Benign Prostatic Hyperplasia (BPH)
Benign Prostatic Hyperplasia also known as 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.
Symptoms Of Benign Prostatic Hyperplasia
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.
Diagnosis Of Benign Prostatic Hyperplasia
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.
Treatment Of Benign Prostatic Hyperplasia
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.
London Urology provides TURis as a day case procedure.