BENIGN PROSTATE HYPERPLASIA (BPH) ( PROSTATE ADENOMA)
Prostate disease is usually associated with age. They can cause lower urinary tract symptoms in men over 50 years of age. These symptoms may be caused by an enlarged prostate, a condition known as benign prostate enlargement.
Benign prostate enlargement is a disease associated with hormonal changes that occur as men grow older. Prostate disease can cause serious symptoms, but it is important to know that BPH is not prostate cancer, it is a benign tumor. BPH does not develop into prostate cancer even if left untreated. However, with age, both benign prostate enlargement and prostate cancer can develop. Some people may have both conditions. You should consult your doctor to discuss any concerns you have.
WHAT IS THE PROSTATE GLAND (PROSTATE)
The prostate gland is an organ, the prostate gland, located in the lower urinary tract, under the bladder and around the urethra. Women don't have a prostate. Produces a fluid called secretion, which is the liquid part of sperm. The prostate has smooth muscles that help push out sperm during ejaculation.
A healthy prostate is the size of a large walnut and has a volume of 15-25 cubic centimeters (cm3). The prostate grows slowly as a man gets older.
PROSTATE EXAMINATIONS
PSA BLOOD TEST
PSA (prostate specific antigen) is a protein produced by the prostate, and its blood levels may be elevated in men with benign prostate enlargement, prostate inflammation, or prostate cancer.
ADVANTAGES
A PSA test can help detect prostate cancer at an early stage. Cancer is easier to treat and much better managed if it is detected in its early stages.
It will also tell you whether you are at risk of getting prostate cancer in the future.
DISADVANTAGES
A high PSA level does not always mean you have prostate cancer (a false positive). Other conditions you may have can raise your PSA level, such as an enlarged prostate or prostate infection.
In some cases, the PSA level may be low even if cancer is present (a false negative result).
PSA testing can detect cancer that would never have had symptoms. This is called overdiagnosis: the discovery of a cancer that is unlikely to cause ill health or pose a threat to a man's life.
RECOMMENDATIONS
The PSA test helps detect prostate cancer at an early stage, when the chance of cure is much higher.
Remember that not everyone with a high PSA level will have cancer, and not everyone who is diagnosed with cancer will need treatment.
Talk to your family doctor about the risks and benefits and whether this test is right for you.
RECTAL EXAMINATION OF THE PROSTATE
A rectal examination using a finger is an important examination to determine the estimated size, shape and, most importantly, consistency of the prostate. This test is known as a digital rectal examination.
IMPORTANT !
Despite the importance and obligation of a RECTAL EXAMINATION OF THE PROSTATE, one must understand that with a finger the doctor can only feel the part of the prostate adjacent to the rectum, cannot determine the condition of the entire gland and can easily miss the disease. To solve the problem, a modern urologist’s office must have an ultrasound machine, on which the doctor, also through the rectum (TRUS), can independently examine the entire prostate and obtain the necessary information.
EXAMINATION OF URINATION FLOW AND VOLUME OF RESIDUAL URINE
Your healthcare provider may start with a urine flow test. This is a simple but very informative examination called uroflowmetry.
You will be asked to go into privacy and urinate in a special tank. This device will measure the strength and flow of your jet.
After this, an ultrasound examination of the bladder is performed to find out how well it is emptied and the volume of residual urine is determined.
This study is a mandatory method for urinary disorders, especially if it is difficult.
ULTRASOUND RECTAL EXAMINATION OF THE PROSTATE (TRUS)
TRUS is an ultrasound diagnostic method used to study the condition of the prostate and neighboring organs, which is carried out using a special sensor inserted into the rectum.
During the examination, the size of the prostate is accurately measured and its structure is studied. The examination is carried out on an outpatient basis and does not require special preparation.
If indicated and necessary, a prostate biopsy can be performed during TRUS, after special preparation.
LASER ENUCLEATION OF THE PROSTATE (HOLEP) -
"GOLD STANDARD" OF TREATMENT
"GOLD STANDARD" OF TREATMENT
If your prostate is larger than 80 cm3, laser enucleation is the best option for your surgical treatment.
There is no limit on the size of the prostate!
Minimally invasive, performed through a canal, without incisions, radical surgery.
