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The Prostate Gland

Anatomy

The prostate is a walnut-sized gland that forms part of the male reproductive system. The gland is made of two lobes, or regions, enclosed by an outer layer of tissue. The prostate gland is located about halfway between the testicles and rectum and is wrapped around the urethra (the urethra is the outlet that discharges urine and semen from the penis). Imagine a pipe passing through the hole of a doughnut. The pipe is the urethra and the doughnut is the prostate.

Function

Function of prostate : We do not know all the prostate's functions. One of its main roles, though, is to squeeze fluid into the urethra as sperm move through during sexual climax. This fluid, which helps make up semen, energizes the sperm and makes the vaginal canal less acidic.

Symptoms that may indicate prostate problems are:

• A weak urinary stream.
• Difficulty in passing urine.
• Difficulty in starting the urination (Hesitancy)
• Frequent urination.
• Urgency (difficulty in postponing urination)
• Awakening frequently at night for urination.
• Interrupted stream of urine.
• Blood in urine.
• Pain or burning while passing urine.
• Sense of incomplete voiding.

General investigation for prostate disease:

• Digital rectal examination of prostate to look for size, consistency, and nodules in the prostate. Urine routine to look for urinary infection.
• Abdominal and pelvic sonography to look for prostate size, post void residual urine, and to look for any secondary pathology in the kidneys.
• A Blood test, Prostate specific antigen (PSA) levels. PSA is the protein produced by the prostate and found in the blood. These levels increase in prostate cancer and prostate infection.
• Cystoscopy
  
  

The disease which involves the prostate commonly are:

• Benign Prostatic Hyperplasia (BPH).
• Prostate cancer (CA Prostate).
• Prostatitis (Infection of the prostate).
  

The World Organization (WHO) Consultation on BPH has adopted his index, and in this context, it is referred to as the International Prostate Symptom Score (IPSS). This measure of voiding symptoms is useful to ascertain symptom severity and treatment response, or change over time without treatment.

Ipss scoring system

1. Not at all
2. Less than 1 time in 5
3. Less than half the time
4. About half the time
5. More than half the time
6. Almost always

Total Symptom Score = Sum of Questions 1 to 7 _____

Mild BPH	Moderate BPH	Severe BPH

MILD MEANS “ WAIT AND WATCH”

If your score is 0-7 on the IPSS score, your symptoms are mild - the usual procedure for you is "watchful waiting".

MODERATE MEANS "MEDICATION"

Moderate means "medication" may be. If your score is 8-19, your doctor may suggest medication as an initial treatment. Medication may be helpful in certain situations. But don't be afraid if there is no improvement in the symptom score; consult your doctor for the same again for other mode of treatment. The drugs of choice available for the medical treatment of BPH are

• Alpha blocker
  
  

  Are high blood pressure medicine that relax the smooth muscle tissue in the prostate, opening the urethra, allowing the normal flow of urine. These drugs can cause dizziness, headache, fatigue and nasal congestion in 5-10% of men.

• 5 alpha reductase inhibitor  

  Shrinks the prostate by 25% to 30% by interfering with the hormonal chain of events that trigger the growth of prostate cells. This drug can lower PSA level about 50 % which may mask the test accuracy in detecting prostate cancer. 5 % of men have reported loss of sexual potency and desire.

SEVERE MEANS"SURGICAL TREATMENT"

If your symptom score is 20-30, watchful waiting or medications are no longer ideal options. Most likely you will have to undergo the surgical intervention for the relief.

Microwave Thermotherapy (TUMT)
Trans uretheral needle ablation (TUNA)
Laser prostatectomty
Trans uretheral resection of prostate. (TURP)

Because drug treatment is not effective in all cases, researchers in recent years have developed a number of procedures that relieve BPH symptoms but are less invasive than conventional surgery.

Transurethral Microwave Procedures

A device that uses microwaves to heat and destroy excess prostate tissue. In the procedure called transurethral microwave thermotherapy (TUMT), sends computer-regulated microwaves through a catheter to heat selected portions of the prostate to at least 111 degrees Fahrenheit. A cooling system protects the urinary tract during the procedure. Procedures take about 1 hour and can be performed on an outpatient basis without general anesthesia. Procedure has been reported to lead to impotence or incontinence. Although microwave therapy does not cure BPH, it reduces urinary frequency, urgency, straining, and intermittent flow. It does not correct the problem of incomplete emptying of the bladder. Ongoing research will determine any long-term effects of microwave therapy and who might benefit most from this therapy. No tissue is available for laboratory test to rule out cancer.



