Enlarged Prostate Treatment

The commonly associated symptoms with BPH are:

• Frequent need to urinate
• Nocturia (increased urination frequency at night)
• Difficulty in starting urination
• Urine stream that stops and starts 
• Weak stream of urine
• Dribbling at the end of urination
• Inability to empty the bladder completely
• Inability to urinate
• Blood in urine
• Urinary tract infections 

1. Physical examination: The doctor will check the patient physically and note down the symptoms of the patient.
2. Digital rectal exam: The doctor will insert a gloved and lubricated finger into the rectum to check the prostate gland for enlargement.
3. Urine test: This test helps in ruling out an infection or other conditions that could lead to similar symptoms.
4. Blood tests: The results can help in diagnosing underlying medical problems, like kidney problems.
5. Prostate-specific antigen (PSA) blood test: The PSA levels in the blood may increase due to an enlarged prostate, infection, surgery, prostate cancer, or recent procedures.
6. Urinary flow test: The patient is asked to urinate into a receptacle attached to a machine that will measure the amount and strength of the urine flow.
7. Postvoid residual volume test: This test helps in measuring the patient’s ability to empty the bladder completely.
8. 24-hour voiding diary: This test helps in recording the amount and frequency of urine of a patient in 24 hours.
9. Transrectal ultrasound: The procedure involves the insertion of an ultrasound probe into the rectum for measuring and evaluating the prostate.
10. Prostate biopsy: Tissue samples are collected by the doctor using needles guided by transrectal ultrasound. The examination of these tissue samples helps the doctor to either diagnose or rule out prostate cancer.
11. Urodynamic and pressure flow studies: This test helps the doctor in measuring the bladder pressure and check how well the bladder muscles are working.
12. Cystoscopy: A flexible, lighted instrument, known as a cystoscope, is inserted into the urethra to view inside the urethra and bladder.

The treatment of BPH may vary depending on the size of the prostate gland, the age of the patient, the severity of the symptoms present, and the overall health of the patient. In some cases of BPH, only watchful monitoring is needed when the symptoms are mild.
Other cases of an enlarged prostate may be treated in the following different ways:

1. Medications: The following different types of medications may be prescribed to treat mild to moderate cases of prostate enlargement:
Alpha blockers: They relax the muscles of the bladder neck and the muscle fibers in the prostate, making urination easier.
5-alpha reductase inhibitors: They shrink the prostate by prevention of hormonal changes that may cause prostate growth.
Combination drug therapy: An alpha-blocker and a 5-alpha reductase inhibitor may sometimes be given together if they are not effective alone.
Tadalafil: This type of medicine is usually given to treat erectile dysfunction, but can also help in treating prostate enlargement.

2. Minimally-invasive surgeries: This type of treatment is recommended if the patient has moderate to severe symptoms, medicines have failed to relieve the symptoms if the patient prefers a definitive treatment, or the patient has bladder stones, urinary tract obstruction, blood in urine, or other kidney problems.

The different types of minimally-invasive surgeries include:

Transurethral resection of the prostate (TURP):
A tube or scope with a light on one end is inserted into the patient’s urethra.
The surgeon will then remove all but the outer portion of the prostate.
TURP helps in relieving the symptoms quickly and most men will have a stronger flow of urine soon after the procedure.

Transurethral incision of the prostate (TUIP):
A lighted scope will be inserted into the patient’s urethra.
The surgeon will make one or two small incisions or cuts in the prostate gland, allowing the urine to easily pass through the urethra.

Transurethral microwave thermotherapy (TUMT):
The doctor will insert a special electrode through the urethra into the prostate area.
The microwave energy from the electrode will destroy the inner portion of the enlarged prostate gland, causing its shrinkage and allowing easy urine flow.

Transurethral needle ablation (TUNA):
The procedure involves passing a scope into the urethra, allowing the doctor to place needles into the prostate gland.
Radio waves are passed through the needles, heating and destroying the excess prostate tissue that blocks the urine flow.

Laser therapy: 
A high-energy laser will help in destroying or removing the overgrown prostate tissue.
Laser therapy helps in relieving the symptoms of an enlarged prostate immediately and has a lower risk of side effects.
Laser therapy can be performed in the following ways:

1. Ablative procedures: This procedure helps in vaporizing the obstructive prostate tissue to increase the flow of the urine, for example, the photoselective vaporization of the prostate (PVP) and holmium laser ablation of the prostate (HoLAP).
2. Enucleative procedures: Procedures like the holmium laser enucleation of the prostate (HoLEP) help in removing all the prostate tissue, blocking the flow of the urine, and preventing the regrowth of tissue.

Prostatic urethral lift (PUL):
The procedure involves the use of special tags to compress the sides of the prostate gland to increase the urine flow.

Embolization:
This procedure involves selectively blocking the blood supply to or from the prostate gland.

Open or robot-assisted prostatectomy: 
The procedure involves the removal of the enlarged tissue by making an incision in the lower abdomen. 
When this procedure is performed using robotic arms controlled by the surgeon, the procedure is known as a robotic-assisted procedure.
The procedure is usually performed in cases of a large prostate gland, damage to the bladder, or the presence of other complications.

The complications of an enlarged prostate gland are:

• Urinary retention (a sudden inability to urinate)
• Urinary tract infections
• Bladder stones
• Bladder damage
• Kidney damage

The side effects of BPH treatment will vary depending on the type of procedure performed and may include the following:

• Bleeding 
• Urinary tract infection
• Erectile dysfunction
• Temporary difficulty in urination
• Retrograde ejaculation (the semen flows backward into the bladder instead of going out through the penis during ejaculation)
• Incontinence (loss of bladder control)
• Infertility
• Impotence
• Overactive bladder

• The recovery following BPH treatment depends on the type of treatment performed.
• Strenuous activities and heavy lifting should be avoided for seven days after laser ablation, transurethral needle ablation, or transurethral microwave therapy. In the case of an open or robot-assisted prostatectomy, the patient may need to restrict these activities for at least six weeks after the procedure.
• The patient should eat a healthy, fiber-rich diet for a quick recovery.
• The patient should drink at least eight glasses of water a day.
• The patient should avoid sexual intercourse, especially anal sex, for at least four to six weeks after the procedure.
• The patient should avoid long drives without approval from the doctor.

Home-remedies: 

The following home remedies can help in controlling the symptoms of an enlarged prostate gland:

• Limit the consumption of liquids at least one or two hours before bedtime
• Limit alcohol and caffeine consumption 
• Limit the consumption of antihistamines and decongestants
• Do not control your urge to urinate
• Eat a healthy diet 
• Exercise regularly 
• Try and urinate at regular intervals
• Practice double voiding (urinate and urinate again after a few moments)
• Stay in a warm room?

Cost of enlarged prostate or BPH treatment in India- 

The cost of an enlarged prostate or BPH treatment in Mumbai is between INR 70,000 to INR 1,80,000.
The cost of an enlarged prostate or BPH treatment in Delhi is between INR 65,000 to INR 1,70,000.
The cost of an enlarged prostate or BPH treatment in Bangalore is between INR 65,000 to INR 1,70,000.
The cost of an enlarged prostate or BPH treatment in Chennai is between INR 60,000 to INR 1,65,000.