Dr. Shailesh Patel

M.Ch (Onco)

Super specialist Cancer surgeon

Done more than 25000 Head-neck cancer, Breast cancer & cervical cancer

Done more than 1000 Laparoscopic cancer surgeon

Prostate

What is Prostate ?

The prostate, is a part of the male reproductive system, is about the same size and shape as a walnut. It is located below the bladder and in front of the rectum and surrounds the urethra, the tube-like structure that carries urine from the bladder out through the penis. The main function of the prostate is to produce ejaculatory fluid.

Prostatic enlargement is a aging process and in Indian male prostate enlargement occurs after the age of 45 years. By the age of 70 years one in 3 males have significant symptoms requiring treatment.

Not all the persons having enlarged prostate require treatment if prostate is enlarged (even more than 50 gms) but not compressing urethra person does not have difficuty in urine and other symptoms so in that case no active treatment is required. (Provided S. PSA is normal). In contrast if prostate is mildly enlarged but compressing urethra patient’s develop early urinary symptoms so in that case medical or surgical treatment is essential.

Common disease conditions of Prostate

Some common problems related to Prostate are:

Prostatitis

Prostatitis is inflammation of a prostate gland. Prostatitis commonly occur in young male patients.

In Prostatitis patients having pain in lower abdomen and perianal region.

Pain may or may not be associated with burning Micturition.

Few patients passes blood in urine.

In DRE prostate is tender and may or may not enlarged.

Urine report may or may not show pus cell( Infection).

Patient’s continuous focus is on the pain and difficult to live his quality life.

In few patient endoscopy is require to diagnose the condition.

Treatment:- Patient has to take medicine from one month to six month. Few patient may require treatment upto 2 years.

Trimethoprim – Sulfamethoxazole is the drug of choice for prostatitis.

Enlargement of Prostate or Benign Prostatic Hyperplasia(BPH) Symptoms

Difficulty in passing urine

Thin stream of urine

Frequency of voiding particularly at night

Sense of incomplete voiding

Urgency

Burning while passing urine

Retention of urine

Diagnosis

At Devasya Institute our aim is to understand your bothering symptoms with the help of international scoring system (IPSS), make an accurate diagnosis by detailed examination and necessary tests including Ultrasound and Urine Flow test (Uroflowmetry). This along with your other medical problems and personal and social circumstances will help us in suggesting the best option of treatment. The prostatic enlargement is a aging process. In some patients we may find cancer in the prostate (Total S. PSA > 4 ng/ml).

In order to help assess the severity of such symptoms, the American Urological Association (AUA) BPH Symptom Score Index was developed. The AUA diagnostic system includes a series of questions that target the frequency of the urinary systems identified above, and as a result, helps identify the severity of the BPH – ranging from mild to severe.

There are a number of diagnostic test procedures that can be used to confirm BPH. The tests vary from patient to patient, but the following are the most common:

IPSS (International Prostate Symptom Score) and Quality of Life Score (QOL):

IPSS is a questionnaire designed to determine the intensity of man’s urinary symptoms and help diagnose prostate enlargement. The patient answers seven questions related to common symptoms of prostate enlargement and severity of each symptom is rated from 0 to 5. These numbers added together provide a score that is used to evaluate the condition.

IPSS is a questionnaire designed to determine the intensity of man’s urinary symptoms and help diagnose prostate enlargement. The patient answers seven questions related to common symptoms of prostate enlargement and severity of each symptom is rated from 0 to 5. These numbers added together provide a score that is used to evaluate the condition. QOL is a questionnaire designed to determine the effect of the urinary symptoms on man’s daily routine. This is rated from 1 to 6.

Digital Rectal Examination (DRE)

Not all the persons having enlarged prostate require treatment if prostate is enlarged (even more than 50 gms) but not compressing urethra person does not have difficuty in urine and other symptoms so in that case no active treatment is required. (Provided S. PSA is normal). In contrast if prostate is mildly enlarged but compressing urethra patient’s develop early urinary symptoms so in that case medical or surgical treatment is essential.

