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TURP Surgery is the gold standard treatment for BPH (Benign Prostatic Hyperplasia) and its associated moderate to severe lower urinary tract symtpoms. It is a viable treatment for those who need active treatment or fail to respond to medical management.
BPH is an age related enlargement of the prostate gland. It occurs in old men and is responsible for causing distressing urinary symptoms.
Trans Urethral Resection of Prostate surgery involves cutting and removing part of the overgrown prostate gland through urethra in order to remove its pressure on that segment of the urethra which runs through it.
Q1 What is a prostate gland?
A1 Prostate gland is present only in men and serves an important function in their body. Its a walnut sized gland that weighs merely 30gms.
Location of Prostate Gland
Located inside the body, in between the urinary bladder (where urine is stored) and the penis. It sits directly beneath the urinary bladder and on top of the pelvic floor muscles.
Prostate gland encircles the neck of the bladder (region where urethra joins the bladder) and a part of urethra. Urethra, a muscular tube that extends from the bladder to the tip of the penis, runs through the middle of the prostate gland, carrying urine from the bladder, to be expelled out of the body through tip of the penis. In males, the urethra also expels the semen, during ejaculation.
It rests in front of the rectum (the lower part of the large intestine that carries the fecal waste to be expelled outside the body, through anus). This is the reason which makes it easy to feel it through rectum using your gloved finger. This exam is referred to as DRE (Digital Rectal Examination).
Function of Prostate Gland
Integral part of Male Reproductive System: Secretes prostatic fluid that forms 30% of the semen.
Prostate gland forms an integral part of male reproductive system and secretes an alkaline fluid, the prostatic fluid that forms 30% of the ejaculated semen or seminal fluid that carries sperms along. The prostatic fluid protects and nourishes the sperms, alongwith other components of the semen, it also produces conducive environment for the transport, survival of the sperm and the its ability to fertilize the egg.
Hence, it has a significant role to play in men's fertility.
Prostate gland also secretes a protein called PSA (Prostate Specific Antigen) in this thin and milky looking prostatic fluid, which can be measured through a blood test and can be a good indicator for detecting various prostatic conditions.
Prostatic muscle contraction ensures semen out during ejaculation and not into the bladder
Furthermore, contraction of the muscles of the Prostate gland forces the semen into the urethra, eventually to be expelled out during ejaculation.
Alongwith the bladder sphincter muscles, the prostate gland ensures that the semen does not enter the urinary bladder during ejaculation, by closing the urethra upto the bladder at that time.
Likewise, during the urination, the urine does not enter anywhere else other than being expelled out of the body , due to the closure of prostatic ducts and seminal ducts during urination.
Prostate gland also plays part in Hormone Metabolism
In the prostate gland, the male sex hormone Testosterone is changed into its biologically active version called DHT (Dihydrotestosterone).
Prostate gland, although an important component of male reproductive system, is not essential for life.
Prostate gland undergoes two growth periods during a man's lifetime. First, during early puberty and second growth phase commences around the age of 25 yrs and it keeps on growing continuously in most of his life. BPH is associated with the second growth phase of prostate gland.
Prostate gland usually grows almost double in size during adolescence under the influence of the male hormone "Testosterone" and its by product DHT (Dihydrotestosterone). Testosterone is primarily produced by Testes but a small amount is also produced by the adrenal glands, the glands that rest above the kidneys.
Q2 What is BPH?
A2 BPH or Benign Prostatic Hyperplasia is a progressive medical condition in which there is age associated enlargement of the prostate gland.
The enlarged prostate presses against the urethra that runs through its centre causing urinary flow obstruction.
Eventually the urinary bladder wall becomes thick, due to the resistance offered by the obstructed urethra. This thickened bladder wall makes the bladder weak leading to incomplete emptying of the bladder or in other words, leaving some residual urine in the bladder every time.
This urinary retention and obstructed urinary flow are responsible for annoying urinary symptoms that the patient experiences.
BPH is not a cancer. It is also sometimes referred to as BPE (Benign Prostatic Enlargement) and is a very common medical condition.
Also known by the following names such as Benign Prostatic Hypertrophy or Benign Prostatic Obstruction.
Q3 Who is more susceptible to develop Benign Prostatic Hyperplasia?
A3 Men with the following factors are more prone to develop BPH:
Men above 40 yrs
Presence of family history of BPH
Presence of Obesity, Cardiovascular disease or Type 2 Diabetes
Q4 What are the symptoms associated with Benign Prostatic Hyperplasia?
A4 Symptoms are assessed at your initial contact with the specialist to make the diagnosis of the BPH and even to rule out other medical conditions other than BPH.
Furthermore, for those patients who are advised watchful waiting, symptoms are assessed in follow ups to see if there is any worsening or progression of the symptoms concerning BPH and also, to know how you are responding to the treatment.
