Prostate Gland: प्रोस्टेट इन्फेक्शन के लक्षण, जांच और इलाज

In this video SimpliHealth expert Dr. Varinder Dhankhar will explain about  Prostate Gland (प्रोस्टेट इन्फेक्शन के लक्षण, जांच और इलाज). The prostate gland is a walnut-shaped gland located just below the bladder and in front of the rectum. It encircles the urinary tube called the urethra.  With age, the shape and size of the gland change, and this could cause problems in the patient after the age of 50. Age-wise growth also may cause urinary problems and even cancer.

Age-wise prostate gland/Prostate gland and urinary problems

Prostate gland increase in size  are the signs of prostate problems. Frequent urge to urinate, dribbling of urine, urine do not come properly, patient urine is not empty, pain while urinating(प्रोस्टेट में दर्द), urine not come properly due to urinary bladder so these are all the trouble of prostate gland. As it is a quality of life disease, it does not affect life expectancy. It is due to physiological changes like hair growth, wrinkles on the face, cataracts. Prostate change is also a physiological change.  It is not a disease, it should be treated.

Prostate gland problems symptoms/प्रोस्टेट इन्फेक्शन के लक्षण

When Prostate gland symptoms show up, the first line of treatment is medicine. We give two types of medicine, one to shrink the size of the gland which affects hormones and one to shrink the size of the gland.  The second is to widen the bladder prostate junction. If the same patient gets relief with these two treatments then this treatment will go lifelong till we achieve favorable results. The treatment depends on the patient, if the patient’s gland is under 30g, a single drug is given to open the bladder neck. Otherwise, we can also use a combination of drugs. So the first line of treatment is medicine unless there are indications of immediate surgery. 

What are the scenarios in which we do not treat the patient with medicine but direct surgery is required? The patient has a stone in the bladder or swelling in both the kidneys. In these scenarios we do not give a choice of medicines but surgery is the only option. 

What are the indications of surgery? 

• Patient medical treatment failed or the medicines are not effective. 
• Side effects of medication. 
• Frequent infection is an indication of prostate surgery. 
• Frequent bleeding is another indication of prostate surgery
• Bladder stone or swelling in the kidney 
• If a patient’s bladder is not completely empty

These are all indications of surgery. 

If we decide to do surgery, which surgery should be done?

It is a myth that if a patient’s gland size is 100 grams in ultrasound then it should be operated. The size of the gland does not matter at all when it comes to deciding  about the treatment of the prostate. Regardless of size, if the gland does not irritate or cause problems, then surgery is not needed. We have seen that a patient has a 200-gram size prostate but there are no symptoms then there is no need for treatment. 

If the patient has 20 grams to 25 grams but he has so much trouble it cannot be treated with medicine then surgery is required. Size is not a criteria, it is a  symptom that decides what the treatment should be. 

Surgery for Prostate gland / प्रोस्टेट इन्फेक्शन का इलाज

If we have decided to do a surgery , then which type of surgery should be done?. There are three types of surgical treatment or procedures:

• Transurethral resection of the prostate  (TURP)

• Laser enucleation of the prostate
• Bipolar TURP

These three types of surgery are available.

TURP 

TURP is gold-standard and has been performed for 50 years now. 

Laser enucleation of the prostate

Laser enucleation of the prostate is being performed from the last decade. It is very advanced and has various advantages. 

In both these procedures we insert a telescope through the urethra and remove the prostate. In both the procedures the instrument is the same, the tract is the same, but the energy source is different.  

Turp is transurethral resection of the prostate in which energy used is electrical current which is similar to soaping ice cream. Chips are scooped and then put in the bladder from where it comes out later. 

We use electrical current and it disperses in this incision stick pipe to get narrow chances there, more bleeding and the gland is not completely removed, so the regrowth is glad is quicker. 

Bipolar TURP

TURP is a gold-standard, easily available in India. We use unipolar current in this.

If we use bipolar current then it is called bipolar TURP. Bipolar TURP compared to unipolar TURP is faster, bleeding is less and you can remove bigger glands. In this, the irrigation used is normal saline which is similar to body fluids so it doesn’t have electrolyte imbalance side effects. 

Laser TURP 

The third modality for prostate treatment is laser TURP. If we imagine the prostate to be an orange, the other layer is intact and the inner pulp is scooped out. We no not scoop it out but go around the circumference and scrape it, so the symptoms are more. And the chances of regrowth are very less. 

Advantages of Laser TURP

-Normal saline is used which is similar to body fluid 

-Due to less bleeding patient’s catheter is removed early

-Recovery is fast as the gland is removed completely

So these are the advantages. 

So there are three types of lasers –

1. Holmium laser 
2. Thulium laser
3. Diode laser

Advantage of Thulium laser 

It has the advantage of various modality combinations of procedures available compared to holmium. In thulium, bleeding is less compared to holmium. With Thulium fiber we can do vaporization or enucleation or a combination of both. 

Thulium is more versatile compared to holmium but holmium is faster compared to thulium. Both lasers are good enough, whichever laser is available you can do the best job with it.

TURP or LASER?

TURP, Bipolar TURP and Laser prostate surgeries are available for prostate gland, which one to choose? 

Depends upon the expertise of the urologist who is doing it,  and depending upon the cost, as laser is costly but has more advantages. If you can afford it, it is best to have a laser enucleation prostate, because there is less bleeding and faster recovery, the catheter is removed within 24 to 48 hours, chances of regrowth are less as more glands are removed. 

Where is the use of lasers essential? 

– Laser antigodlin cannot close vaporization of the prostate through holmium prostate distraction is an advantage. 

– Patient has recently gone through a bypass surgery or wall replacement where blood thinner should not be stopped. 

– Lasers have an advantage if the gland is big. If the gland is above 150g, then laser surgery is more effective than TURP or bipolar TURP. 

So in these indications laser surgery is better than TURP, otherwise, both are equal and the results are the same. There is one more procedure, Prostatic Artery Embolization that is in the experimental stage. 

In this we do a prostate gland angiography, in which blood supply is stopped by putting a plug in its vessels. Prostate artery embolization is still in the experimental stage in this blood supply is stopped from one side of the gland leading the gland to shrink and relieving the symptoms. 

The Patient needs to be in local anesthesia and if the patient is unfit for anesthesia but needs surgery, the research on standard of care is not available. There is not enough evidence whether it is helpful to treat prostate artery embolization to treat prostate gland or not. If the patient is unfit or the gland is big Prostate Artery Embolization can be considered. 

Bottom Line 

• Prostate grows with age. It is not a disease but a physiological change. 
• It is a quality of life disease, it should be treated to improve the quality of life.  
• First line treatment is medicine if it improves the condition it should be taken lifelong. 
• If the medicine are not working or there is a requirement of a surgery, then there are two types of surgeries available: 

        – TURP which is gold-standard 

          -Laser enucleation prostate which is better in comparison to TURP. 

So stay safe, stay healthy.