Benign prostatic enlargement can be diagnosed and treated using different methods. The Department of Urology at Singapore General Hospital shares and explains what they are.
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Diagnosis of benign prostatic enlargement
Some of the common tests to diagnose benign prostatic enlargement include:
1. Digital rectal examination (DRE)
Your doctor inserts a gloved finger into the rectum and feels the prostate next to the rectum. This gives him a general idea of the size and condition of the gland.
2. Urine flow test
A special device you urinate into measures how quickly the urine is flowing. A reduced flow often suggests BPE.
A small tube, a cystoscope, is passed through the opening of the urethra in the penis. It contains a lens and light system that helps your doctor see the inside of the urethra, prostate and the bladder to identify the location and degree of the obstruction.
Treatment may not be needed in mild cases. In moderate to severe cases, the following treatment options are available:
1. Drug treatment
Drugs that relax the smooth muscle of the prostate and bladder neck are used to improve urine flow and reduce bladder outlet obstruction.
Drugs that inhibit production of the male hormone DHT, which is involved with prostate enlargement, are used to prevent progression of growth of the prostate or actually shrink the prostate in some men.
2. Surgical treatment
Most urologists recommend removal of the enlarged part of the prostate as the best long-term solution for someone with BPE. With surgery for BPE, only the enlarged tissue that is pressing against the urethra is removed; the rest of the inside tissue and the outside capsule are left intact.
Surgery may be performed by the following methods:
Transurethral resection of the prostate (TURP)
This is the most common technique used in 90 per cent of all prostate surgeries for BPE. Under anaesthesia, a resectoscope is inserted through the penis. The surgeon uses the resectoscope with a special wire loop or laser fibre to remove the obstructing tissue one piece at a time. The pieces of tissue are carried by the fluid into the bladder and then flushed out at the end of the operation.
In those cases when a transurethral procedure cannot be used, or if the gland is extremely large, open surgery may be needed. Under anaesthesia, the surgeon makes an incision in order to reach the prostate capsule to scoop out the enlarged tissue from inside the gland.
A laser fibre is passed through the urethra into the prostate using a cystoscope, and bursts of laser energy are delivered to destroy the prostate tissue. As with TURP, laser surgery requires anaesthesia and a hospital stay. This technique is often used for selected people with smaller glands.
At the end of surgery, a urinary catheter is inserted through the opening of the penis to drain urine from the bladder into a collection bag for a few days.