Question

A 60-year-old male patient has a condition called "prostatic hypertrophy."

• Why does this cause problem, both with starting a stream of urine, as well as with ejaculation?
• Identify the anatomical location as to why the doctor performed a "digital exam" to identify this prostatic hypertrophy?
• What anatomical structure is removed during a "vasectomy?"
• At what anatomical location would removing it be the least invasive to the man having the surgery?

Answer 1

PROSTATIC HYPERPLASIA:

INTRODUCTION:

Enlargement of the prostate is called benign prostatic hyperplasia (BPH). It occurs when the cells of the prostate gland begin to multiply. These additional cells cause your prostate gland to swell, which squeezes the urethra and limits the flow of urine. BPH is not the same as prostate cancer and doesn’t increase the risk of cancer. However, it can cause symptoms that can affect your quality of life. BPH is common in men older than 50 years.

CAUSES:

BPH is considered a normal condition of male aging, and many men older than 80 years have BPH symptoms. Although the exact cause is unknown, changes in male sex hormones that come with aging may be a factor. Any family history of prostate problems or any abnormalities with your testicles may raise your risk of BPH.

SYMPTOMS:

The symptoms of BPH are often very mild at first, but they become more serious if they aren’t treated. Common symptoms include:

• incomplete bladder emptying
• nocturia, which is the need to urinate two or more times per night
• dribbling at the end of your urinary stream
• incontinence, or leakage of urine
• the need to strain when urinating
• a weak urinary stream
• a sudden urge to urinate
• a slowed or delayed urinary stream
• painful urination
• blood in the urine

COMPLICATIONS:

Complications of an enlarged prostate can include:

· Sudden inability to urinate (urinary retention). You might need to have a tube (catheter) inserted into your bladder to drain the urine. Some men with an enlarged prostate need surgery to relieve urinary retention.

· Urinary tract infections (UTIs). Inability to fully empty the bladder can increase the risk of infection in your urinary tract. If UTIs occur frequently, you might need surgery to remove part of the prostate.

· Bladder stones. These are generally caused by an inability to completely empty the bladder. Bladder stones can cause infection, bladder irritation, blood in the urine and obstruction of urine flow.

· Bladder damage. A bladder that hasn't emptied completely can stretch and weaken over time. As a result, the muscular wall of the bladder no longer contracts properly, making it harder to fully empty your bladder.

· Kidney damage. Pressure in the bladder from urinary retention can directly damage the kidneys or allow bladder infections to reach the kidneys.

DIAGNOSIS:

• Urinalysis: Your urine is checked for blood and bacteria.
• Prostatic biopsy: A small amount of prostate tissue is removed and examined for abnormalities.
• Urodynamic test: Your bladder is filled with liquid via a catheter to measure the pressure of your bladder during urination.
• Prostate-specific antigen (PSA) test: This blood test checks for cancer of the prostate.
• Post-void residual: These tests the amount of urine left in your bladder after urination.
• Cystoscopy: This is the examination of your urethra and bladder with a tiny lighted scope that is inserted into your urethra
• Intravenous pyelography or urography: This is an X-ray exam or CT scan that is done after a dye is injected into your body. The dye highlights your entire urinary system on the images produced by the X-ray or CT.

TREATMENT OPTIONS FOR ENLARGED PROSTATE

MANAGEMENT:

Men experiencing minimal symptoms of BPH may choose to practice what is called active surveillance. This means to simply monitor your condition and continue to meet with his physician regularly until changes warrant intervention.

NON-INVASIVE TREATMENT:

· Transurethral Microwave Therapy. A controlled dose of microwave energy is delivered to the prostate, destroying excess prostate tissue that is causing blockage.

· Transurethral Needle Ablation. Low-level radio frequency energy is delivered to the prostate, destroying excess tissue.

· Laser Therapy. Removal of the prostate tissue to reduce overall size.

· Laser Vaporization. Uses higher energy laser vaporize the enlarged prostate obstruction and open the urethra.

SURGICAL TREATMENT FOR ENLARGED PROSTATE:

· Transurethral resection of the prostate (TURP). In this surgery, the inner portion of the prostate is removed. Used 90% of the time, this is the most commonly used surgical procedure for BPH.

· Open prostatectomy (open surgery).The surgeon makes an incision and removes the enlarged tissue from the prostate.

· Laser surgery - Laser surgery uses laser energy to destroy prostate tissue and shrink the prostate.

Transurethral incision of the prostate (TUIP).This surgery does not involve removing prostate tissue. A few small cuts are made in the prostate gland to reduce the prostate's pressure on the urethra, making urination easier.

MEDICATIONS FOR ENLARGED PROSTATE:

There are two main classes of pharmaceuticals that work to alleviate enlarged prostate symptoms: alpha blockers and alpha reductase inhibitors

· Alpha Blockers. Alpha blockers relax the smooth muscle around the bladder neck and within the urethra.

· Inhibitors. Inhibitors stop the conversion of the male hormone testosterone to DHT to reduce the prostate's size, eliminating blockage.

Vasectomy is minor surgery to block sperm from reaching the semen that is ejaculated from the penis. Semen still exists, but it has no sperm in it. After a vasectomy the testes still make sperm, but they are soaked up by the body.

VASECTOMY:

The male vasa deferentia are cut and tied or sealed so as to prevent sperm from entering into the urethra and thereby prevent fertilization of a female through sexual intercourse.

There are two types of vasectomies: the incision method, and the no-scalpel (no-cut) method. No-cut methods lower the risk of infection and other complications, and generally take less time to heal.