Aashray urology institute

Benign Prostatic Hyperplasia

Overview
BPH or Benign Prostatic Hyperplasia is the enlargement of prostate due to hormonal changes after the age of 40, in males. Several effective treatment options 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. 
BPH (benign-prostatic-hyperplasia) overview
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What Is Prostate?

The prostate gland is present in all males. With advancing age, as the hair grows white and the eyes develop a cataract, so too does the prostate gland enlarge.
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).

Prostate gland
Image Source: National Institute of Diabetes
and Digestive and Kidney Diseases, National
Institutes of Health.

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, often they approach a urologist very late when a lot of urine is retained in the bladder or they can’t pass urine at all or till the kidney is damaged badly. 

benign prostatic hyperplasia (BPH)

How does the prostate enlarge?

  1. Non-Obstructive Enlargement:

    In about 80% of people, the prostate gland enlarges outwards, wherein it doesn’t compress the urethra.

  2. Obstructive Enlargement:

    In the remaining 20% of people, the prostate swells in an inward direction, causing obstruction to the urinary stream. This can lead to urinary retention, bladder stones, urinary incontinence, or even kidney damage if left untreated.

What Are The Symptoms Of BPH/Benign Prostatic Hyperplasia?

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

  1. A slow, interrupted, or weak urine stream
  2. Difficulty in starting urine flow
  3. Need to strain while urinating
  4. 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 and may require 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 Treatment 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 even if their prostate is enlarged. A mere enlargement of prostate on sonography is not an indication for treatment. It is also important to know whether it is an obstructive enlargement or not, which can be known by Uroflowmetry test.

Surgical treatment or removal is needed only when the prostate is obstructive.

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: 

Typically, the surgical options vary from Open surgery to Bipolar Enucleation of prostate. Let’s see each of them one by one.

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.)

Transurethral Resection Of The Prostate (T.U.R.P.)
Image Source: National Institute of Diabetes
and Digestive and Kidney Diseases, National
Institutes of Health.

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. 

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 both T.U.R.P. and Holmium Laser Surgery. 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.

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. 

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. 

BPH CHECK LIST

Before undergoing prostate surgery at any place, you should check the following:

  1. Are you advised surgery merely because the prostate is enlarged on sonography? Or is it actually proved with tests like Uroflowmetry that your prostate is obstructive and can damage kidneys if not removed? If not, than you may be undergoing surgery which is not really essential and hence you may continue having symptoms for which you got operated upon!
  2. Are you offered the "PLATINUM STANDARD" procedure Bipolar T.U.R.P.? Or are you offered routine T.U.R.P.? Are you lured into spending more money for experimental procedures like HOLMIUM laser, which is not proved superior to Bipolar T.U.R.P. and is basically good for a selected few cases?
  3. Is your treating surgeon himself going to operate or is somebody else going to come at his place and operate? In that case, will he be there to take your care in the post-operative period?
  4. Will your Urologist attempt complete removal of prostate tissue or will he just remove some bit of it and come out?
  5. What is the "morbidity and mortality rate" of your Urologist? In other words, what percentage of his operated patients require blood transfusion, have complications like incontinence, infection, recurrence, repeated urethral dilatations etc.?

Why Choose Aashray?

  1. At Aashray, accurate diagnosis of prostate disorders with real-time Uroflowmetry and if necessary, urodynamic study are offered. Thus, surgery is suggested only to obstructed cases, ensuring excellent postoperative results.
  2. We offer the platinum standard "BIPOLAR T.U.R.P." procedure to our patients and are able to give world-class results as we use machines like AUTOCON II 400 surgical diathermy (the first in Gujarat) and VIO - 3 electrosurgical generator (ERBE).
  3. In patients with a large prostate gland, we offer T.U.B.E. (Trans-Urethral Bipolar Enucleation) surgery (using VAPO ENUCLEATION loop by KARL STORZ), which was pioneered by us in India.
  4. Minimal morbidity and no mortality in the large number of T.U.R.P. procedures that have been carried out at our center.
  5. We attempt complete resection of the prostate so that it need not be repeated after a few years.
  6. 24 hours (round-the-clock) post-operative care by qualified doctors focused on urology.

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

Taking care of yourself...

These lifestyle changes may prove helpful in patients of BPH:

• Avoid caffeine, which irritates the bladder, and alcohol, which increases urineproduction.

• Stay active and warm so as not to retain urine.

• Over-the-counter cold and cough medicines (antihistamines and decongestants)tighten the muscles that control urine flow making urination difficult.

• Avoid drinking liquids after 7 p.m.

• Try to empty your bladder completely every time you urinate.• Urinate as soon as you feel the urge and don't force the urine.

• Try to urinate regularly throughout the day.

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. 
Book Appointment
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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