Benign prostate surgery options uk,is the prostate gland hard,what is the best treatment for an enlarged prostate young - Tips For You

Transurethral Resection of the Prostate (TURP) is a procedure to remove excessive growth of the prostate gland, resulting from Benign Prostatic Hyperplasia (BPH). Recent technological advances to reduce the invasive aspect of surgical treatments of BPH offer options such as lasers, microwave, radio waves, and ultrasound. After discharge, precautions are recommended for the purpose of healing, comfort, and preventing damage to the treated area. Sexual function returns for most men, but the doctor may advise against ejaculation for up to two months.
As BPH progresses, it can lead to enlargement of the prostate gland (a condition called benign prostatic enlargement [BPE]). The size of the prostate gland in patients with an enlarged prostate is not always directly related to a patient’s symptoms. The glandular cells produce a milky fluid, and during sex the smooth muscles contract and squeeze this fluid into the urethra. The prostate gland also contains an enzyme called 5 alpha-reductase that converts testosterone to dihydrotestosterone, another male hormone with a major impact on the prostate. The ureters empty into the bladder, which rests on top of the pelvic floor, a muscular structure similar to a sling running between the pubic bone and the base of the spine. When the internal sphincter is open, urine flows out of the bladder into the urethra (the tube that carries urine from the bladder out through the penis). Urine flows from the kidney through the ureters into the urinary bladder where it is temporarily stored. Urinary retention (inability to void) is a serious symptom of severe BPH that requires immediate medical attention. Some diagnostic tests are used to rule out cancers of the prostate or bladder as the cause of symptoms. The doctor will ask about the patient’s personal and family medical history, including past and present medical conditions.
To determine whether the bladder is obstructed, an electronic test called uroflowmetry measures the speed of urine flow.
Cystoscopy, also called urethrocystoscopy, is a test performed by a urologist to check for problems in the lower urinary tract, including the urethra and bladder. In this procedure, a thin tube with a light at the end (cytoscope) is inserted into the bladder through the urethra.
Ultrasound is a painless procedure that can give an accurate picture of the size and shape of the prostate gland.
The postvoid residual urine volume (PVR) test measures the amount of urine left after urination.
Some evidence indicates that the same risk factors associated with heart disease may increase the risk of developing BPH. How often have you had a sensation of not emptying your bladder completely after you finished urinating? How many times did you most typically get up to urinate from the time you went to bed at night until the time you got up in the morning?
Your doctor can discuss with you the various treatment options and the likelihood of symptom relief they may provide.
Men with moderate-to-severe symptoms often respond to the same medications as men with mild symptoms. The most common reason for choosing surgery is obstruction of the bladder outlet, which causes urinary retention. Increased urinary flow and reduced urine retention are the greatest improvements resulting from surgery.
Certain lifestyle changes may help relieve symptoms and are particularly important for men who choose to avoid surgery or drug therapy. Pelvic floor muscle exercises, first developed to help women with childbirth, may also help men prevent urine leakage, particularly after surgical procedure.
Generally, manufacturers of herbal remedies and dietary supplements do not need approval from the Food and Drug Administration to sell their products.
Other popular herbs include include extracts from African plum tree (Pygeum africanum), rye grass pollen (Secale cerale), stinging nettle root (Urtica dioica), South African star grass (Hypoxis rooperi), and pumpkin seed oil (Cucurbita peponis). Patients should be aware that high doses of zinc supplements may increase the risk and progression of BPH.
Because these two types of drugs work in different ways, combinations of the two may control symptoms in select patients more effectively than either drug alone. Drugs that block these receptors relax the muscles in and around the prostate, increase urinary flow and improve symptoms, sometimes significantly.
Alpha-blockers are prescribed for most men with BPH symptoms whose prostates are not significantly enlarged. A special concern for tamsulosin (Flomax), and other selective alpha-blockers, is that they are associated with a condition called intraoperative floppy iris syndrome (IFIS). The prostate gland contains an enzyme called 5 alpha-reductase that converts testosterone to another androgen called dihydrotestosterone. 5-alpha-reductase inhibitors are not as effective as alpha-blockers in improving BPH and urinary tract symptoms, but they can help modestly reduce symptoms for some men.