The symptoms associated with Benign prostatic Hyperplasia may be:
Difficulty in initiating urination
Increased frequency of urination (the person has to go eight or more number of times in a day, to urinate)
Weak or interrupted urinary flow
Dribbling or passing drops at the end of urination
Nocturia (the person has to wake up at night to pass urine)
Urinary retention or inability to completely empty the bladder (significant amount of residual urine in the bladder even after urination)
Urinary Incontinence (no control over urination; leakage of urine)
Q5 How is Benign Prostatic Hyperplasia diagnosed?
A5 Generally, a male patient over 50 yrs of age who is presenting with LUTS (Lower Urinary Tract Symptoms) is believed to have BPH.
Bladder and urethra are the components of the Lower Urinary Tract.
To confirm the diagnosis of BPH your specialist will run some investigations or tests.
Initial evaluation of the patient who presents with lower urinary tract symptoms mandatorily includes
These are the steps taken as initial evaluation and to assess the severity of the symptoms and how bothersome they are for you is equally essential.
If deemed necessary, your specialist may order more comprehensive tests to rule out other medical conditions and to confirm diagnosis of BPO (Benign Prostatic Obstruction) that is responsible for your lower urinary tract symptoms.
PSA (Prostate Specific Antigen) test is also recommended in selected patients.
Other tests that may be ordered are
Urodynamic tests such as Uroflowmetry,
Q6 What may be the complications of the untreated Benign Prostatic Hyperplasia?
A6 The following may be the complications associated with untreated BPH:
Damage to the kidneys and the bladder
Urinary tract infections (UTI)
Hematuria (Blood in the urine)
Acute or Chronic Urinary Retention
Q7 How is Benign Prostatic Hyperplasia treated?
A7 Benign Prostatic Hyperplasia can be treated in the following ways:
Minimally Invasive Procedures
The choice of treatment modality is at the discretion of the urologist, based on the severity of symptoms and the patient's preferences. Your doctor may suggest watchful waiting in case of mild enlargement of the prostate gland which is not bothersome and may ask you to get regular check ups done.
Q8 When is surgery recommended for the treatment of Benign Prostatic Hyperplasia?
A8 Surgery is a viable treatment option for prostate enlargement or BPH when;
Medicines and Minimally Invasive procedures have proved futile in providing relief
Symptoms are worsening and hampering daily activities considerably
Complications have ensue
Q9 What are the different types of surgery that can be done for the treatment of BPH?
A9 Surgery is done either to remove the enlarged prostatic tissue which is responsible for the annoying urinary symptoms or it may entail making cuts in the prostate in order to widen the urethra.
The different surgical options are:
TURP (Trans Urethral Resection of Prostate)
TUIP (Trans Urethral Incision of Prostate)
Laser Prostate Surgery
Q10 What is the duration of the TURP surgery?
A Usually 1 hour
Q11 How long is the hospital stay for TURP surgery?
A11 2 to 3 days
Q12 What kind of anesthesia is used for TURP surgery?
A12 Either General or Spinal anesthesia is used for performing TURP surgery. In General anesthesia patient is put to sleep and in Spinal anesthesia there will not be any sensation below waist. The type of anesthesia given for TURP surgery is at the discretion of the specialist keeping in mind your requirement.
Q13 How do I prepare for the TURP surgery?
A13 Your specialist will advise you on the kind of preparation required for TURP surgery. Preparation includes stopping any medicine several days before the procedure, that increases your risk of bleeding such as blood thinners like Warfarin or Clopidogrel.
Your urologist may prescribe an antibiotic soon before or after the surgery to prevent infection.
Q14 What does TURP or Trans Urethral Resection surgery of the Prostate involve?
A14 Trans Urethral Resection of the Prostate surgery
After an anesthesia is given to you, a special instrument called as Resectoscope will be slided inside your urethra, though the tip of your penis.
Once it reaches at the level of the prostate gland, it will cut the excessive prostatic tissue with the help of a wire loop, till it is all done. The cut tissue will be simultaneously pushed inside the bladder during the procedure, with the help of an irrigating fluid.
Once the procedure is finished the bladder will be drained of all trimmed prostatic tissue, till it is emptied of it.
No incisions are made on the outside of your body to get to the prostatic area.
TURP surgery is the most common surgery performed to treat enlarged prostate gland (Benign Prostatic Hyperplasia).
Q15 What can I expect after TURP surgery?
A15 Once TURP Prostate surgery is over, you will need to stay in the hospital for around 2 days.
During this time, a urinary catheter will be placed inside your bladder through your urethra, to help you urinate and urine will be collected in the drainage bag attached to the catheter.
The catheter is in place till the time inside of your urethra is healing. Once the swelling subsides and you can pass urine without any issues, the catheter will be removed.
Once you are discharged from the hospital, you will be given a set of instructions to help you recover smoothly and fast.
Abstinence from sex for 4 to 6 weeks
Fibre rich diet to help prevent constipation
Avoid lifting heavy things and sternuous activities
Avoid driving till the time you have catheter in place and are on analgesics or pain killers.
These are the general set of instructions. However, there may be more, depending upon your requirement.
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