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Enlarged Prostate

What is BPH?

"Benign Prostatic Hyperplasia, or BPH, is a condition associated with the enlargement of the prostate gland located below the urinary tract surrounding the urethra in males. The condition is referred to as benign, meaning it is not cancerous. The term ‘prostatic’ is associated with the prostate gland, and ‘Hyperplasia’ refers to the enlargement of the gland.
The primary function of the prostate gland is to produce the fluid that nourishes and transports sperm (seminal fluid). However, people with an enlarged prostate have difficulty in emptying their bladder properly due to the narrowing of the urethra. This results in the urge to urinate frequently , especially at night. It is estimated that out of the more than 70% of men who are likely to have an enlarged prostate over 50 years, 25% require surgical procedures."

How does BPH occur?

The leading cause of BPH or enlarged prostate is still a matter of debate. However, prostate gland enlargement mainly occurs due to hormone changes which trigger prostate cell growth. Some studies have shown that high levels of dihydrotestosterone (DHT), which is common in men older than 50 years supports prostate development. Other reasons for BPH can be lifestyle, eating disorders, obesity, heredity, etc.

Casuses

  • Aging
  • Infection in the urinary tract
  • Inflammation of the prostate
  • Change in male sex hormones
  • Damage or injury to the testicles

Symptoms

  • Increased frequency of urination at night (nocturia)
  • Difficulty in starting urination
  • Inability to urinate (in severe cases)
  • Weak urine stream
  • Blood while urinating
  • Dribbling at the end of urination
  • Inability to completely empty the bladder

Diagnosis

Diagnostic Test

The doctor will recommend the following tests to rule out the possibility of enlarged prostate due to other conditions. Some of the diagnostic tests include –

Ultrasound – Doctors generally recommend an ultrasound of the prostate gland to detect any abnormal growth within the prostate using 3D imaging to determine the amount of enlargement around the prostate.
Prostate-specific antigen (PSA) blood test – Doctors usually recommend a PSA blood test to check for any increased PSA levels in an enlarged prostate. This helps the urologists to detect signs of prostate cancer.
Urinary flow test – This test is done to measure the strength and amount of your urine flow and determine if the condition is stable or getting worse with time.
Postvoid residual volume test – Sometimes, when the patient is unable to empty the bladder completely, this test is recommended to measure the amount of urine left in your bladder after the urination. This is done via ultrasound or inserting a catheter into your bladder.
24-hour voiding diary – The doctors suggest this test to record the frequency and amount of urine expelled, especially if more than one-third of your daily urinary output occurs at night.
Urine test – The doctor analyzes a sample of your urine to rule out any signs of infection or other conditions that can lead to similar symptoms.
Blood tests – Blood tests indicate any infections in the kidneys and indicate abnormal functioning.

Diagnosis by the Doctor

The diagnosis for enlarged prostate involves a combination of physical examination along with some tests to confirm BPH. Since heredity is a risk factor for BPH, the doctor analyzes your family history report. These diagnostic exams are recommended by the doctor in case of moderate as well as complex cases-
Digital rectal exam – The doctor inserts a finger into your rectum to check for any signs of prostate enlargement.
Cystoscopy – A light, flexible scope called a cystoscope is inserted into your urethra to allow the doctor to see inside your bladder.
Prostate biopsy – The doctor uses needles guided by a transrectal ultrasound to take a tissue sample of the prostate and analyze the tissue to rule out the chances of prostate cancer.
Urodynamic and pressure-flow studies – This test measures the bladder pressure and determines how well your bladder muscles work using a catheter that is inserted through your urethra.

SEVERITY

Grade I

score of 7 or less – Mild BPH

Grade II

score of 8 to 19 – Moderate BPH

Grade III

score of 20 to 35 – Severe BPH

Risks & Complications

During the surgery

The surgical procedures for BPH surgery are safe and efficient to treat enlarged prostate. However, like any other surgery, there are several risks involved with the procedure that can lead to several complications. It all depends on the medical condition of the patient and the surgical expertise of the surgeon.
Some of the risks associated with the different surgical procedures of BPH are as follows –
Abnormal bleeding during the surgery which may require transfusion
Improper fluid absorption
Retrograde ejaculation; when semen flows into your bladder
Erectile dysfunction
Infection around the surgical site
Urinary incontinence
Urethral stricture that results in ‘split-stream’ of urine
Post TURP syndrome; symptoms include shortness of breath, seizures, and coma

Complication of open Prostatectomy

Infertility
Impotence
Wound infection
Overactive bladder
Urine leakage when you feel the urge to urinate

If left untreated

Enlarged prostate or prostatic hyperplasia is a serious medical condition that can lead to several health problems in men above 50 years of age. There are several risks and complications that can result due to prolonged BPH. Therefore, it is important to consult your doctor as soon as you experience symptoms of enlarged prostate.
If left untreated, BPH can cause-
Sudden inability to urinate
Urinary tract infections
Kidney stones
Bladder damage
Kidney damage

When to consult a Urologist for BPH treatment?

"It is important to seek medical attention if you’re having issues related to the urinary tract. Patients who experience symptoms associated with an enlarged prostate, such as improper emptying of the bladder, nocturia, or any obstruction in the urinary tract, are at risk of BPH. Consult a urologist if you are experiencing the following symptoms –
Nocturia
Frequent urination
Blood in urine
Erectile dysfunction
Having trouble urinating"

Treatment overview

Non-Surgical

Non-surgical methods for BPH include various medications, dietary changes, and lifestyle modifications. However, these medications mostly reduce symptoms associated with the enlarged prostate and do not cure the disease.

Surgical

The surgical procedures for an enlarged prostate include minimally invasive techniques and laser surgery. However, the choice of surgery depends on the size of your prostate, the severity of the condition, your medical health, and the age factor. Surgical procedure is usually recommended when medications are ineffective that can progress the condition.

Insurance Coverage

"The surgeries for BPH are done to reduce symptoms which cause great discomfort due to enlarged prostate. Lack of treatment can cause severe complications that may require surgical procedures. Therefore, a surgical procedure to treat BPH is deemed a medical necessity.

Thus, some medical insurance companies cover the cost of surgical procedures for BPH partially or entirely. However, the insurance claim will depend on the type of your insurance policy and the terms and conditions set by the insurance provider. There are also other payment options to pay for the BPH surgery. A few of the insurance providers that may cover the cost of enlarged prostate are as follows:

Star Health Insurance
New India Health Insurance
Bajaj Allianz
Religare
ICICI Lombard"

Recovery rate

"The recovery from enlarged prostate surgery can vary depending on the patient’s health condition and the surgeon's surgical expertise. The tips provided by the doctor also depend on the type of surgical technique used for the procedure. However, it is important to consult with your doctor regularly to avoid any complications and ensure a smoother and faster recovery. Some of the post-operative care after your BPH surgery are-
Avoid lifting heavy equipment for around a week after your surgical procedure.
Refrain from heavy exercises for about 6 weeks after prostatectomy.
Drink plenty of fluid during the first 2 weeks after the surgery to flush any new bleeding from the bladder.
Avoid consumption of alcohol and coffee for the first few weeks after the procedure.
Avoid food that can cause constipation or force you to strain during bowel movements."
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