There is ongoing debate on whether 5-alpha-reductase inhibitors can help prevent prostate cancer.
These drugs decrease prostate-specific antigen (PSA) levels, which may mask the presence of prostate cancer.
Although some of these minimally invasive procedures may be an appropriate choice for patients depending on the circumstances, none of them to date have proven superior to TURP. Transurethral resection of the prostate (TURP) involves surgical removal of the inner portion of the prostate, where BPH develops. During recuperation at home, the patient should avoid driving, operating heavy equipment, lifting, sudden movements, and straining the muscles in the lower tracts, such as during a bowel movement.
Drinking 8 glasses of water a day after surgery is important to flush the bladder and help healing.
TUIP is less invasive than TURP, has a lower rate of the same complications, particularly retrograde ejaculation, and usually does not require a hospital stay. These procedures have a faster recovery time and less risk of incontinence than invasive surgical procedures, but their longterm effectiveness is unclear. Holmium laser enucleation of the prostate (HoLEP) is a newer technique that can actually cut and vaporize the tissue. Photoselective vaporization of the prostate (PVP) uses a potassium-titanyl-phosphate (KTP) laser ("green-light" laser) to vaporize prostate tissue. These minimally invasive procedures carry less risks for incontinence or problems with sexual function than invasive procedures, but it is unclear how effective they are in the long term. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Surgery is not a suitable treatment for urge incontinence unless stress incontinence is also a symptom.
The prostate gland plays an essential role in the functioning of the male reproductive system, secreting fluid into the urethra during ejaculation.
A new and promising laser procedure, GreenLight™ Laser PVP (photoselective vaporization of the prostates) has been demonstrated to remove prostate gland overgrowths using pulses of light with nearly no bleeding, less catheterization, and a greatly reduced recovery time. For men with other health problems that make the newer procedures inadvisable, TURP is the best option for treatment of BPH. Patients will require rest and should drink large quantities of water to flush out the bladder to prevent a urinary tract infection. While the ability to orgasm is unaffected by TURP, your ejaculate may no longer exit through the penis. The procedure takes about 1 hour. The surgeon will insert a tube-like tool called a cystoscope (or endoscope) through your urethra (the tube that carries urine from your bladder out of the penis). BackgroundHyperplasia is a general medical term referring to an abnormal increase in cells. The prostate is a walnut-shaped gland located below the bladder and in front of the rectum. As the bladder fills to its capacity of 8 - 16 oz of fluid, the nerves send signals from the bladder to the brain that indicate how full the bladder is. The detrusor muscles (which surround the bladder) contract, while the internal sphincter (a strong muscle encircling the neck of the bladder) relaxes. SymptomsLower urinary tract symptoms (LUTS) are categorized either as voiding (formerly called obstructive) or storage (formerly called irritative) symptoms. As the bladder becomes distended with urine, nerve impulses from the bladder signal the brain that it is full, giving the individual the urge to void.
The doctor will usually press on and manipulate (palpate) the abdomen and sides to detect signs of kidney or bladder abnormalities.
To perform this test, the patient urinates into a special toilet equipped with a measuring device. The doctor can determine the presence of structural problems including enlargement of the prostate, obstruction of the urethra or neck of the bladder, anatomical abnormalities, or bladder stones.
The doctor may insert tiny instruments through the cytoscope to take small tissue samples (biopsies). It can give an accurate measure of postvoid residual urine and can be used to check for kidney damage caused by severe BPH.
Normally, about 50 mL or less of urine is left; more than 200 mL is a sign of abnormalities. Prostatitis is an inflammation of the prostate gland that can be caused by bacterial or nonbacterial factors.
A number of medications can cause lower urinary tract symptoms or urinary retention, and can worsen symptoms of BPH. Watchful waiting (also known as active surveillance) involves lifestyle changes and an annual examination.
