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Healthcare
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Prostate
Disease
Dr.
Kalyan Kumar Sarkar, MS, FRCS, is a veteran
Consultant Urological Surgeon. Dr. Sarkar
was trained initially in Kolkata, and then
in the U.K. and has been operating solo urological
practice in Kolkata from 1994. Here are some
questions which generally arrise in the people's
mind about prostate. Dr. K. K. Sarkar is giving
all the answers below to know the prostate
and its diseases properly. |
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FREQUENTLY
ASKED QUESTIONS
What is the prostate
gland?
The prostate
is a walnut-sized gland that is part of the
male reproductive system. It is located below
the bladder (the organ where urine is stored)
and surrounds the upper portion of the urethra
(the tube that carries urine out of the body).
The gland is made of 2 main lobes, or regions,
on either side of the urethra, enclosed by
an outer layer of tissue (the capsule). The
gland is made up of two main types of tissue:
glands and smooth muscle.
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What
is its function?
The seminal fluid discharged
during ejaculation carries sperm cells. The
prostate gland makes the fluid portion of
the semen. This fluid energizes the sperm
and makes the vaginal canal less acidic.
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What
is benign prostatic hyperplasia?
The prostate gland begins
to enlarge after the age to 40. The reason
for the enlargement is not fully clear, and
is likely to be due to subtle changes in the
hormone levels with increasing age. This enlargement
is not due to cancer. |
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What
are the consequences of this enlargement?
The prostate tissue
as it enlarges squeezes the urethra from all
sides, creating a mechanical obstruction to
emptying of the bladder. Initially the bladder
respond by contracting more strongly so that
the urine can be emptied and the patient has
no symptoms apart from slight
diminution of flow. Later the |
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obstruction causes irritability of the bladder
muscle causing urinary frequency and urgency.
As the disease progresses, the bladder weakens,
resulting in incomplete bladder emptying,
eventually progressing to stoppage of urinary
flow: retention of urine. Sometimes the high
pressures generated in the bladder due to
obstruction are transmitted back to the kidneys.
This is a potentially dangerous situation,
and can result in serious kidney damage, which
may be permanent. |
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What are the symptoms of BPH?
The most common
symptoms of BPH are:
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A weak urine stream · Dribbling after voiding
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Feeling that the bladder has not emptied completely
after urination
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Frequent urination, particularly at night (i.e.,
nocturia) and having to rush to the toilet to
pass urine
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Hesitant, interrupted, or weak urine stream
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Leakage of urine (I. E., overflow incontinence)
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Pushing or straining to begin urination
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Blood in the urine (i. e., haematuria)
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Does
the size of the prostate determine severity
of symptoms?
The size
of the prostate does not always determine
how severe the obstruction or the symptoms
will be. Some men with greatly enlarged glands
have little obstruction and few symptoms while
others, whose glands are less enlarged, have
more blockage and greater problems. Sometimes
a man may not know that he has any obstruction
until he suddenly fiends himself unable to
urinate at all, called acute urinary retention.
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What
causes acute urinary retention?
When partial obstruction
is present, severe constipation, alcohol,
cold temperatures, or a long period of immobility
can bring on urinary retention. Certain
drugs like cough syrups and cold remedies
may also precipitate urinary retention.
Acute urinary retention causes severe pain
and discomfort. Catheterisation may be necessary
to drain urine from the bladder and obtain
relief.
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How is BPH diagnosed?
Symptoms are
the first indications of prostate trouble. However,
there are several tests, which may be employed
by a doctor to arrive at a diagnosis. Some of
these include:
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A digital rectal examination. The doctor inserts
a gloved finger into the rectum and feels the
part of the prostate next to the rectum. This
exam allows the doctor to feel the prostate
gland and get a general idea of the size and
condition of the gland.
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A urine test can help detect infection, which
causes inflammation (prostatitis) that can lead
to similar symptoms.
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A prostate-specific antigen (PSA) test is sometimes
used in order to rule out cancer as a cause
of urinary symptoms.
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An ultrasound examination is usually performed
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Sometimes, a urine flow study, which measures
how quickly the urine is flowing, may be done.
A reduced flow often suggests BPH.
What
can happen as a consequence of BPH?
Severe BPH can cause serious
problems over time. Urine retention and strain
on the bladder can lead to urinary tract infections,
bladder or kidney damage, bladder stones and incontinence.
If the bladder is permanently damaged, treatment
for BPH may be ineffective. When BPH is found
in its earlier stages, there is a lower risk of
developing such complications.
