Understanding the Prostate
The prostate is a walnut-sized gland that forms part of the male reproductive system. The prostate secretes fluid that carries sperm. It surrounds the urethra, the canal which carries urine from the bladder out of the body.
With age and time, the prostate enlarges causing pressure on the urethra, similar to a clamp on a garden hose. This causes problems with urination.
BENIGN PROSTATE HYPERTROPHY
Half of all men over the age of 50 will develop an enlarged prostate, also known as Benign Prostatic Hyperplasia, or BPH.
Symptoms
By the time a man reaches his 70's or 80's, 80% will experience urinary symptoms including:
- Frequent urination, especially at night
- Sudden need to urinate
- Need to strain or push to urinate
- Pain or burning
- Feeling that your bladder never completely empties
- Dribbling or leaking
- Weak stream
Loss of Personal Freedom
Many men report changes to lifestyle such as avoiding travel, using bathroom stalls instead of urinals or not wearing light colored pants. Frequent trips to the bathroom can disrupt sleep.
Diagnosis
You may first notice symptoms of BPH yourself, or your doctor may find that your prostate is enlarged during a routine checkup. When BPH is suspected, you may be referred to a urologist, a doctor who specializes in problems of the urinary tract and the male reproductive system. Several tests help the doctor identify the problem and decide the best course of treatment. The tests vary from patient to patient, but the following are the most common.
Digital Rectal Exam (DRE)
This exam is usually the first test done. The doctor inserts a gloved finger into the rectum and feels the part of the prostate next to the rectum. This exam gives the doctor a general idea of the size and condition of the gland.
Prostate Specific Antigen (PSA) Blood Test
In order to rule out cancer as a cause of urinary symptoms, your doctor may recommend a PSA blood test. PSA, a protein produced by prostate cells, is frequently present at elevated levels in the blood of men who have prostate cancer. The U.S. Food and Drug Administration has approved a PSA test for use in conjunction with a digital rectal exam to help detect prostate cancer in men age 50 or older and for monitoring prostate cancer patients after treatment.
Rectal Ultrasound
If there is a suspicion of prostate cancer, your doctor may recommend a test with rectal ultrasound. In this procedure, a probe inserted in the rectum directs sound waves at the prostate. The echo patterns of the sound waves form an image of the prostate gland on a display screen.
Urine Flow Study
Sometimes the doctor will ask a patient to urinate into a special device which measures how quickly the urine is flowing. A reduced flow often suggests BPH.
Intravenous Pyelogram (IVP)
IVP is an x-ray of the urinary tract. In this test, a dye is injected into a vein, and the x-ray is taken. The dye makes the urine visible on the x-ray and shows any obstruction or blockage in the urinary tract.
Cystoscopy
In this exam, the doctor inserts a small tube through the opening of the urethra in the penis. This test allows the doctor to determine the size of the gland and identify the location and degree of the obstruction.
Treatment options
The appropriate treatment should be carefully selected considering the stage of the disease, current medical conditions, and the patients and the physicians concern.
The treatment alternatives for BPH ,successfully practiced at Hattat Hospital include:
A Simple and Effective Solution: GreenLight™ laser system
Medication
Medical therapy is usually the first line of defense against enlarged prostate symptoms. Medications are costly, must be taken every day for the rest of your life and may stop working over time. Side effects can include impotence, retrograde ejaculation, dizziness, headaches, fatigue and loss of sexual drive.
Heat Therapies
Heat or thermal therapies rely on different energy sources to heat and destroy prostate tissue. The destroyed tissue is left in the body and is expelled over time. This results in an incomplete reduction of tissue and prostate swelling that causes increased urinary symptoms for several weeks to months. You may need to wear a catheter for a few days or several weeks.Common heat treatments include: transurethral microwave thermal therapy(TUMT), transurethral needle ablation(TUNA®) and interstitial laser coagulation(ILC). These treatments are not always effective in relieving urinary symptoms or restoring good urine flow, and symptoms may return after a year or two.Side effects of heat therapies may include pain and irritation during urination, urinary tract infections, incontinence, urinary retention, impotence and retrograde ejaculation.
Invasive Surgery
Transurethral Resection of the Prostate (TURP) is known as the "gold standard" of treatment. Enlarged prostate tissue is removed surgically resulting in symptom relief and restored urine flow.TURP is an invasive surgical procedure. There is a greater risk of complications, including excessive blood loss, blood transfusion, incontinence, impotence, infection, painful urination and a high rate of retrograde ejaculation. TURP requires a 1-4 day hospital stay and 1-3 days wearing a catheter. Recovery time averages 4-6 weeks.
GreenLight
PVP for Photoselective Vaporization of the Prostate, performed with the GreenLight™ laser system, offers a unique and simple solution to BPH because it combines the effectiveness of TURP, the surgical "gold standard" with the safety, comfort and ease of a therapeutic alternative.The GreenLight laser system uses a very high powered "green laser" which immediately vaporizes and precisely removes enlarged prostate tissue.Most patients return home a few short hours after the PVP procedure and can return to normal, non-strenuous activities within days.
 The Procedure:
A thin fiber is inserted into the urethra through a cystoscope. The fiber delivers green laser energy that quickly vaporizes and precisely removes enlarged prostate tissue. The physician is able to safely view and control the treatment area, tailoring it to each patient’s anatomy and needs. Natural urine flow is immediately restored and urinary symptoms are relieved. Patients may be released after a few hours or after an overnight stay. Many patients do not need a catheter. If one is required, it is usually removed in less than 24 hours. After the procedure you may have some mild discomfort such as slight burning during urination for a week or so. This is easily managed with mild pain medications and anti-inflammatory drugs. Most patients can resume normal activities like driving a car or working a desk job within the week. The GreenLight PVP Laser Procedure should not affect your ability to have an erection or an orgasm. Retrograde ejaculation” or “dry climax”, may occur. If you are sexually active, you can look forward to remaining so.
GreenLight PVP Procedure is:
Safe - the GreenLight PV System designed for this procedure is very precise and the vaporization is limited to the excess tissue only
Minimally invasive - no large openings are required to access the treatment area
Various anesthetic options - to insure patients' comfort nearly any type of anesthesia can be used, from local to general
No rectal thermal monitoring device necessary - due to high safety and limited injury area there is no need to monitor temperature inside the treatment area.
Virtually blood-free - dramatically decreased healing time
Low (about 50%) incidence of catheterization - no constraints, immediate freedom of movement
Short (less than 24 hours) catheterization time - for those patients who would require a catheter, the constrains are very short-term
Outpatient procedure - go home the same day
Immediate relief of symptoms - immediate improvement of the quality of your life
Preservation of sexual functions - there is no risk of sexual dilapidation as result of the procedure
Hardly any recovery time - with the exception of strenuous activities for about 2 weeks, you can resume your normal routine right away
Effective - long lasting proven results
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