In general, there is no reason to treat BPH with medications unless symptoms become very uncomfortable. Recent developments in drug therapy have reduced the number of surgical procedures needed and delayed their use.
A quarter of men with moderate symptoms, and even more men with severe symptoms, eventually need surgery.

Studies have suggested that when hematuria is left untreated, two-thirds of patients continue to bleed and one third require surgery. Men with BPH should avoid, if possible, the many medications for colds and allergies that contain decongestants, such as pseudoephedrine (Sudafed). Men who are taking diuretics, which increase urination, may want to talk to their doctor about reducing the dosage or switching to another drug. Other drugs that may worsen symptoms are certain antidepressants and drugs used to treat spasticity.
These exercises strengthen the pelvic floor muscles that both support the bladder and close the sphincter. Some evidence indicates that fruits and vegetables rich in beta-carotene and vitamin C may help protect against BPH.
Just like a drug, herbs and supplements can affect the body's chemistry, and therefore have the potential to produce side effects that may be harmful. Beta-sitosterol is a plant sterol found in some of these herbs that is marketed as a dietary supplement for prostate health. Finasteride (Proscar) and dutasteride (Avodart) block the conversion of testosterone to dihydrotestosterone, the male hormone that stimulates the prostate. The combination treatment may work best for patients with larger prostate glands and higher PSA readings.
Alpha-adrenergic antagonists, commonly called alpha-blockers, were originally used to treat high blood pressure. Even men with moderately enlarged prostates might try alpha-blockers before more intense treatments because these drugs work fairly quickly, have no effect on sexual drive, and are the least expensive treatment for BPH. Nonselective alpha-blockers relax all smooth muscles in the body that surround blood vessels. Alpha-blockers can reduce blood pressure, which may cause dizziness lightheadedness, and fainting. Finasteride (Proscar) and dutasteride (Avodart), known as 5-alpha-reductase inhibitors (5-ARIs), block this enzyme and thus reduce dihydrotestosterone in the prostate.
However, these drugs take several months before they have an effect so men may not notice any signs of improvement for 3 - 6 months.
The main side effects of finasteride and dutasteride are erectile dysfunction, lowered sexual drive (libido), and reduced semen release during ejaculation. The American Society of Clinical Oncology and American Urological Association recently issued guidelines concerning the pros and cons of 5-ARIs for prostate cancer prevention.
To resolve this problem, doctors calculate PSA levels in men taking these drugs by doubling the PSA values. The most effective surgical procedure, transurethral resection of the prostate (TURP) is also the most invasive.
Over 5 - 10 years of follow-up, a higher percentage of patients receiving these less invasive procedures need surgery again. It is the most common surgical procedure for BPH, although the number of procedures has dropped significantly over the past decades because of the availability of effective medications.
If the fluids used during TURP build up, water intoxication can develop, which can be serious.
A Foley catheter generally remains in place for 3 - 5 days after surgery to allow urination. Complications after TURP can be high, depending on the skill of the surgeon and other factors, but their incidence has decreased considerably over the past decades because of advances in surgical technique and more widespread expertise.
Temporary stress incontinence (urine leakage after activities such as sneezing, coughing, or lifting) occurs in most surgical patients. Retrograde ejaculation (ejaculation into the bladder rather than out through the urethra) is very common.
Symptomatic relief is usually maintained for at least 15 years after surgery, but BPH may return or patients may need a second operation for other reasons. In TUIP, the surgeon makes only one or two incisions in the prostate, causing the bladder neck and the prostate to spring open and reduce pressure on the urethra. More studies are still needed, however, to determine whether they are comparative in long-term effectiveness. In open prostatectomy, the enlarged prostate is removed through an open incision in the abdomen using standard surgical techniques. A fiberoptic tip is threaded through the scope to direct a diode laser emission to targeted areas of the prostate.
