Enlarged prostate, the key treatments are:
- Medical Treatment
- Laser for Enlarged Prostate
Generally, early problem is controlled with medicines to relax prostate muscles or reduce the size. Medication is required on a long term basis, otherwise symptoms and problems would recur. Generally the improvement in symptoms and urine flow is significantly less with medicines than with surgery.
When the symptoms progress, fail to respond to medicines or patient develops retention, stones or repeated infections, surgery is required to remove part of prostate to open urine passage.
This is the standard technique for the removal of enlarged prostate gland. In this technique, telescope is passed from urethra and small pieces of prostate are cut with the help of electric current passed through a metal loop. All pieces are washed out from the bladder.We still continue to offer TURP to patients who prefer this technique, as we have over the years.
Laser PVP (Photoselective Vaporization of the Prostate)
Laser PVP (Photoselective Vaporization of the Prostate)? GreenLight™ Laser PVP is a recent addition to the minimally invasive techniques in the treatment of BPH. The procedure uses the technology of high-powered laser light combined with fiber optics to vaporize the overgrowth of prostate cells quickly and accurately. As the surgeon directs the laser at the prostate, the intense pulses of light emitted from the fiber are absorbed by the blood. Within moments, the temperature of the blood becomes so great it causes the nearby cells to vaporize. GreenLight™ is being used as an alternative totransurethral resection of the prostate (TURP) and has been shown to be its equal in terms of effectiveness in improvement of symptoms.
Post operative complications.
- Minimal bleeding
- Only 30% of patients need a post-op catheter
- Discharge on the same day
- Resume normal activities in 2 to 3 days with caution
- Return to vigorous activity level in 4 to 6 weeks
- Complications occur infrequently and are mild if they do
- Post-operative impotence has not been associated with PVP
- Retrograde ejaculation is less likely with PVP
- Erectile Dysfunction is not typical in PVP patients
- Long-term success in improved urine flow
- Fewer symptoms of urinary obstruction
This treatment is highly effective for small and uncomplicated stones only. In this treatment, patient lies on a special machine which generate high pressure shock waves which pass through the skin to fragment the stones. Then the small pieces pass with urine through the natural passage.
Percutaneous Nephrolithotomy (PCNL) is a procedure to remove medium-sized or large stones from the kidney by means of a nephroscopepassed into the kidney through a small puncture created in the patient’s back. A nephroscope uses an ultrasonic or laser probe to break up large kidney stones and suction it out. This procedure is usually done under general anaesthesia or spinal anaesthesia.
To undergo PCNL, it is ideal for the patient to have two functioning kidneys and large sized (2 cm) stone in one of the kidneys with extrarenal pelvis with mild to moderate hydronephrosis.
The advantage of the PCNL procedure as against an open surgery is that PCNL reduces the length of hospital stay, and leaves only a small stab wound scar. Also during the post-operative period, a negligible amount of pain is felt allowing the patient to recover faster.
How is the Percutaneous nephrolithotomy (PCNL ) Surgery performed?
While you are under the general anaesthetic the surgeon will examine your bladder with a long, thin, semi-rigid or flexible telescope and pass a small tube up to your kidney, which has the stone. This is used to pass a mixture of a coloured dye and x-ray dye to the kidney making it easier to see during the operation.
You will then be placed face down on the operating table and the consultant will make one or more small incisions into your back. This is done using special metal or balloon dilators (see diagram). This enables the consultant to pass a telescope into your kidney.
The stone or stones in the kidney are then removed either intact or in pieces after breaking them with special instruments. X-rays will be taken during and at the end of the procedure to ensure that all accessible bits of the stone have been removed from your kidney.
- A telescope is passed down into the kidney so that the surgeon can see the stone.
- The stone is broken up and then the pieces are removed using a special instrument.