|Discussion in 'All Categories' started by Sukhdeo Yadav - Dec 12th, 2012 11:20 am.|
My age is 68 year and I have nelarged prostate gland. I want to know the different surgical options available. Especially I am intrested to know what is TURP and am I a good candidate for this surgery. Sir, Please explain to me in detail.
re: I have enlage prostate grand by Dr J S Chowhan - Dec 12th, 2012 11:23 am
Dr J S Chowhan
|Dear Mr Sukhdeo Yadav
Thanks for asking the answer of your question. Dear Mr Sukhdeo Yadav
Thanks for asking the answer of your question. Obstruction of the flow of urine by an enlarged prostate is a very common condition. Almost 50% from the male population above age 50 may have some clinical proof of prostate enlargement.
TURP (prostate operation to alleviate obstruction) methods are among the most generally carried out procedures in males older than 70.
Surgery to alleviate the prostatic enlargment continues to be referred to because the early 1800s, but the introduction of fibreoptic telescopes and videocamera imaging has greatly enhanced the rate of success of TURP.
The prostate is formed as an inverted pear and lies just beneath the neck from the urinary bladder. It's about 5 centimetres (3 inches) lengthy and three-4cm wide. The urethra, which runs in the bladder through the center of the prostate and thru your penis, carries urine in the bladder.
Just beneath the prostate is really a muscular diaphragm that functions because the exterior urinary sphincter. This sphincter, which circles the urethra, is under both reflex and voluntary control.
Across the back wall from the urethra within the prostate, there's an elevation known as the verumontanum, which is into this elevation that sperm (with the ejaculatory ductwork) and spermatic secretions in the seminal vesicles and prostate go into the urethra.
Benign Prostatic Hyperplasia (BPH) is really a condition triggered by an excessive development of prostate tissue round the urethra. The prostate growth is affected through the male hormone, testosterone. Prostate growth increases as we grow older.
Using the elevated size the prostate, the urethra is compressed leading to decreased urinary flow and incomplete draining from the bladder. Our prime pressure needed to empty the bladder brings about an elevated chance of urinary infection and bladder gemstones. Inflammation from the bladder and urethra could also cause bloodstream within the urine.
Due to the elevated pressure around the bladder wall muscles, the wall can become oversensitive. This brings about the signs and symptoms of emergency (feeling to urinate) and nocturia (the necessity to urinate during the night).
Backpressure in the bladder may modify the renal system leading to the renal system to swell (hydronephrosis) with eventual kidney failure.
Someone by having an enlarged prostate gripes of signs and symptoms that are based on obstruction of the flow of urine, irritation and signs and symptoms that occur later.
Obstructive signs and symptoms: -
1. Hesitancy or delay in the flow of urine throughout attempted peeing. There's home loan business pressure and size the urinary stream. There might be intermittency (breaks in flow of stream), dribbling a basketball of urine in the finish of peeing and a sense of incomplete draining from the bladder.
2. Irritative signs and symptoms include elevated frequency and emergency of peeing nocturia discomfort on peeing from bladder gemstones infection or fits and bloodstream within the urine from infection, inflammation or bleeding veins at the top of prostate.
3. Postponed signs and symptoms are individuals of kidney failure because of kidney participation and the introduction of a hernia or haemorrhoids from constant pushing throughout peeing.
Throughout the physical examination, the prostate is examined. Digital rectal exam (DRE) is completed by placing a finger in to the rectum. The prostate lies just while watching rectum and could be felt for size and nodules. You should eliminate a prostate cancer.
Urine analysis searches for bloodstream and bacteria.
Bloodstream tests can include electrolytes (power of salt within the bloodstream), serum urea nitrogen and creatinine like a baseline of kidney function.
A Prostate Specific Antigen (PSA). The PSA level might be slightly elevated with BPH because of elevated size the gland, but any increase indicates cancer of the prostate.
Uroflowmetry (measurement of the flow of urine) is among the easiest and many tests for bladder outlet obstruction. Normal people will often have the flow of urine rates between 12 - 20 cc/sec. Flow rates of under 10 cc/sec are noticed with bladder outlet obstruction.
The rest of the volume (volume remaining) after peeing could be measured either by catherization (catheter put into the bladder) or ultrasound
(using seem waves). Residual volumes more than 100 - 15O cc are often suggestive of significant prostate obstruction.
Ultrasound doesn't need the positioning of the catheter or any other instrument within the bladder. Seem surf is returned from the bladder to a receiving unit that converts the waves right into a picture. This test can identify urinary volume, gemstones within the bladder and proof of back pressure around the renal system. Additionally, it may appraise the size and amount of the prostate and assist in making decisions on appropriate treatment.
Uroflowmetry may be the measurement from the rate of urinary flow per second and is a vital analysis to look for the existence of bladder outlet obstruction. This really is coupled with an ultrasound assessment of the quantity of urine left within the bladder following the completion. This really is carried out through the urology nurses within the Urology Affiliates suite at Cabrini Hospital.
Medical treatments are right for patients who've mild signs and symptoms of urinary obstruction or are extremely old or unwell to endure a surgical treatment.
Respite from obstruction might not be immediate in most cases necessitates prolonged treatment. Treatment might be ineffective rich in grade obstruction.
You will find two primary drug groups that are utilized to treat BPH: -
1. Muscle Relaxants - This number of drugs blocks nerve impulses visiting the muscles from the involuntary internal sphincter thus reducing urinary flow. Side affects of those medicines include low bloodstream pressure, lightheadedness, fast heartbeat, fatigue, nasal congestion and retrograde ejaculation (sperm adopts the bladder).
