By Dr. H. S. Bhatyal, Senior Director & HOD – Urology & Renal Transplantation, BLK-Max Super Speciality Hospital, New Delhi
Prostate is a small walnut shaped gland in men that sits just below the bladder and surrounds the urethra (tube carrying urine outside the bladder). Prostate has various functions -seminal fluid secretion (component of semen), hormone production and regulates flow of urine.
Prostate enlargement issues are common in men especially > 50 yrs. of age and 50 % patients would develop some prostatic symptoms. Symptoms could be bothersome, disrupting quality of life.
Symptoms
- Obstructive symptoms – Hesitancy, thinning of urine stream, intermittency, incomplete emptying of bladder, overflow incontinence (passing urine without knowledge)
- Irritative symptoms – Increased frequency, urgency (difficult to control urine), involuntary passing of urine, pain during passing urine
- Haematuria – Blood in urine (rarely)
Severity of symptoms may vary from person to person, some may carry on, others may find it difficult as it impacts daily activity & sleep.
Diagnosis
1. Physical Examination – Digital rectal examination : USG of kidney, ureter and bladder area is mandatory to check the size of prostate, abnormal texture, bladder volume, residual urine after passing urine and state of kidneys
2. Blood Test – PSA : Marker of prostate cancer
Neglecting the symptoms may lead to large volume of urine in the bladder-resulting in recurrent UTI, bladder stones formation and deterioration of kidney function.
Treatment
Treatment primarily depends on type of symptoms
1. Lifestyle changes – Limit tea coffee, alcohol intake, decreased fluid intake in evening
2. Medical management – For medical management following medications are prescribed to settle the condition
- Relaxation of prostatic muscles and bladder neck- Alpha blockers-Alfuzosin, Tamsulosin & Silodosin
- Decrease the size of prostate – Finasteride, Dutasteride (this is given in elder patients with large prostates)
- Irritative symptom treatment – Solifenacin, Darifenacin, Mirabegron
3. Minimally invasive treatments – Laser Vaporisation of prostate, TURP, Bipolar TURP, HOLEP (Holmium laser )
- Urolift, Rezum Therapy: (modalities need to be established)
5. Robotic simple prostatectomy -The surgery is done for very large sized prostates
6. Open prostatectomy-This procedure is very rarely done now a days
