Prostate problems are common; 1 in 5 men will develop prostatic symptoms and 1 in 6 will develop prostate cancer, which is now the most frequent cancer in men. At London Urology we specialise in the treatment of prostate problems, using advanced surgical therapies and intervention. Promotion of male health and prostate screening means that success rates of surgical intervention are increasing.
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Prostate Enlargement: Benign Prostate Hyperplasia (BPH)
Benign Prostatic Hyperplasia (BPH, an enlarged prostate) is a very common condition that occurs as men age. By the age of 70, approximately 8 out of 10 men have an enlarged prostate.
Often an enlarged prostate does not cause any problems but if symptoms occur, these include:
- Weak urine flow
- Hesitancy in emptying the bladder
- Feeling your bladder is not empty after you have been to the toilet
- Frequency in passing urine
As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the gland to press against the urethra. The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination. Eventually, the bladder weakens and loses the ability to empty itself, so some of the urine remains in the bladder
Many people feel uncomfortable talking about the prostate, since the gland plays a role in both sex and urination. If left untreated, an enlarged prostate resulting in urinary symptoms can lead to infections and more rarely, kidney damage.
A doctor will examine your prostate and take blood and urine tests to check the function of your kidneys and rule out other potential problems. A specialist may use cystoscopy, a special telescope to examine the bladder and you may have a scan to examine the prostate and bladder, and a urine flow test to assess the blockage.
Surgery is not always necessary and some patients may just need regular monitoring of the condition. Medication may be used to relax the muscle tissue around the bladder, depending on the individual patient. Most people will notice an improvement within days.
Transurethral resection of the prostate (TURP)
Patients are discharged from hospital 48 hours following TURP and should avoid heavy physical exercise for 2 weeks. Urinary flow is usually markedly improved immediately but frequency may take 6-12 weeks to completely settle. All patients experience retrograde ejaculation after TURP i.e. sperm going back into the bladder at the time of climax, rather than coming out of the penis, and being washed out of the bladder the next time it is emptied. There is also a 5% risk of impotence after TURP, usually in men aged over 70 years.
TURP involves coring out the central part of the prostate (rather like one might core out the centre of an apple) to physically enlarge the channel one passes urine through. It was the first ‘keyhole’ operation and remains the standard to which other operations for BPH are compared. It is performed under general or spinal anaesthetic, usually lasts 45 minutes and involves no incisions on the outside. It is performed using an electrical loop inserted into the urethra via a telescope. It cuts tissue and seals blood vessels. As it removes the prostate in slivers. These are washed out at the end of the operation and a catheter is inserted for 2 days, through which irrigation fluid flows into the bladder to rinse any blood in it.
- Transurethral Resection in saline (TURis)
TURis is an electrosurgery system used at London Urology for use in TURP for BPH patients. Although the procedure remains the same as the traditional method for TURP, TURis involves utilising saline solution instead of glycerine to deliver the electricity.
The main advantage is the reduced risk of serious complications. Previously, if too much glycerine got absorbed into the bloodstream, it can cause TURP syndrome that in rare cases can result in seizures, heart pain and even coma.
With TURis, it doesn’t matter if the fluid conducts electricity, meaning that saline can be used instead of glycine. Saline has the same sodium concentration as blood, making it safer.
Also, the previous method of TURP meant that the electricity had to flow through the patient’s body. This isn't the case for TURis, meaning that you can make the wire loop hotter. This increased heat, and the type of energy used, is better at sealing blood vessels, and so patients bleed far less.
Green light laser prostatectomy
Green light laser prostatectomy is a revolutionary new, minimally invasive treatment of an enlarged prostate. Unlike more traditional methods of treatment, there will be no problems with erections.
The central portion of the prostate is vapourised using a powerful laser, allowing the urine to pass through the prostate more easily and improving the urinary flow. A better flow allows the bladder to store more urine and reduce urinary frequency.
The fibre is introduced via a telescope down the penis under a general or a spinal anaesthetic and a catheter to drain the bladder is often required post-operatively for a short period.
The result is very little blood loss during the procedure and a rapid return to normal activities. There is also no upper limit to the size of prostate that can be treated, although very large prostates require a longer operation.
Find out more with our Prostate Enlargement FAQ.
