BENIGN PROSTATIC HYPERPLASIA (BPH)
What is it?
BPH is a condition in which enlargement of the prostate causes blockage of urine flow out fo the bladder. This commonly affects men over 40 years of age and is a normal part of the ageing process.
While the cause is not entirely understood, it is thought that it is linked to testosterone receptors and cell growth/death cycles which causes the prostate to enlarge after puberty. The prostate is normally the size of a walnut and can increase to over 20 times in size.
Interestingly, the size of a prostate does not always correlate with the severity of symptoms a man can experience. Some men can have very little issues while others, even with smaller prostates, can have significant difficulties voiding.
Lower Urinary Tract Symptoms (LUTS) encompasses a range of traits such as:
Sensation of incomplete emptying
Waking at night to void
Below is the International Prostate Symptom Score sheet (I-PSS). It is a useful measure to help your Urologist assess the severity of your symptoms.
Various medications have been shown to provide significant improvements in urinary flow and symptoms. These agents relax the smooth muscles within the prostate and reduce the size.
While some benefit may be experienced within a few days, it often takes around 6 months to see its full effect.
Transurethal Resection of Prostate (TURP) is a procedure in which the occlusive portion of the prostate removed via a telescopic sheath and camera that is inserted into the penis. A electrical current is passed through a wire loop to excise layers of the internal prostate and cauterise any bleeding. This technique has been proven to be effective from the early 20th Century and still remains the gold standard in the volume of tissue removed and improvement to flow and IPSS.
This can be performed under general or spinal anaesthetic. The procedure takes up to 1 hour and involves a 1-2 days stay in hospital. There are no external incisions/scars and most patients feel an immediate improvement in symptoms.
UroLift is a new minimally invasive technique which relieves blockage caused by BPH.
It involves placing "anchors" into the prostate to hold the urethra open and avoids cutting or removing any prostate tissue. This has been clinically proven to show a demonstrable benefit to flow and symptoms while also having less side effects to sexual function.
GreenLight Laser Photoselective Vaporisation of the Prostate (PVP) uses focused high energy light to destroy prostatic tissue. This is done endoscopically to create an open channel for urinary flow. The advantage of this is that patients who take blood thinning agents, eg warfarin, can safely remain on it throughout the peri-operative period.
Because of the the intense heat energy, blood vessels are sealed off while the prostate tissue is ablated. This results in decreased blood loss and a faster recovery.