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All facts about Benign Prostatic Hyperplasia/Enlargement (BPH/BPE), its diagnosis and available treatments

What is prostate gland?

• A prostate gland is an accessory gland of male reproductive system that wraps around the male urethra near the bladder.
• Prostate gland developed at age of 12 years, and it starts growing in middle age.
• The prostate surrounds the urethra, the tube that carries urine from the bladder through the penis and outside the body.
• Prostate gland contains crucial enzyme, 5-alpha-reductace which converts the hormones testosterone in the body to DHT.

What is Benign prostatic hyperplasia/enlargement (BPH/BPE)?

• BPH/BPE is a condition that occurs when the prostate gland enlarges, potentially slowing or blocking the urinary stream.
• Other names for benign prostatic hyperplasia include benign prostatic hypertrophy and an enlarged prostate.
• The prostate normally enlarges to some degree in all men with advancing age, although not all men require treatment.
• As the prostate gets bigger, it may press on the urethra and cause the flow of urine to be slower and less forceful.
• "Benign" means the enlargement isn't caused by cancer or infection.
• "Hyperplasia" means enlargement.

What are symptoms of BPH?

The symptoms of BPH can likely begin after an age between 40 to 50 years and only in men. The most common symptoms of BPH include:
• Frequent urination (able to hold less than 2 hours)
• Getting up in the night for urination (Nocturia)
• Sudden desire to pass urine (Urgency) or leakage of urine (Urgency incontinence)
• A hesitant, interrupted, or weak stream of urine
• Failure to pass urine (urinary retention)
• Dribbling of urine
• Incomplete emptying of the bladder
• Blood in Urine
• Frequent urinary tract infection
• Straining during urination

How to diagnose BPH and types of investigations required?

To know if BPH or any another problem is causing symptoms, a urologist will ask you questions, perform an examination and will order few tests as below:
• Rectal examination – Your urologist will need to perform a rectal examination to feel the size and shape of the prostate gland.
• Urinalysis – You might be asked for a urine sample to see if you have a urinary tract infection, diabetes, or certain kidney disorder.
• Blood tests – A blood test to check the prostate-specific antigen (PSA) level is often recommended.
• Ultrasound test – A USG test to know the size of prostate, thickness of bladder and structure of kidneys and post void residual urine.
• Uroflowmetry Test – This is a special kind of test to know how much prostate gland is obstructing the urethra.

Mention role of Prostate specific antigen (PSA) in evaluation?

• PSA, or prostate-specific antigen, plays a role as one of the diagnostic markers though it is non-specific.
• Elevated PSA levels may indicate BPH or Prostate gland infection or Prostate cancer and needs to be evaluated further.
• Regular PSA screenings can aid in monitoring prostate health and detecting potential issues like prostate cancer in their early stages.

What are the treatments available for BPH?

Watchful waiting – If symptoms are mild and not bothersome, then regular monitoring is what all is needed and don't need the treatment right away.
Medicines – There are 2 types of medicine commonly used to treat BPH. One type relaxes the muscles that surround the urethra, and another reduces the size of prostate.
Surgery – There are several ways to treat BPH with surgery. They can involve removing obstructing prostate and making the urethra wider so that more urine can flow through easily.

Explain LASER surgery of prostate?

• It is also known as Holmium LASER enucleation of prostate (HoLEP)/ Thulium fibre LASER enucleation of prostate (ThuLEP)?
• There are different types of laser prostate surgeries, but they all involve the use of laser energy to remove or vaporize excess prostate tissue that is causing urinary issues.
• Best approach is LASER enucleation, which involves removing the inner part of the prostate to alleviate urinary symptoms.
• Laser prostate surgery is often considered as a minimally invasive option compared to traditional surgical methods, and it may result in less bleeding and a faster recovery.

How is LASER prostate surgery (HoLEP/ThuLEP) performed?

• LASER prostate surgery is performed by endoscopy method, that means a tiny camera will insert in urethra along with an energy source used which is a LASER fiber.
• It doesn’t involve any surgical cut over the body and performed through urethra.

Mention Post operative care after LASER surgery of prostate.

• Try to avoid constipation. Eat foods that have a lot of fiber.
• Drink plenty of water, especially if your urine looks red or you pass small blood clots. It is normal for your urine to have a small amount of blood in it right after surgery.
• Avoid lifting weighted things for some time.
• Avoid smoking and alcohol intake.
• Increase your activity slowly – Start with short walks around your home and walk a little more each day.
• Take prescribed medication as advised.

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