Prostate is a small walnut shaped gland in men that sits just below the bladder and surrounds the urethra (tube carrying urine outside the bladder). Prostate has various functions -seminal fluid secretion (component of semen), hormone production and regulates flow of urine. Prostate enlargement issues are common in men especially > 50 yrs. of age and 50 % patients would develop some prostatic symptoms.
Symptoms could be bothersome, disrupting quality of life.
Symptoms
- Obstructive symptoms – Hesitancy, thinning of urine stream, intermittency, incomplete emptying of bladder, overflow incontinence (passing urine without knowledge).
- Irritative symptoms – Increased frequency, urgency (difficult to control urine), involuntary passing of urine, pain during passing urine.
- Haematuria – Blood in urine (rarely).
- Severity of symptoms may vary from person to person, some may carry on, others may find it difficult as it impacts daily activity & sleep.
Diagnosis
- Physical Examination – Digital rectal examination: USG of kidney, ureter and bladder area is mandatory to check the size of prostate, abnormal texture, bladder volume, residual urine after passing urine and state of kidneys.
- Blood Test – PSA: Marker of prostate cancer.
Neglecting the symptoms may lead to large volume of urine in the bladder-resulting in recurrent UTI, bladder stones formation and deterioration of kidney function.
Treatment
Treatment primarily depends on type of symptoms:
Lifestyle changes – Limit tea coffee, alcohol intake, and decreased fluid intake in evening.
Medical management – For medical management following medications are prescribed to settle the condition
Relaxation of prostatic muscles and bladder neck- Alpha blockers-Alfuzosin, Tamsulosin & Silodosin
Decrease the size of prostate – Finasteride, Dutasteride (this is given in elder patients with large prostates)
Irritative symptom treatment – Solifenacin, Darifenacin, Mirabegron
Minimally invasive treatments – Laser Vaporisation of prostate, TURP, Bipolar TURP, HOLEP (Holmium laser).
Urolift, Rezum Therapy – (modalities need to be established).
Robotic simple prostatectomy –The surgery is done for very large sized prostates.
Open prostatectomy-This procedure is very rarely done now a days.
(Author is Senior Director & HOD – Urology & Renal Transplantation, BLK-Max Super Specialty Hospital, New Delhi)
