The prostate gland is a part of the male reproductive system. Its main role is to produce the fluid that carries and protects sperm. It is located in the lower abdomen in men only.
The prostate surrounds the upper part of the urethra, the thin tube that carries urine from the bladder to the penis. It also carries semen from the prostate and sperm from the testicles to penis during ejaculation.
As men get older the prostate can enlarge, which can restrict the flow of urine to the urethra. This will lead to poor flow or the inability to completely void the bladder of urine. It may also increase the frequency and urgency of urination – this can be particularly uncomfortable at night where multiple trips to the bathroom may be needed.
When it comes to BPH, the terms hypertrophy and hyperplasia are used interchangeably. This is because the two processes are very similar. Hyperplasia is an increase in the number of muscle fibers due to some type of stimulus (for example: exercise) Hypertrophy is the increase of the mass of an entire muscle through natural growth. Seeing as prostate enlargement can be due to both natural growth and some kind of stimulus (such as excess red meat consumption), both terms are used.
BPH rarely shows any symptoms in men younger than 40. Symptoms become more prevalent as men get older and are seen in 90% of men in their seventies and eighties.
• Frequent or sudden urges to urinate
• Pain or discomfort during urination
• Difficulty urinating
• Drops of urine after urination
• Slow start to urination
• Sensation that the bladder isn’t fully emptied after urination
• Blood in the urine
• Pain in the perineum – the area between the anus and scrotum
Treating BPH will involve reducing the mass of the prostate enlargement. This is achieved through different surgical techniques.
Transurethral Resection of the Prostate: This is done by inserting an instrument called a resectoscope through the urethra to get a visual of the prostate tissue and the lining of the bladder. The urologist is then able to trim away enlarged lobes of the prostate. The capsule of the prostate is left intact.
Prostatectomy: A prostatectomy is when the enlarged prostate is removed by enucleating it from its capsule. The sphincter muscle and nerves remain intact. This is done when the prostate is too large to treat any other way. It can be done robotically.
Laser Treatment: Holmium laser enucleation of the prostate (HoLEP) is a minimally invasive procedure where a laser is used to cut away the obtrusive tissue. An instrument called a morcellator is the used to cut the resected prostate tissue into smaller pieces. The tissue is then removed via the rectoscope.
While he is primarily a urological cancer surgeon, Dr Arianayagam also sees patients with more general urological problems such as benign prostatic hypertrophy. He has an extensive experience in TURP and laser prostatectomy.
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