This type of surgery is also a good option for men with a smaller prostate.
Suitable for men who take blood thinning medications for other diseases.
Alternative: Open incision surgery only.
Usually the operation is performed under general spinal anesthesia. A special laser resectoscope is inserted into your bladder through the urethra without making an incision in your lower abdomen. The resectoscope has a high-resolution camera, through which the doctor can see the prostate on a monitor at high magnification and carry out precise surgery.
High laser energy is used to remove the enlarged part of the prostate with minimal bleeding. The doctor then uses an instrument known as a morcellator to remove the enucleated part of the prostate from the bladder.
After surgery, a urinary catheter is inserted into the bladder to drain urine, which is usually removed the day after surgery when the man is discharged home.
WHAT YOU CAN EXPECT
Laser prostate surgery may be performed as an outpatient procedure, or you may need to stay overnight in the hospital to ensure the surgery is successful.
BEFORE THE SURGERY
You will be given one of two types of anesthesia:
General anesthesia means you will be unconscious during the procedure.
Spinal anesthesia means that you will have an anesthetic injected into your spine to relieve pain. With this type of anesthesia, you will be conscious during the operation, but will not feel pain.
ADVANTAGES OF THE SURGERY
The advantages of this method of operation are undeniable:
No cuts.
Unlimited size of prostate adenoma.
There is no need to discontinue blood thinning medications.
Minimal blood loss.
Minor postoperative pain.
Short bladder catheterization time.
A short stay (less than 1 day) in the clinic or the operation is performed on an outpatient basis.
Fast rehabilitation.
SIDE EFFECTS
Blood in the urine (hematuria) for a few days to a week after the procedure
Irritative urinary symptoms such as painful urination, difficulty urinating, an urgent or frequent need to urinate, or the need to get up frequently during the night to urinate for several days after surgery. These signs are more typical after electrical resection (TURP surgery) compared to laser enucleation and disappear within a short time
Urinary incontinence after surgery. This may occur due to the fact that your bladder is accustomed to displacing urine through the urethra narrowed by the prostate adenoma and a short adaptation period is required.
Retrograde ejaculation. After any operation on the prostate for adenoma, sperm may be thrown not forward, as before, but back into the bladder. During the next urination after ejaculation, sperm comes out along with urine
RISKS OF SURGERY
Urinary retention. Some men experience difficulty urinating after laser surgery. If this happens, you will need to have a urinary catheter installed for several days to drain urine from the bladder. The risks are the same as with all other treatments for prostate adenoma.
Urinary tract infection. Urinary tract infection is more likely with prolonged use of a urinary catheter.
Narrowing (stricture) of the urethra (urethra). This condition makes it difficult for urine to flow out of the bladder through the urethra and may require additional treatment. Just as scars form on the skin of the body, internal scars can form after prostate surgery. The risk is the same as with all other methods of treating prostate adenoma, does not exceed 2%.
Retrograde ejaculation. Retrograde ejaculation is a condition in which sperm enters the bladder during ejaculation. It is not painful or harmful. If you have retrograde ejaculation, then at the moment of orgasm, little or no sperm is released from the penis. This is important if you are planning to have children, since retrograde ejaculation interferes with the release of sperm from the penis. The risks are the same as with all other treatments for prostate adenoma.
Erectile dysfunction. After laser surgery for prostate adenoma, the risk of erectile dysfunction is minimal and much lower than with TURP of the prostate, which is an advantage of laser therapy, since the laser does not penetrate deep into the prostate gland and does not damage the nerves that pass next to the prostate gland.
AFTER SURGERY
Ask your doctor about any restrictions or recommendations to follow after surgery.
Avoid strenuous physical activity, such as heavy lifting, for two weeks after laser prostate enucleation.
Refrain from sexual intercourse until your doctor gives you permission. Most men can resume sexual activity within a week or two after the procedure.
Watch your urine. Drink plenty of fluids and avoid strenuous exercise unless your urine is light (or pink) and some time has passed since surgery.
Take antibiotics as recommended. If your doctor has prescribed you antibiotics, you must complete the full course of antibiotics as recommended by your doctor.
You may need a urinary catheter after surgery because the flow of urine may be blocked due to swelling.