Vaporization is effective immediately and also may pose lower risks for prolonged urinary retention and reoperation rates than coagulation. The procedure is virtually bloodless and may be a better option for men taking anticoagulant ("blood thinner") medication. Transurethral microwave thermotherapy delivers heat using microwave pulses to destroy prostate tissue. Transurethral needle ablation is a relatively simple and safe procedure, using needles to deliver high-frequency radio waves to heat and destroy prostate tissue. Transurethral electrovaporization uses high voltage electrical current delivered through a resectoscope to combine vaporization of prostate tissue and coagulation that seals the blood and lymph vessels around the area. A device called Thermoflex, which circulates heated water through a catheter to destroy prostatic tissue, has been approved for treating BPH. Association between tamsulosin and serious ophthalmic adverse events in older men following cataract surgery. Progression of benign prostatic hyperplasia: systematic review of the placebo arms of clinical trials.
The effect of doxazosin, finasteride and combination therapy on nocturia in men with benign prostatic hyperplasia. Systematic review and economic modelling of effectiveness and cost utility of surgical treatments for men with benign prostatic enlargement.
Alternative approaches to endoscopic ablation for benign enlargement of the prostate: systematic review of randomised controlled trials.
Minimally invasive treatments for benign prostatic enlargement: systematic review of randomised controlled trials.
Five-year follow-up of feedback microwave thermotherapy versus TURP for clinical BPH: a prospective randomized multicenter study.
Benign prostatic hyperplasia: Etiology, pathophysiology, epidemiology, and natural history.
The effects of dutasteride, tamsulosin and combination therapy on lower urinary tract symptoms in men with benign prostatic hyperplasia and prostatic enlargement: 2-year results from the CombAT study. Fruit and vegetable consumption, intake of micronutrients, and benign prostatic hyperplasia in US men. Evidence-based guidelines for the management of lower urinary tract symptoms related to uncomplicated benign prostatic hyperplasia in Italy: updated summary. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions.
If the muscles that keep your bladder closed are weak, you may have accidents when you sneeze, laugh or lift a heavy object (stress incontinence). Medications are not suitable for everyone and possible complications will be discussed with prior to being prescribed.
It is performed by a urologist in a hospital under general anesthesia or spinal anesthesia coupled with a sedative. If the prostate has grown too large, newer procedures they may not be effective, and some may feel more comfortable with surgery than an unfamiliar technology.
The catheter will remain in for a few days to a week and must be flushed regularly by the patient after discharge; instructions on how to do this are given while in the hospital. This occurs if the valve to the bladder, which controls the direction of semen, is damaged during the procedure. Samadi’s record of personally conducted robotic procedures and success rates are beyond compare. As the prostate grows, it can squeeze the urinary tube (urethra), causing urinary symptoms. The most important androgen is testosterone, which is produced in the testes throughout a man''s lifetime. An enlarged prostate may be accompanied by few symptoms, while severe LUTS may be present with normal or even small prostates. By voluntarily relaxing the sphincter muscle around the urethra, the bladder can be emptied of urine. The doctor inserts a gloved and lubricated finger into the patient''s rectum and feels the prostate to estimate its size and to detect nodules or tenderness. These abnormalities include narrowing of the urethra, weakened bladder, and prostate muscle contractions.
The size of the prostate, determined by exam or ultrasound, cannot indicate the need for medications. The drug finasteride may help some men with this condition and should probably be tried before surgery. Such drugs, known as adrenergics, can exacerbate urinary symptoms by preventing muscles in the prostate and bladder neck from relaxing to allow urine to flow freely. These are important drugs for many people with high blood pressure, with a proven track record for saving lives. Dietary choices should also focus on increasing intake of healthy fats, such as omega-3 fatty acids, and limiting intake of saturated fats and trans-fatty acids. There have been several reported cases of serious and even lethal side effects from herbal products. They include terazosin (Hytrin), doxazosin (Cardura), tamsulosin (Flomax), alfuzosin (Uroxatral), and silodosin (Rapaflo).
