Mr Amir Kaisary, Consultant Urologist at The Wellington Hospital, talks to us about enlarged prostates - the symptoms, the treatments and the latest options available to men, including Green Light Laser Therapy.
The prostate is an essential reproductive gland which supports and promotes male sperm function and fertility. Positioned just under the bladder, the urethra runs through the middle of the prostate. Issues arise when the prostate becomes enlarged, and the urethra becomes constricted, leading to a blockage.
Over the age of 40, all men have some enlargement of their prostate, but only one in ten will ever develop an obstruction which needs treatment. Size is irrelevant, as the smallest prostates may cause severe obstruction and the bigger glands none at all.
Common symptoms men may have include: frequent urination, weak urine flow, trouble starting and stopping the urinary stream and an inability to completely empty the bladder. Each patient is assessed as an individual and requires a careful history to be taken, and some of these questions will cover both blockage and irritative symptoms.
A clinical assessment by a doctor includes an abdominal palpation and a rectal examination.
These simple but valuable investigations include:
Flow rates can vary from day to day, and a poor flow may not necessarily mean there is an obstruction; it may result from a weak bladder.
Residual urine can be measured by abdominal ultrasound, and again this may vary from day to day.
In selected cases, further evaluation of the prostate gland can be obtained via a dedicated ultrasound rectal examination, which assesses the character and volume of the prostate and may help in the management or treatment of the disease.
Not every patient necessarily needs intervention. Those with mild symptoms and no abnormal examination findings may only need to be watched and reviewed regularly.
Medical treatment includes tablets, which can help the bladder outlet relax and open up, while other medication can lead to the shrinkage of the prostate, which could ease the constriction around the central part of the gland. One should acknowledge that, as with most medications, these drugs have adverse effects that should be made clear to the individual patient before treatment begins.
Traditionally, surgical treatment known as TUR (Transurethral resection of the prostate gland) aims to remove the inner zone tissue to produce a wide-open channel for urine flow to pass through. It is important to point out that while impotence is not necessarily the outcome of surgery, it can cause most patients to become infertile.
However, there is now another surgical option available to prostate patients. Green Light Laser Therapy is an advanced technology and acknowledged as a safe and effective procedure, where prostate tissue can be removed by a special high-powered laser energy, which heats up the prostate tissue causing it to vaporize. This minimally invasive procedure can be performed as a day case, meaning no hospital stay, and can limit some of the effects of traditional surgery. Other benefits include less blood loss, quicker recovery, and a lessened risk of erectile dysfunction.
It is prudent to state that attending a “one stop prostate assessment unit”, like the one at The Wellington Hospital, could be helpful in achieving a better quality of life outcome for a man and his prostate.