Uroflowmetry (Urine flow test):

With the help of a uroflow meter, a test is performed which records urine flow to determine how quickly the bladder can be emptied. With a full bladder, the patient urinates into a device that measures the amount of urine, the time it takes for urination, and the rate of urine flow. A reduced flow rate may indicate prostate enlargement.

Laboratories Studies

Prostate Specific Antigen (PSA) Blood Test

PSA Test: This is a blood test to check the levels of prostate specific antigen (PSA) in a patient who may have BPH. Normal result generally means absence of prostate cancer. Higher level along with abnormal feeling prostate raises the suspicion of prostate cancer and requires further evaluation.

Urinalysis

Urine Culture

Imaging Techniques

Ultrasound test (including post void residue measurement):

This test is performed with full bladder and immediately after urination. At full bladder, the volume of urine is measured and any changes in bladder wall due to prostate enlargement are noted. The shape and size of prostate are also noted. The patient is then asked to urinate and the residual urine is determined by ultrasound. Post void residue (PVR) less than 50 ml generally indicates adequate bladder emptying and measurements of 100 to 200 ml or higher often indicate blockage.Rectal Ultrasound.

Cystoscopy

Urodynamic Test is advised when patient is having Diabetes.

Urodynamic Test is advised when patient is Treatment

Some common problems related to Prostate are:

Watchful Waiting:

Is recommended as an important option for men who have mild symptoms and do not find them particularly bothersome.

Medical therapy:

Today’s most common method for controlling moderate symptoms of BPH. Several medications are available to control moderate symptoms of BPH.Generally, early problem is controlled with medicines to relax prostate muscles or reduce the size. Medication is required on a long term basis, otherwise symptoms and problems would recur. Generally the improvement in symptoms and urine flow is significantly less with medicines than with surgery.When the symptoms progress, fail to respond to medicines or patient develops retention, stones or repeated infections, surgery is required to remove part of prostate to open urine passage.

Minimally invasive treatment:

Several minimally invasive therapies are available that allows the doctor to access the prostate through urethra and reduce the size of the prostate or decrease obstruction of the urethra.

Surgical treatment:

Surgical intervention is necessary in patients in whom benign prostates obstruction causes renal insufficiency, urinary retention, recurrent UTIs, bladder calculi, hydronephrosis, or large postvoid residual volume.

For management of enlarged prostate:

conventional endoscopic resection of prostate:-

Cystoscopy

TUR-P( Trans Urethral Resection of Prostate) is carried out by urologists under anaesthesia an endoscope is passed through urethra and all chips removed.

Urodynamic Test is advised when patient is having Diabetes.

Laser Treatment for enlarged prostate

Devasya Kidney & Multi Speciality Hospital

Awarded As "Best Kidney Hospital" In City By AMA.

First Kidney Hospital Having

ISO 9000-2000 Certificate.

[email protected]

Dr. Shailesh Patel

M.Ch (Onco)

Prostate

What is Prostate ?

Common disease conditions of Prostate

Some common problems related to Prostate are:

Diagnosis

Urodynamic Test is advised when patient is having Diabetes.

Urodynamic Test is advised when patient is Treatment

Some common problems related to Prostate are:

Is recommended as an important option for men who have mild symptoms and do not find them particularly bothersome.

Several minimally invasive therapies are available that allows the doctor to access the prostate through urethra and reduce the size of the prostate or decrease obstruction of the urethra.

Surgical intervention is necessary in patients in whom benign prostates obstruction causes renal insufficiency, urinary retention, recurrent UTIs, bladder calculi, hydronephrosis, or large postvoid residual volume.

TUR-P( Trans Urethral Resection of Prostate) is carried out by urologists under anaesthesia an endoscope is passed through urethra and all chips removed.

Urodynamic Test is advised when patient is having Diabetes.

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