Because these drugs are short-acting, symptoms return very quickly once a man stops taking the medication. Some doctors now recommend alpha-blockers as first-line treatment for patients with moderate-to-severe symptoms. Selective alpha-blockers target more specifically the smooth muscles of the prostate, but they can also affect other areas of the body, such as the eyes. Orthostatic hypotension, a sudden drop in blood pressure when standing, can occur and increases the risk of falling.

Patients who are planning cataract or other eye surgery should be sure to inform their doctors prior to the surgery. This process helps to shrink an enlarged prostate and prevent future growth of the prostate. The 5 alpha-reductase inhibitors are most effective in reducing symptoms in men with enlarged prostates. It has the highest risk for serious complications, including blood loss, erectile dysfunction, and urinary incontinence.
This condition is referred to as the transurethral resection (TUR) syndrome and includes abdominal cramps, nausea, vomiting, lethargy, and dizziness.
This device is a tube inserted through the opening of the penis to drain the urine into a bag. After the catheter is removed, patients often feel some pain or sense of urgency as the urine passes over the surgical wound. TUIP is generally used only for men with minimally enlarged prostates (30 grams or less) who have obstruction of the neck of the bladder. Laser procedures can usually be done as an outpatient procedure, and there is little risk for bleeding.
Results from several recent clinical trials report sustained improvement up to 1 year after the procedure.
A microwave antenna is inserted through the urethra with ultrasound used to position it accurately.
Another technique uses a balloon filled with hot water to destroy tissue around the urethra. You will usually be organised to have a cystometrogram (urodynamic study) prior to any treatment being started. A resectoscope (an instrument much like a cystoscope with the advantages of a microscope, light, irrigation capability, and a wire loop) or a spring-action cutting tool, is inserted into the urethra to access the enlarged prostate gland. A significant improvement in recovery is seen after the catheter has been removed and, while some of the pre-operative symptoms may continue, they will slowly decrease over a period of two to eight weeks.
Samadi had explained at our first consultation .There were no surprises or unexpected incidents.
This tool will remove part of your prostate gland piece by piece with an electric current. Why the Procedure is Performed The prostate gland often grows larger as men get older. It is the most common noncancerous form of cell growth in men and usually begins with microscopic nodules in younger men. These urinary difficulties are part of a group of symptoms called collectively lower urinary tract symptoms (LUTS).
DiagnosisA doctor makes a diagnosis of BPH based on description of symptoms, medical history, physical examination, and various blood and urine tests. Certain procedures that test reflexes, sensations, and motor response may be performed in the lower extremities to rule out possible neurologic causes of bladder dysfunction. However, bladder obstruction can also be caused by other conditions including weak bladder muscles and problems in the urethra. The most common method for measuring PVR is with a catheter, a soft tube that is inserted into the urethra within a few minutes of urination. Such conditions can produce obstruction, impairor weaken the detrusor muscles surrounding the bladder, or cause other damage that impacts the urinary tract. Your doctor needs to monitor your condition to determine when it may be time to start treatment.
They include drug therapies to help shrink or relax the prostate, minimally invasive procedures that use heat to reduce excess prostate tissue, and major surgery to remove part of the prostate. Men with mild symptoms who choose surgery only experience minor improvement afterward but face the same risks as patients with more severe symptoms. Transurethral resection of the prostate (TURP) is the standard procedure, but less invasive procedures, particularly those using heat or lasers to destroy prostate tissue, are becoming more common.
Antihistamines, such as diphenhydramine (Benadryl), can also slow urine flow in some men with BPH.
Patients should check with their doctor before using any herbal remedies or dietary supplements. A large, high-quality study found that saw palmetto had no benefit for treating BPH for men with moderate-to-severe BPH when the herb was taken for 1 year. In addition to relieving symptoms, they increase urinary flow and may even help shrink the prostate. The muscle cells in the prostate are stimulated by molecules called alpha adrenergic receptors.