Being the most common form of cancer in men, over 40,000 men are diagnosed with prostate cancer every year. An estimated 50% of men over 50 are diagnosed with prostate cancer and this figure increases to 80% in men over 80. In most cases these cancers lay dormant and will grow slowly particularly in elderly men. However in some less common cases these cancer cells are known to be megastatic (spreading) and can move to other areas of the body.
- Frequent urination
- Difficulty maintaining a steady stream of urine
- Having to urinate during the night
- Blood in the urine
- Change in sexual function and performance
There are many factors that will affect the risk of having cancer. Generally speaking men with a family history of prostate cancer will be 2 to 3 times more likely to get it themselves. There is no super food diet that can 100% eliminate the risk of getting cancer however the risk can be decreased with a healthy diet high in fibre and low in fat and sugars.
There are many tests that can gather information about the prostate and urinary tracts. There are the less evasive methods such as Ultrasound, CT scans and cytoscopy. There is one test that can confirm the presence of cancerous cells in the body, which is a biopsy. A doctor will remove a small piece of the prostate to examine under microscope.
In some cases, it may be possible to avoid a biopsy. The Hospital is able to offer the most modern prostate imaging using our MRI scanner. The multiparametric 3T MRI offers improved accuracy in assessment of small areas of prostate tumour and to assess any potential spread. This enables more superior and personalised care. If the scan reveals an abnormality, we offer highly skilled image-guided prostate biopsy.
Early prostate cancer
For cancer in the early stages there are various different treatment options available depending on the circumstances of each case. These may include:
- Watchful waiting – This is for patients who may not be fit enough for more invasive procedures.
- Active surveillance – Generally speaking this means that a doctor will study the rate of growth in the cancer over a period of time to determine whether a cancer is growing and whether to start any treatment.
Advanced prostate cancer
When the urologist has determined that the cancer is megastatic they will then make the decision on whether or not to start further treatment. There are many variations of treatment available. Some of the options may be:
- Hormonal therapy – This is the next stage after watchful waiting before surgery or radiotherapy. The urologist will give the patient an injection or tablets in order to cease the production of hormones in the gland which the cancer depends on.
- Chemotherapy – When hormonal therapy is no longer working, as the cancer has adapted and no longer requires the presence of testosterone to survive, chemotherapy can take its place. This is the use of anti-cancerous drugs designed to shrink and control the size of the cancer.
- Surgery – An urologist will perform a prostatectomy and remove the entire prostate in order to remove the cancerous cells.
- Radiotherapy – The aim of this is to destroy the cancerous cells through the use of a high energy x-rays whilst still trying to preserve the healthy cells.
Find out more with our Prostate Cancer FAQ.
Prostatitis is the swelling or inflammation of the prostate gland. Symptoms can occur sporadically over a period of months. Most prostate problems affect mainly older men, however prostatitis can develop in men of all ages.
- Passing urine frequently
- Pain when passing urine
- Pain when ejaculating
- Pain in the lower back, pelvis, genitals and buttocks
- Fever (High temperature)
Acute vs. chronic prostatitis
- Acute prostatitis – Caused by bacterial infection, this infection can be a medical emergency where intravenous antibiotics may be required. Men with this disease will have fever like symptoms aches, chills and pain in the lower back and gentile area. This will develop rapidly and affects an estimated 1 in 10,000 men.
- Chronic prostatitis – (Chronic pelvic pain syndrome) will affect 1 in 10 men between the ages of 30-50 years old. Although the cause is uncertain this can be described as pelvic or penile pain without evidence of infection. Symptoms will last at least three months and vary in severity affecting areas of the testicles, tip of the penis, pubic or bladder area.
A doctor will give you a rectal examination. They will take a urine sample to test the amount of bacteria present in the urine. Blood tests, ultrasound or a CT scan may be required to determine any other conditions that could cause these symptoms. A specialist may perform a cytoscopy to check for any bladder abnormalities.
This is treated by a 4-6 week course of antibiotics. The symptoms should pass after two weeks, however to prevent any reoccurrence of infection it is imperative that the patient should see out the duration of the course. Paracetamol or Ibuprofen may be used to easy any pain or fever-like symptoms. In some case a specialist may suggest a prostatectomy (removal of the prostate) when there are small stones (calculi) in the prostate.
London Urology at the Hospital of St John & St Elizabeth offers a comprehensive and rapid access service for private patients seeking expert treatment for prostate problems and other urological conditions, including same day urgent referrals, last minute appointments and a 24hr on-call emergency service. Contact us today about appointments and enquiries.
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