The Prostate Gland
The prostate is a walnut-sized gland that forms part of the male reproductive
system. The gland is made of two lobes, or regions, enclosed by an outer
layer of tissue. The Prostate Gland is located about halfway between the
testicles and rectum and is wrapped around the urethra (the urethra is
the outlet that discharges urine and semen from the penis). Imagine a
pipe passing through the hole of a doughnut. The pipe is the urethra and
the doughnut is the prostate.
Function of prostate : We do not know all the prostate's functions. One
of its main roles, though, is to squeeze fluid into the urethra as sperm
move through during sexual climax. This fluid, which helps make up semen,
energizes the sperm and makes the vaginal canal less acidic.
Symptoms that may indicate prostate problems are:
- A weak urinary stream.
- Difficulty in passing urine.
- Frequent urination.
- Urgency (difficulty in postponing urination)
- Awakening frequently at night for urination.
- Interrupted stream of urine.
- Blood in urine.
- Pain or burning while passing urine.
- Sense of incomplete voiding.
General investigation for prostate disease:
- Digital rectal examination of prostate to look for size, consistency,
and nodules in the prostate.
- Urine routine to look for urinary infection.
- Abdominal sonography to look for prostate size, post void residual
urine, and to look for any secondary pathologies in the kidneys.
- Blood test, Prostate specific antigen (PSA) levels. PSA is the
protein produced by the prostate and found in the blood. These levels
increase in prostate cancer and prostate infection.
The disease which involves the prostate commonly are:
- Benign prostate hyperplasia.
- Prostate cancer.
The World Organization (WHO) Consultation on BPH has adopted
his index, and in this context, it is referred to as the International
Prostate Symptom Score (IPSS). This measure of voiding symptoms is useful
to ascertain symptom severity and treatment response, or change over time
Ipss scoring system
|1. Over the last month or so, how many
times did you most typically get up to urinate from the time you went
to bed at night until the time you got up in the morning?
||0 1 2 3 4 5
|2. Over the past month or so, how often
have you had a sensation of not emptying your bladder completely after
you finished urinating?
||0 1 2 3 4 5
|3. Over the past month or so, how often
have you had to urinate again less than two hours after you finished
||0 1 2 3 4 5
|4. Over the past month or so, how often
have you found that you stopped and started again several times when
||0 1 2 3 4 5
|5. Over the past month or so, how often
have you found it difficult to postpone urination?
||0 1 2 3 4 5
|6. Over the past month or so, how often
have you had a weak urinary stream?
||0 1 2 3 4 5
|7. Over the past month or so, how often
have you had to push or strain to begin urination?
||0 1 2 3 4 5
- Not at all
- Less than 1 time in 5
- Less than half the time
- About half the time
- More than half the time
- Almost always
Total Symptom Score = Sum of Questions 1 to 7 _____
MILD MEANS “ WAIT AND WATCH”
If your score is 0-7 on the IPSS score, your symptoms are mild –
the usual procedure for u is “watchful waiting”.
Moderate means “medication” may be If your score is 8-19,
your doctor may suggest medication as an initial treatment. Medication
may be helpful in certain situations. But don’t be afraid if there
is no improvement in the symptom score, consult your doctor for the same
again for other mode of treatment. The drug of choice available for the
medical treatment of BPH are
- Alpha blocker
Are high blood pressure medicine that relax the smooth
muscle tissue in the prostate, opening the urethra, allowing the normal
flow of urine. This drugs can cause dizziness, headache, fatigue and
nasal congestion in 5-10% of men.
- 5 alpha reductase inhibitor
Shrinks the prostate by 25% to 30% by interfering
with the hormonal chain of events that trigger the growth of prostate
cells. This drug can lower a mans PSA level about 50 % which may mask
the test accuracy in detecting prostate cancer. 5 % of men
have reported loss of sexual potency and desire.
Do not be on medication to Escape Surgery .
Severe means “Surgical
If your symptom score is 20-30, watchful waiting or medications are no
longer ideal options. Most likely you will have to undergo the surgical
intervention for the relief.
Microwave Thermotherapy (TUMT)
Minimally Invasive Therapy
Trans uretheral needle ablation (TUNA)
Trans uretheral resection of prostate. (TURP)
drug treatment is not effective in all cases, researchers in recent years
have developed a number of procedures that relieve BPH symptoms but are
less invasive than conventional surgery.
Transurethral microwave procedures
A device that uses microwaves to heat and destroy excess prostate tissue.
In the procedure called transurethral microwave thermotherapy (TUMT),
sends computer-regulated microwaves through a catheter to heat selected
portions of the prostate to at least 111 degrees Fahrenheit. A cooling
system protects the urinary tract during the procedure. Procedures take
about 1 hour and can be performed on an outpatient basis without general
anesthesia. Procedure has been reported to lead to impotence or incontinence.