Drugs in both categories are similar in effectiveness for reducing symptoms and improving urinary flow. IFIS appears more likely to occur with the newer, selective alpha-blockers than non-selective alpha blockers. These drugs can also help prevent against urinary retention, and possibly reduce the need for future prostate surgery. Because lower urinary tract symptoms (LUTS) and ED often occur together in older men, researchers are investigating whether PDE5 inhibitors may help improve BPH symptoms. However, because it is more effective than less invasive procedures, TURP remains the procedure of choice for many doctors. It occurs in about 2% of patients and is a temporary condition occurring immediately after surgery, which can be treated with diuretics to remove excess fluid. Sometimes, scarring in the bladder severe enough to cause obstruction occurs within a year of the procedure and may require transurethral incision (TUIP). Open prostatectomy is used only for severe cases, about 2 - 3% of BPH patients, when the prostate is severely enlarged, the bladder is damaged, or other serious problems exist.
Approved in 1998, this procedure is being performed less frequently as urologists turn to newer laser technologies (HoLEP, PVP). Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. The electricity generated through the cutting tool removes small pieces of tissue until the urethra is no longer restricted. It reaches normal adult size and shape, about that of a walnut, when a man is in his early 20s. DHT stimulates cell growth in the tissue that lines the prostate gland (the glandular epithelium) and is the major cause of the rapid prostate enlargement that occurs between puberty and young adulthood.
The test helps rule out prostate cancer or problems with the muscles in the rectum that might be causing symptoms, but it can underestimate the prostate''s size.
However, patients may have to take these drugs for up to 6 - 12 months to achieve full benefits.
Because of the reduced blood pressure side effect, do not take phosphodiesterase inhibitors [such as sildenafil (Viagra)] at the same time, at least without advice from a doctor.
Some studies indicate that sildenafil improves urinary symptoms in men who have both ED and LUTS. When considering invasive surgery, the patient should be sure that the surgeon is experienced in performing these procedures.
The surgeon uses the endoscope to cut away excess prostatic tissue, and water solutions are used to flush away the excised matter.
Occasionally, the scab on the surgical wound loosens, causing a sudden appearance of blood in the urine that can be alarming. More often, the urethra is scarred and narrows, but usually this condition can be corrected by a simple stretching procedure performed in the doctor's office.
Computer-generated microwaves pulse through the antenna to heat and destroy prostate tissue. Unfortunately, stents often need to be removed later because of poor placement or complications, including irritation when urinating, urinary tract infections, and treatment failure. To control bleeding, the vessels are cauterized by the wire loop and the bladder and urethra are irrigated with a saline solution. The gland generally remains stable until about the mid-40s, when, in most men, the prostate begins to grow again through a process of cell multiplication. Usually this stops after a rest, but the patient should notify the doctor at once if he is concerned about abnormal bleeding or clotting or has unusual feelings of discomfort. In making a decision about prostatectomy, it is essential that the doctor explains the consequences of a diminished sexual capacity that occurs after this procedure. When the temperature becomes too high, the computer shuts down the heat and resumes treatment when a safe level has been reached. Any duplication or distribution of the information contained herein is strictly prohibited. A urinary catheter is put in for the purpose of resting the bladder and prostate, keeping the urethra open if swelling develops, and to empty the bladder of blood to avoid clotting. Removing part of the prostate gland can often make these symptoms better. Before you have surgery, your doctor will suggest you make changes in how you eat or drink. In about 4% of cases, hemorrhage occurs either during or following surgery, requiring a transfusion. Prostatectomy should be considered a last resort if the patient still has an active sex life.
The procedure takes 30 minutes to 2 hours, and the patient can go home immediately afterward.
ReferencesAbrams P, Chapple C, Khoury S, Roehrborn C, de la Rosette J; International Scientific Committee. Blood loss and transfusion are more likely to occur in TURP than in minimally invasive procedures. Your prostate may also need to be removed if taking medicine and changing your diet do not help your symptoms. TURP is one of the most common procedures for this problem. A bladder irrigation solution may be attached to the catheter to continuously flush the catheter.

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