Transurethral needle ablation

The TUNA System delivers low-level radiofrequency energy through twin needles to burn away a well-defined region of the enlarged prostate. Shields protect the urethra from heat damage. The TUNA System improves urine flow and relieves symptoms with fewer side effects when compared with transurethral resection of the prostate (TURP). No incontinence or impotence has been observed. No tissue is available for laboratory test to rule out cancer.

Surgical Treatment

Most doctors recommend removal of the enlarged part of the prostate as the best long-term solution for patients with BPH. With surgery for BPH, only the enlarged tissue that is pressing against the urethra is removed; the rest of the inside tissue and the outside capsule are left intact. Surgery usually relieves the obstruction and incomplete emptying caused by BPH. The following section describes the types of surgery that are used.

Transurethral surgery:

In this type of surgery, no external incision is needed. After giving anesthesia, the surgeon reaches the prostate by inserting an instrument through the urethra.

A procedure called TURP (transurethral resection of the prostate) is used for 90 percent of all prostate surgeries done for BPH. With TURP, an instrument called a resectoscope is inserted through the penis. The resectoscope, which is about 12 inches long and 1/2 inch in diameter, contains a light, valves for controlling irrigating fluid, and an electrical loop that cuts tissue and seals blood vessels.

During 45 - 90 minutes operation, the surgeon uses the resectoscope's wire loop to remove the obstructing tissue one piece at a time. The pieces of tissue are carried by the fluid into the bladder and then flushed out at the end of the operation.

Most doctors suggest using TURP whenever possible. Transurethral procedures are less traumatic than open forms of surgery and require a shorter recovery period.

Another surgical procedure is called transurethral incision of the prostate (TUIP). Instead of removing tissue, as with TURP, this procedure widens the urethra by making a few small cuts in the bladder neck, where the urethra joins the bladder, and in the prostate gland itself. Although some people believe that TUIP gives the same relief as TURP with less risk of side effects such as retrograde ejaculation, its advantages and long-term side effects have not been clearly established.

Open surgery.

In the few cases when a transurethral procedure cannot be used, open surgery, which requires an external incision, may be used. Open surgery is often done when the gland is greatly enlarged, when there are complicating factors, or when the bladder has been damaged and needs to be repaired. The location of the enlargement within the gland and the patient's general health help the surgeon decide which of the three open procedures to use. With all the open procedures, anesthesia is given and an incision is made. Once the surgeon reaches the prostate capsule, he scoops out the enlarged tissue from inside the gland.

Laser prostatectomy

The doctor passes the laser fiber through the urethra into the prostate using a cystoscope and then delivers several bursts of energy lasting 30 to 60 seconds. The laser energy destroys prostate tissue and causes shrinkage. Like TURP, laser surgery requires anesthesia and a hospital stay. One advantage of laser surgery over TURP is that laser surgery causes little blood loss. Laser surgery also allows for a quicker recovery time. But laser surgery may not be effective on larger prostates. The long-term effectiveness of laser surgery is not known.

Your Recovery After Surgery in the Hospital

If you have surgery, you'll probably stay in the hospital depending on the type of surgery you had and how quickly you recover.

At the end of surgery, a special catheter is inserted through the opening of the penis to drain urine from the bladder into a collection bag. Called a Foley catheter, this device has a water-filled balloon on the end that is placed in the bladder, which keeps it in place.

This catheter is usually left in place for several days. Sometimes, the catheter causes recurring painful bladder spasms the day after surgery. These may be difficult to control, but they will eventually disappear.

You may also be given antibiotics while you are in the hospital. Many doctors start giving this medicine before or soon after surgery to prevent infection. However, some recent studies suggest that antibiotics may not be needed in every case, and your doctor may prefer to wait until an infection is present to give them.

After surgery, you will probably notice some blood or clots in your urine as the wound starts to heal. If your bladder is being irrigated (flushed with water), you may notice that your urine becomes red once the irrigation is stopped. Some bleeding is normal, and it should clear up by the time you leave the hospital. During your recovery, it is important to drink a lot of water (up to 8 cups a day) to help flush out the bladder and speed healing.

Do's and Don'ts

Take it easy the first few weeks after you get home. You may not have any pain, but you still have an incision that is healing—even with transurethral surgery, where the incision can't be seen. Since many people try to do too much at the beginning and then have a setback, it is a good idea to talk to your doctor before resuming your normal routine. During this initial period of recovery at home, avoid any straining or sudden movements that could tear the incision. Here are some guidelines:

• Continue drinking a lot of water to flush the bladder.
• Avoid straining when moving your bowel.
• Eat a balanced diet to prevent constipation. If constipation occurs, ask your doctor if you can take a laxative.
• Don't do any heavy lifting.
• Don't drive or operate machinery