Aashray urology institute

Benign Prostatic Hyperplasia

Overview
BPH or Benign Prostatic Hyperplasia is the enlargement of the prostate due to hormonal changes after the age of 40. Several effective treatments like Medical Management, Surgical Options like Bipolar Enucleation, Bipolar T.U.R.P., T.U.B.E. (Trans-Urethral Bipolar Enucleation) are offered at Aashray. 
Benig Prostatic Hyperplasia overview
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What Is Prostate?

The prostate gland is present in all males. It is the size and shape of a walnut and is situated around the urethra, at the base of the bladder. It produces prostatic fluid (part of the semen in which sperms travel). With advancing age, as the hair grows white and the eyes develop a cataract, so too does the prostate gland enlarge.

prostate-img

What Is BPH/ Benign Prostatic Hyperplasia?

When the prostate gland starts to enlarge due to hormonal changes after the age of forty, it is called BPH or Benign (non-malignant) Prostatic Hyperplasia (enlarged). BPH doesn’t always cause a problem. In some cases, men have an enlarged prostate and don’t know about it; however, in other cases, swelling causes the problem. 

The enlargement of the prostate is a slow and painless process and all it does initially is cause poor urinary stream. Therefore, unfortunately, as it doesn’t cause any pain, many people don’t recognize this in time, or even when they recognize it, they don’t seek urological help considering it is an age-related process. Thus, when they approach a urologist when it’s too late when a lot of urine is retained in the bladder or they can’t pass urine at all or the kidney is damaged badly. 

Benign Prostatic Hyperplasia

What Are The Types Of BPH/Benign Prostatic Hyperplasia?

What Are The Symptoms Of BPH/Benign Prostatic Hyperplasia?

Dr. Ashit Shah, MB, MS, DNB(Urology), DLU(France), has listed symptoms BPH has. They are as follow - 

  1. A slow, interrupted, or the weak urine stream
  2. Difficulty in starting urine flow
  3. Need to strain while urinating
  4. The urgency in the need to urinate
  5. Frequent urination, especially at the night
  6. “Leaking” or “Dribbling” before or after urination 
  7. In extreme cases, one might not be able to urinate at all. In this emergency, immediate catheterization is required followed by surgery later on. 

What To Expect During The Health Checkup?

During the health checkup, the following tests will be taken to arrive at a diagnosis - 

  1. A history of symptoms and Prostate Symptom Score
  2. A digital rectal examination to know the size and condition of the gland
  3. Ultrasound study to know the volume of the prostate gland, post-void residue, and the status of kidneys 
  4. A urine flow study (Uroflowmetry) to measure how fast the urine flows 
  5. A urine microscopy test to detect infection
  6. A prostate-specific antigen (PSA) test to rule out Prostate Cancer

What Are The Treatments Options For BPH/Benign Prostatic Hyperplasia?

Not everyone with an enlarged prostate needs surgical treatment to remove it. Some may be candidates for medical management while some may not require any kind of treatment at all because what’s important to know is not merely whether the prostate is enlarged or not but also whether it is an obstructive enlargement. Surgical treatment or removal is needed only when the prostate is obstructive. The prostate’s obstructiveness is assessed by the combination of sonography and uroflowmetry, which helps the urologist decide the management. 

1. Medical Management:

In non-obstructive enlarged prostate, the patient is prescribed medicines that help reduce his symptoms and improve his urine flow. However, it should be borne in mind that these drugs do not remove the prostate and they have to be taken for a long time (sometimes life long) as symptoms may recur once medicines are stopped.


2. Surgical Options: 

Open Surgery, Transurethral Resection Of The Prostate (T.U.R.P.), Holmium Surgery, Bipolar T.U.R.P., Bipolar Enucleation Of The Prostate, TUNA, TMT.

What To Expect Before Surgery?

For all the surgical treatments for BPH, you can expect the following - 

  1. You will be admitted on the day of the surgery.
  2. You may be asked not to eat or drink a few hours before the surgery.
  3. You will be given regional anesthesia. So, you won’t feel any pain or discomfort during the actual procedure which may take around 30-120 minutes depending on the size of the prostate and the type of the procedure. 

Open Surgery

Traditionally, the prostate is removed by open surgery which required a hospital stay of a minimum of 7-10 days and had considerable morbidity in the form of pain, bleeding, infection etc., and a higher mortality rate. Open surgery is rarely indicated and even huge prostate glands (100 gms or more) can be safely removed with the latest techniques like Bipolar T.U.R.P. and Bipolar Enucleation.

Transurethral Resection Of The Prostate (T.U.R.P.)

  • The standard operation for removal of the prostate has been T.U.R.P., wherein the prostate gland is removed endoscopically without incisions/stitches. This is a painless procedure with much less morbidity, mortality, and hospital stay. T.U.R.P. is the most commonly performed surgery for the prostate worldwide. It has been long considered the golden standard surgery for the prostate. However, it has certain disadvantages like bleeding, T.U.R. syndrome (electrolyte and blood abnormalities in the body), and also it is less safe in the patients who have large prostate glands (>80 gms) and patients who have high risk, that is, patients who have compromised heart, lung etc. 
Transurethral Resection Of The Prostate

Holmium Surgery

Many laser surgical options have been tried out for the prostate but none has been successful. Nowadays, holmium laser is being promoted as standard therapy for BPH but it is not internationally accepted as it’s not efficient as T.U.R.P. Also, it is a lengthy surgery as compared to T.U.R.P. and it causes a lot of dysuria post-operatively. Many times, there is no resected prostate tissue available for histopathological examination. Thus, holmium laser surgery is definitely not an alternative to the standard T.U.R.P. operation in all cases. It may be of use in a selected group of patients. 

