Prostate Gland
The prostate is a gland in the male reproductive system found below the bladder and in front of the rectum. The Common Ailments Of Prostate Gland:
- Prostatitis: is an inflammation of the prostate gland. It can be either acute or chronic. Acute Prostatitis is usually associated with bacterial infection and acute onset of symptoms of lower urinary tract e.g. burning micturition, poor stream and pain in perineal region and is usually accompanied with fever.
Chronic Prostatitis can be bacterial or abacterial. It presents with vague lower tract symptoms with on and off exacerbation of symptoms.It is seen in younger patients. - Prostatic Abscess: is a focal accumulation of pus in the prostate gland. It presents with pain while passing urine, fever at times-retention of urine and heaviness in the perineal region.
- Benign Enlargement Of Prostate (BEP): is a benign (non- cancerous) increase in the size of the prostate in older age group of males.
- Prostate Cancer
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Assessment
Assessment of prostate disease includes a detailed history which includes history of the act of micturition, past history and family history. A clinical examination is necessary including digital rectal examination to assess the prostate.
The investigations include laboratory investigation of urine and blood as indicated, assessment of flow of urine on Uroflowmeter and USG or Trans Rectal Ultrasound as and when indicated.
Treatment
- Prostatitis: Acute prostatitis is treated with intravenous antibiotics. The patient may or may not require urinary drainage in the form of a per urethral catheter or a supra pubic catheter (catheter is put through the abdomen just above the bladder so as to avoid passage of urine through the urethral passage). Chronic prostatitis requires long term oral antibiotic treatment (if it is bacterial prostatitis) along with drugs to ease out urination and the congestion and inflammation of the prostate.
- Prostatic Abscess: Under proper antibiotic coverage, Trans Rectal Ultrasound guided puncture of the abscess is done and pus is drained out. It’s treatment involves long term antibiotic and may require urinary drainage in the form of per urethral catheter or SPC.
- BEP (Benign Enlargement Of Prostate): Most patients of prostate enlargement can be treated as out patients with medical treatment.
Surgery Of Prostate
Primarily involves removal or cutting of the adenomas so as to relieve the pressure on the prostatic urethra which results in a better urinary flow. Methods available are:
(Trans Urethral Resection Of Prostate) is GOLD STANDARDARD in prostatic management involves Endoscopic Trans Urethral Resection of the prostate with the mono polar current, with glycine as the irrigating fluid. Post-operatively patient is kept in hospital for 3-4 days.
(Plasma Kinetic Resection Of Prostate) is Conventionally like TURP, but here, the more superior method of cutting the tissue is used. PLASMA KINETIC CUTTING, which closes the blood vessels as cutting occurs, using normal saline as the irrigating fluid (NS is a physiological solution therefore its absorption is not dangerous )Bleeding is significantly low and hospital stay and catheter time is also less than TURP. Also called as BIPOLAR TURP, it is now replacing TURP majorly. It is successfully used for cardiac patients, high risk patients and patients on pace-makers.
TUBE (transurethral bipolar enucleation) of Prostate is the latest in treatment of BEP. Here the adenoma is enucleation using the bipolar. It has an advantages of blood loss, less operative synptoms e.g. Bony while hasty urine (specially post laser prostate surgery) lesser chances of urinary incontinence.
Here the energy source used to resect the adenoma of prostate is LASER (light amplification by stimulated emission of radiation). Various types of lasers have been coming and going ever since its advent 30 yrs ago. None of them have been able to replace the GOLD STANDARD TURP. HOL YAG is a versatile urology laser. Advantage of laser is that it is safer in patients with high cardiac risk .
Rarely done now a days. Only indication is a very large gland for example 250 gm or more. That too can be managed by a staged endoscopic procedure.