Although microwave therapy does not cure BPH, it reduces urinary frequency,
urgency, straining, and intermittent flow. It does not correct the problem
of incomplete emptying of the bladder. Ongoing research will determine
any long-term effects of microwave therapy and who might benefit most
from this therapy. No tissue is available for laboratory test to rule
Transurethral needle ablation
The TUNA System delivers low-level radiofrequency energy through twin
needles to burn away a well-defined region of the enlarged prostate. Shields
protect the urethra from heat damage. The TUNA System improves urine flow
and relieves symptoms with fewer side effects when compared with transurethral
resection of the prostate (TURP). No incontinence or impotence has been
observed. No tissue is available for laboratory test to rule out cancer.
Most doctors recommend removal of the enlarged part of the prostate as
the best long-term solution for patients with BPH. With surgery for BPH,
only the enlarged tissue that is pressing against the urethra is removed;
the rest of the inside tissue and the outside capsule are left intact.
Surgery usually relieves the obstruction and incomplete emptying caused
by BPH. The following section describes the types of surgery that are
In this type of surgery, no external incision is needed. After giving
anesthesia, the surgeon reaches the prostate by inserting an instrument
through the urethra.
A procedure called TURP (transurethral resection of the prostate) is used
for 90 percent of all prostate surgeries done for BPH. With TURP, an instrument
called a resectoscope is inserted through the penis. The resectoscope,
which is about 12 inches long and 1/2 inch in diameter, contains a light,
valves for controlling irrigating fluid, and an electrical loop that cuts
tissue and seals blood vessels.
During the 90-minute operation, the surgeon uses the resectoscope's wire
loop to remove the obstructing tissue one piece at a time. The pieces
of tissue are carried by the fluid into the bladder and then flushed out
at the end of the operation.
Most doctors suggest using TURP whenever possible. Transurethral procedures
are less traumatic than open forms of surgery and require a shorter recovery
Another surgical procedure is called transurethral incision of the prostate (TUIP). Instead of removing tissue, as with TURP, this procedure widens
the urethra by making a few small cuts in the bladder neck, where the
urethra joins the bladder, and in the prostate gland itself. Although
some people believe that TUIP gives the same relief as TURP with less
risk of side effects such as retrograde ejaculation, its advantages and
long-term side effects have not been clearly established.
In the few cases when a transurethral procedure cannot be used, open
surgery, which requires an external incision, may be used. Open surgery
is often done when the gland is greatly enlarged, when there are complicating
factors, or when the bladder has been damaged and needs to be repaired.
The location of the enlargement within the gland and the patient's general
health help the surgeon decide which of the three open procedures to use.
With all the open procedures, anesthesia is given and an incision is made.
Once the surgeon reaches the prostate capsule, he scoops out the enlarged
tissue from inside the gland.
The doctor passes the laser fiber through the urethra into the prostate
using a cystoscope and then delivers several bursts of energy lasting
30 to 60 seconds. The laser energy destroys prostate tissue and causes
shrinkage. Like TURP, laser surgery requires anesthesia and a hospital
stay. One advantage of laser surgery over TURP is that laser surgery causes
little blood loss. Laser surgery also allows for a quicker recovery time.
But laser surgery may not be effective on larger prostates. The long-term
effectiveness of laser surgery is not known.
Your Recovery After Surgery in the Hospital
If you have surgery, you'll probably stay in the hospital depending on
the type of surgery you had and how quickly you recover.
At the end of surgery, a special catheter is inserted through the opening
of the penis to drain urine from the bladder into a collection bag. Called
a Foley catheter, this device has a water-filled balloon on the end that
is placed in the bladder, which keeps it in place.
This catheter is usually left in place for several days. Sometimes, the
catheter causes recurring painful bladder spasms the day after surgery.
These may be difficult to control, but they will eventually disappear.
You may also be given antibiotics while you are in the hospital. Many
doctors start giving this medicine before or soon after surgery to prevent
infection. However, some recent studies suggest that antibiotics may not
be needed in every case, and your doctor may prefer to wait until an infection
is present to give them.
After surgery, you will probably notice some blood or clots in your urine
as the wound starts to heal. If your bladder is being irrigated (flushed
with water), you may notice that your urine becomes red once the irrigation
is stopped. Some bleeding is normal, and it should clear up by the time
you leave the hospital. During your recovery, it is important to drink
a lot of water (up to 8 cups a day) to help flush out the bladder and
Do's and Don'ts
Take it easy the first few weeks after you get home. You may not have
any pain, but you still have an incision that is healing—even with
transurethral surgery, where the incision can't be seen. Since many people
try to do too much at the beginning and then have a setback, it is a good
idea to talk to your doctor before resuming your normal routine. During
this initial period of recovery at home, avoid any straining or sudden
movements that could tear the incision. Here are some guidelines:
- Continue drinking a lot of water to flush the bladder.
- Avoid straining when moving your bowel.
- Eat a balanced diet to prevent constipation. If constipation occurs,
ask your doctor if you can take a laxative.
- Don't do any heavy lifting.
- Don't drive or operate machinery