The prostate gland is a male gland that’s non-existent in the female pelvis. It is located in the pelvis behind the pubic bone and surrounding the upper part of the urethra.
Benign prostatic hyperplasia, also known as prostate enlargement, is a very common disease that affects the prostate gland, which is an important part of the male urogenital system and is responsible for secreting 70% of the semen.
This enlargement occurs as the number of cells increases thus causing an increase in the size of the prostate gland but in a non-cancerous way, hence, it is benign. (i.e., non-carcinogenic).
It is worth noting that the incidence of this inflation is very big, especially as men get older, i.e., after the age of forty, however in men over the age of ninety, the incidence of benign prostatic hyperplasia becomes almost a certainty.
The symptoms of benign prostatic hyperplasia are similar to the symptoms of some other disorders that affect this anatomical location of the prostate in the urogenital system, disorders that affect the cells of the prostate as well as some of the surrounding organs can be summarized as follows:
- Weak or slow urine flow ( Weak stream )
- the sensation of a full bladder despite urination.
- Difficulty and pain when urinating.
- Frequent urination and intermittent stream of urine .
- Urgent need to urinate, especially at night.
- Return to urinating again a minute after the end of urination for the first time.
Diagnosis of BPH depends on the clinical symptoms and signs that we referred to previously, in addition to observing the anatomical changes that occur in the prostate gland, which can be detected using the following methods:
- History (the general indication of prostate symptoms and an accurate assessment of symptoms)
- Clinical examination of the abdominal and pelvic area, to sense any disturbances or changes in the abdominal and pelvic area that contains the prostate gland.
- Calculate urine outflow rate.
- Urine test to see how much urine remains in the bladder after urinating.
- Pressure flow studies to measure pressure in the bladder and urination.
- Urine analysis to check for blood or infection.
- A urine culture analysis.
- A blood test to detect prostate-specific antigen (PSA), which indicates an increase in the normal level of prostate disorders, including prostate cancer.
- A digital rectal exam.
- Prostate ultrasound examination.
The treatment methods used depend on the severity of the onset of symptoms and the severity of the inflation. Therapeutic measures are listed as follows:
- Self-monitoring while following the doctor’s instructions regarding health, diet, and sexual habits.
- The use of drugs that inhibit prostate cell division and prevent it from enlarging.
- The drug class of choice for doctors is the alpha 1 receptor inhibitors, and this group includes the following drugs:
Ø Alpha reductase inhibitors
Surgical treatment includes removing the prostate gland and this only takes place in the advanced stages of the disease. There are many surgical interventions available; the most recent of them are laser and vaporization or Plasma Kinetics
Invasive surgical treatments are used in cases that do not respond to drug therapy, which makes surgery necessary to relieve symptoms and avoid complications, and these surgeries include:
-Endoscopic surgery to remove prostate tissue pressing on the urethra:
The surgery is performed via inserting a small surgical instrument through the urethra opening that reaches the site of prostate pressure on the urethra, then begins to remove the enlarged prostate tissue through cutting and cauterization, this surgery is one of the most common types of prostate surgery.
Possible complications with this surgery:
Infections resulting from infection of the wound, and it is presented with a course of strong antibiotics before and after surgery. Bleeding during the operation. Retrograde ejaculation: It is painless and does not represent a medical concern except in terms of fertility and the ability to conceive. Erection problems: The normal ability to have an erection may be affected for some time after the operation, but it will gradually improve within a few months.
-Transurethral incision of the prostate:
The concept behind the surgery is instead of removing enlarged prostate tissue, the surgeon makes a small incision in the prostate tissue in the area where the urethra is obstructed which helps urine pass more easily and relieves symptoms.
This surgery is used in cases of moderate inflation, or cases in which the general health condition of the patient does not allow performing other types of surgery. In the case of the transurethral incision, the patient gets to go home on the same day with a urinary catheter placed for a few days, yet the improvement of symptoms is relatively slower than in the case of Endoscopic surgery.
Possible complications from this surgery: Retrograde ejaculation of semen: It occurs at a lower rate than prostate tissue removal surgery. Erection problems: The normal ability to have an erection may be affected for some time, but it will gradually improve over a few months.
Prostatectomy is when you make an incision in the abdomen and remove the inner part of prostate tissue. This surgery is used in advanced cases of prostate enlargement, where it is no longer possible to rely on other types of surgeries, and is resorted to in the event of advanced complications regarding the bladder and urethra. It takes several weeks to recover from this surgery. Possible complications with this surgery: bleeding and loss of large amounts of blood. contamination and the occurrence of infections. incontinence. Retrograde ejaculation of semen. Erection problems.
Treatment of enlarged prostate with minor surgeries:
What is meant by minor surgeries, are the surgeries in which the smallest surgical intervention possible is minimally invasive, and many modern techniques are used to reduce the potential for complications and increase the speed of the patient’s recovery, the most important of which are:
-Treatment of benign prostatic hyperplasia with laser:
The idea is to impair and remove enlarged prostate tissue with a high-powered laser beam. This type of treatment is used in some patients with an enlarged prostate, whose general health does not allow them to undergo other more invasive surgeries.
Laser treatment of prostate enlargement depends on two basic mechanisms:
Cauterization: where the laser beam burns enlarged prostate tissue.
Vacuum: where the laser tools empty the enlarged prostate tissue in a similar way to a prostatectomy.
Disadvantages of laser treatment of enlarged prostate: