgery has to be performed. In that case, I open the bladder through the incision in the lower abdomen and this way enucleate the enlarged part of the prostate. After this kind of surgery, patient has to spend in the hospital 7 to 10 days.
Remember, the problems with passing urine are quite common in men above 50 and can increase with age. They shouldn’t be treated like a taboo. If You feel, that Your urine stream is getting weaker, wake up at night, need to push, or You see these kinds of symptoms at Your relatives – please read and fill the questionnaire and count the points. If Your score is 8 or higher – do not hesitate to book a visit in my office. I will talk with You and I’m sure, You will find a help with me.
Dr. Maciej Szwedowski, M.D., PhD, FEBU
International Visiting Professors
Saudi German Hospital Dubai