Holmium Surgery
Holmium Surgery

Bipolar T.U.R.P.

This is a novel surgery that is an improved version of the standard T.U.R.P. surgery and it makes the surgery for the prostate very safe. In this procedure, no electric current passes through the body and there are negligible chances of T.U.R. syndrome. There is much less bleeding during the procedure and the recovery time is shorter. The operating time is also comparatively shorter. Hence, it can be performed in patients with small and medium-sized prostate glands. It is much safer in high-risk patients and even in patients with heart pacemakers. It is cheaper than Holmium Laser Surgery and thus has the advantages of T.U.R.P. and Holmium Laser Surgery but disadvantages are none. Bipolar T.U.R.P. is thus considered to be the platinum standard surgery for the prostate.

Bipolar Enucleation Of The Prostate:

This is the latest technique for prostate surgery in the world which simulates open surgical removal of the prostate minus its complications. Aashray Urology Institute, is one of the pioneers in India to offer this technique to our patients using the prototype “Vapo EnucleAtion Loop'' by Karl Storz. This technique is best suited in patients with large and very large prostate glands. 

TUNA, TMT etc.

Other minimally invasive options like TUNA, TMT, HIFU, Prostate Stent etc. have not been able to replace Bipolar T.U.R.P. 

What To Expect After The Surgery?

It’s natural to be concerned about how you will feel and what your physical limitations might be after the surgery.  You may expect the following things after any surgical procedure for BHP - 

  1. You can eat and drink after 4-6 hours.
  2. Your catheter will be removed after 2-5 days.
  3. You may have to take stool softeners to avoid strain and risk dislodging scabs from your healing prostate cavity.
  4. The color of urine may be red. Drink a lot of water to prevent clots and to wash them away. 
  5. You may also continue to see blood in your urine later as scabs break off from the wound. 
  6. Initially, for the first few days, you may find difficulty in holding urine and it may take a while before you can control your bladder entirely.
  7. Your prostate is likely to be sore, limiting your normal activities for a while. Do not strain yourself and avoid heavy physical activities and lifting heavy objects.
  8. Eat normally, limit your activity to walking, and avoid sex for 6-8 weeks till the wound heals.

What Are The Risks Associated With Surgical Procedures?

There are risks and possible complications with any surgical procedure. One side effect is retrograde ejaculation. After the surgery, as the prostate gland is removed, during the orgasm semen may travel backward into the bladder and not come out through the urethra. It may later come out along with urine. This is normal and harmless. The feeling of orgasm is the same as was before the operation, only the ejaculation is not seen outside. 

Contact the doctor immediately - 

  1. If you have excessive bleeding.
  2. If you have a fever and chills.
  3. If you have trouble while urinating.
  4. If you have to strain even after taking stool softener/laxatives. 

Why Choose Aashray?

  1. Aashray Urology Institute, is a dedicated center for stone surgery offering minimally invasive options.
  2. At Aashray, LUMENIS Laser Lithotripsy (world’s no.1 lasers) are used.
  3. It is equipped with the world’s best intracorporeal pneumatic lithotripsy system (Swiss lithoclast). 
  4. It is the first private institute in Gujrat to use Miniperc XS and Allengers Extracorporeal Lithotripsy System.
  5. World-class endoscopy instruments including Flex X2 Flexible Ureteroscope are used at Aashray. 
  6. At Aashray, dedicated urological ultrasound (BK Medicals) is used for interventional procedures.
  7. Xenon light source is used at Aashray.
  8. At Aashray, the Spies System (STORZ) is used for recording and documentation.
  9. At Aashray, all endoscopic procedures are done under fluoroscopic guidance as well as video monitoring. Also, after all procedures are done, check x-rays are taken to confirm 100% stone clearance.
  10. At Aashray, not just the machines but the man behind the machines is an expert too with the conversion rate < 0.001%. 

In short, you are in safe and expert hands at Aashray!

Book Appointment

If you have any questions or doubts about any BPH/ Benign Prostatic Hyperplasia treatment or any other treatment available at Aashray Urology Institute, book a consultation with Dr. Ashit Shah and he will expertly guide you on the same. 
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Dr. Ashit Shah

Dr. Ashit Shah

Meet the doctor

Dr. Ashit Shah

MB, MS, DNB(Urology), DLU(France)

Dr. Ashit Shah

Dr. Ashit Shah

Dr. Ashit Shah is a senior consultant Urologist heading Aashray Urology Institute. After completing his M.B.B.S. and M.S. in General Surgery, he was awarded Diplomate of National Board (D.N.B.) in Genito-Urinary Surgery by the National Board of Examinations, New Delhi. He earned his Diplomate in Laparoscopic Urology from Louis Pasteur University, Strasbourg, France in the year 2006. Dr. Shah has a special interest in Endo-Urology, especially Urolithiasis i.e. Urinary Stone Disease. Having spent more than 27 years in the profession of Urology, he has experience of over 75,000 urological consultations and more than 15,000 surgeries. Being counted amongst the torch bearers of ethical and transparent medical practice in the city of Vadodara, he was conferred ‘Inspiring Urologist Award’ for the year 2019 by The Economic Times.

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