2. Hormonal Agents - These drugs make an effort to turn back effect of testosterone around the prostate leading to home loan business size. This is achieved by obstructing the result of testosterone around the prostate. Unwanted effects of those drugs can include impotence along with a lack of libido.
Transurethral Resection from the Prostate (TURP)
Surgical treatment is usually indicated for obstructive or irritative signs and symptoms of BPH that won't be relieved by medical management.
A substantial reduction in the flow of urine rate (<10 cc/sec) or significant residual volumes (>100 - 150 cc).
Acute or sudden urinary retention
BPH is really a disease that's progressive. Surgical treatment is advised before complications arise.
The process typically takes under an hour or so to do and it is usually carried out under spine or general anaesthesia.
The individual is positioned within the lithotomy position (using the legs elevated and spread).
The bladder is stuffed with a unique solution that doesn't conduct electrical current.
A cystoscope, that is a special telescope, is placed in to the penis and passes in the urethra, until it reaches the prostatic area of the urethra.
A special wire loop, known as the resectoscope, will be placed in to the urethra. The resectoscope has electrical current passing with the loop that functions to chop the prostate tissue. The resectoscope shaves off "chips" from the enlarged prostate. The shaving begins in the margin from the bladder outlet and progresses in to the prostatic area of the urethra as much as the verumontanum and perhaps beyond thus the removed portion includes a few of the involuntary internal sphincter.
The ejaculatory ductwork that open around the verumontanum and carry spermatic secretions are maintained. The voluntary exterior sphincter lies underneath the verumontanum. This sphincter may also be maintained, to permit charge of peeing.
In the finish from the procedure, the bladder outlet remains open and clear. The bladder is irrigated to purge out any thrombus and prostatic chips.
GYRUS TURP is really a more recent technique presently getting used by Urology Affiliates. This involves bipolar diathermy resection from the prostate that has the possibility benefits of 1. permitting using normal saline irrigation fluid that is safer compared to glycine irrigation combined with standard TURP. 2. there's less bleeding and three.it enables vaporisation from the prostatic chips while shaving thus departing less tissue debris in the finish from the procedure.
Urology affiliates now routinely make use of this way of prostate removal.
Complications seen with TURP as well as their approximate rates of occurrence are: -
Perforation of the bladder (<1 %).
Inability to pass urine -usually due to muscle dysfunction with longstanding BPH (5%).
Stricture of the urethra from scarring (2.5%).
Urinary incontinence from damage to the sphincter (<2%).
Impotence (5% dependent on patient age)
Retrograde ejaculation (passage of sperm) (50%) - because of the loss of the internal sphincter, spermatic secretions may go upwards into the bladder rather than down through the penis during ejaculation. These secretions will pass out later during urination. This may give rise to sterility due to reduced sperm count.
TUR Syndrome (<2%) - Extensive TURP, especially with very large prostates, may open up venous blood vessels during surgery. Fluid in the bladder may get absorbed into the blood causing fluid overload and electrolyte (salt) imbalance in the body. Fluid overload may be particularly a problem in a patient with heart or lung disease. Electrolyte imbalance may cause neurologic symptoms, including seizures and coma. This syndrome is now preventable with the use of the new bipolar resectoscope. (GYRUS TURP).
Blood tinged urine may be present at the end of the procedure. Frankly bloody urine with clots may require irrigation of the bladder through the catheter. The catheter is kept in until the urine clears, which is usually 24 - 48 hours. Patients usually stay in the hospital during this time. Patients do not usually experience much pain after the operation and can usually shortly return to work. Antibiotics are usually given for a several days to a few weeks after the operation to prevent infection. About 8% of patients will require a repeat TURP or opening of a scar or stricture (narrowing) during the remainder of their lives.
Please do not hesitate if you have any further quesry.
J S Chowhan
re: I have enlage prostate grand by Ramakrishna - Aug 1st, 2013 6:28 pm
|iam 52 years suffering from chronic urinary retention due to bladder out let obstruction one year ago TURP and BOO were performed july 2012 without any improvement and i continue to self catheterize myself for 5 times a day. Recently iam finding it difficult to pass the catheter and dropped from 14f to 12F to 10 F . cYSTOSCOPY REVEALED RESIDUAL TISSUE OBSTRUCTING THE OUTLET. Repeat turp was recommended at least to facilitate trouble free catheterizing. Iam scared of second surgery as the first one is an extreamly painful experience and took 6 months for manageable recovery.Still iam experiencing the after effects of surgery my bladder condition is diagnosed as hypotonic. Iam afraid of incontinence, impotence scarring what shall i do please answer|
re: I have enlage prostate grand by Ramakrishna - Aug 1st, 2013 6:29 pm
|iam 52 years suffering from chronic urinary retention due to bladder out let obstruction one year ago TURP and BOO were performed july 2012 without any improvement and i continue to self catheterize myself for 5 times a day.
Recently iam finding it difficult to pass the catheter and dropped from 14f to 12F to 10 F . CYSTOSCOPY REVEALED RESIDUAL TISSUE OBSTRUCTING THE OUTLET. Repeat turp was recommended at least to facilitate trouble free catheterizing. I am scared of second surgery as the first one is an extreamly painful experience and took 6 months for manageable recovery.Still iam experiencing the after effects of surgery my bladder condition is diagnosed as hypotonic. Iam afraid of incontinence, impotence scarring what shall i do please answer.
You should not worry about second surgery. In experienced hand it is very safe. Without surgery repeated self cathetarization has always the chance of infection.
J S Chowhan
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