Does BPH cause cancer?
BPH does not cause cancer.
However, cancer does occur more often as men get
older. Therefore, it is important that the prostate
gland is checked regularly. All men over age 50
should have an annual prostate examination and
those who have a higher risk because of a family
history should be examined yearly starting at
age 40.
Is there any treatment?
Many men have only minimal
urinary symptoms, and tests exclude the presence
of severe urinary obstruction. They can simply
be followed up expectantly: this is known as watchful
waiting. In patients with more severe symptoms
active treatment has to be considered. This may
involve the use of drugs, surgery, or certain
other non-surgical interventions.
What are the oral medications
available?
The prostate gland is
made up of muscles and glands and drugs are available
that work on these tissues. Alpha-blocking drugs,
such as terazosin, relax the muscles surrounding
the urethra as it passes through the prostate,
making it easier to urinate. These drugs have
certain side effects like dizziness and tiredness,
as they tend to lower blood pressure. They have
to be prescribed with care in patients with high
blood pressure or other cardiac complaints. Drugs
like finasteride inhibit production of the hormone
DHT, which is involved with prostate enlargement.
Up to 20-30 % reduction in prostate size may be
achieved with this agent. Patients get symptomatic
relief and risk of complications like acute urinary
retention is reduced. However this drug has side
effects as well, though uncommon: tenderness of
the nipples, and difficulties with sexual function.
It is important to realise that these drugs do
not cure BPH: they only alleviate symptoms and
have consequently to be taken for life. Judiciously
used these drugs give relief to a large number
of patients, and are particularly useful in patients
with mild symptoms, and those who want to defer
surgery temporarily.
What are the non-surgical options?
Various forms of heat
treatment have been applied to the prostate :
transurethral thermotherapy (microwave) and TUNA
(radio-frequency). None of these treatments are
curative, and it becomes difficult to justify
the expense of these methods in an Indian population.
What are the surgical
options?
The main cause of symptoms
in patients with prostatic enlargement is the
physical presence of the swollen tissue and clearly,
for cure, the tissue has to be removed. The process
of removal has to be safe, effective and economical.
There should be long lasting benefit from surgery.
In olden days the surgical process involved a
"cutting" procedure with associated with blood
loss, complications, prolonged hospitalisation.
Nowadays the technique of transurethral surgery
(popularly known as "microsurgery") has made the
surgery a lot simpler. This is a safe and effective
operation performed in large numbers of patients
with good results.
Transurethral surgery
( Transurethral resection of prostate : TURP )
In this type of surgery,
no external incision is needed. Usually full general
anaesthesia is not required and the entire operation
is performed under a spinal anaesthetic with a
small injection in the back. The patient is fully
awake during the operation and may actually watch
his own operation on a TV monitor! The surgeon
reaches the prostate by inserting an instrument
through the urethra called a resectoscope. The
resectoscope, which is about 12 inches long and
1/3 inch in diameter, contains a light, valves
for controlling irrigating fluid and an electrical
loop that cuts tissue and seals blood vessels.
The surgeon views the operation field on a television
screen and cores away the prostate tissue using
the resectoscope wire loop. The pieces of tissue
are carried by the fluid into the bladder and
then flushed out at the end of the operation.
Usually the operation takes about 30-60 minutes
to perform. These days blood transfusion is required
only in a minority of patients.
Open surgery
Open surgery is performed
when the gland is greatly enlarged, when there
are complicating factors, or when the bladder
has been damaged and needs to be repaired.
Laser surgery
The laser (Holmium Laser)
can be used to enucleate the prostate through
the urethra. This is a bloodless procedure, and
when the technique is refined may well become
a treatment of choice. For the moment laser prostatectomy
is undergoing clinical trials and is not a regular
option.
How can symptoms of BPH be controlled?
When symptoms
of BPH are not severe, these lifestyle changes
might prove helpful.
- Limit
intake of tea, coffee, and alcohol. Alcohol
increases urine production and may cause congestion
in the prostate gland. Caffeine irritates the
bladder.
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Stay active. Urine is retained when you don't
move around. Even a little increase in activity
can make a difference.
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Stay warm. Being cold can lead to retention
of urine.
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Avoid over-the-counter antihistamines and decongestants.
These drugs tighten the muscles that control
urine flow, making it more difficult to urinate.
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Don't drink any liquid after 7 p.m.
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Each time you urinate, try to empty your bladder
completely.
Dr.
Kalyan K Sarkar, MS. , FRCS.
mail : kalyan@urosurge.org
url : www.urosurge.org
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