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Enlarged Prostate Gland

Benign Enlargement of Prostate and Laser treatment


Prostate gland has been the focus of research for a long time. This gland is the internal sex organ in men and contributes to the volume of semen. As the age advances, degenerative changes take place in the human body affecting almost all organs. The Prostate gland is no exception to this. A complex and delicate balance of hormones that control this gland tends to trip with age and results in an in ordinate growth of Prostate gland. Thus it is the price men have to pay for maturity. However the extent of enlargement of prostate varies greatly among men. Therefore, while some men would be affected more severely than others, a certain percentage of them may never be bothered by it at all. 

Prostate is a pear shaped organ of the size of walnut situated just below the urinary bladder in men. The urinary passage (urethra) passes through this gland. As the age advances, this organ grows in size and constricts the urinary passage. Almost 60% of men at the age of 60 years and all men at the age of 90 years would have some degree of prostatic enlargement. However, only about two thirds of these would have any symptoms pertaining to enlarged prostate. These symptoms comprise of increased frequency of urination, hesitancy in passing urine, sense of incomplete evacuation of urinary bladder, urgency to pass urine and occasionally loss of control over urination. All these make the act of voiding a frustrating experience and some men spend more time in the toilet than in their bedrooms. In addition to causing inconvenience to the individual, enlarged prostate can cause backpressure on to the kidneys leading to their failure.

In extreme cases there is complete inability to pass urine and this requires evacuation of urine by passing a rubber tube into the bladder and connecting it with an external bag. Usually, the onset of symptoms is so gradual that the person does not even realize the he is suffering from a disability until some kind of crisis is precipitated.

Enlargement of prostate could be benign or malignant An expert urologist should be able to differentiate between benign and malignant enlargement of prostate on the basis of clinical examination along with simple investigations like ultrasonography and blood levels of PSA.

The prostate gland in an adult male weighs around 20 Gms. Ultrasonography of the urinary tract can provide information about the size of the prostate, the pattern of growth of the prostate. An important piece of information provided by this investigation is whether the prostate gland is allowing the bladder to empty out completely or not. Normally a health urinary tract should be able to expel all urine leaving behind no residual urine. Uroflowmetry is another investigation employed to assess the obstruction caused by enlarged prostate. During this test, a person is asked to hold urine till the bladder is full when he is required to pass urine in a computerized container which generates a graph indicating flow rate of the urine. The parameters of this graph along with the overall shape of the graph are vital to making decisions regarding the further course of action.

If benign enlargement of Prostate (BPH) is diagnosed at an early stage, medical treatment is quite effective for relieving the symptoms and retarding its further growth. However, if diagnosed at a later stage, surgical treatment of enlarged prostate is generally required. 

For the last half a century, minimally invasive surgical method of treatment of the enlarged prostate gland has been Trans Urethral Resection of Prostate, popularly known as TURP. This is done by passing a fine telescope through the natural urinary passage. Therefore there are no cuts and stitches for this kind of operation. Prostate is chipped off using electric energy and removed piecemeal. However, this procedure, though considered as the gold standard of treatment of enlarged prostate, has a few short comings as well. For around two decades now, medical scientists all over the world have been working to develop newer methods as alternatives to TURP so as to further simplify the treatment. One such development is the use of LASER technology for removal of enlarged prostate gland. 

Laser Prostatectomy is a novel invention and is rapidly replacing TURP operations worldwide. Laser energy is used to remove the obstructing prostate gland through the urinary passage. A thin plastic catheter is left over right in the urinary bladder through the urinary passage. The method is almost completely bloodless and results in a quick recovery of the patient. 

This translates into a short admission period and early return to usually daily activity. Various kinds of Laser machines have been developed, each attempting to improvise its predecessor.

Laser prostatectomy using 100 watts Holmium Laser is called HoLEP (Holmium Laser Enucleation of Prostate). For the last half a decade Holmium laser has established its role in the treatment of enlarged prostate gland. 

Holmium laser fiber is passed through a telescope into the natural urinary passage. Laser energy delivered through this fiber is used to cut large chunks of prostate gland in a blood less manner. These chunks of prostate tissue are then further fragmented into smaller bits by using a ‘morcellator’, which can then be easily recovered through the urinary passage itself. This procedure is conducted under spinal anesthesia and a siliconized rubber catheter is left inside the urinary bladder overnight. The patient is discharged the very next day after he confidently passes urine to his satisfaction.

As may be evident by the above description, Laser treatment of prostate has several advantages.

  1. The procedure is almost blood less when compared to the existing TURP, hence there is no need for blood transfusion even during treatment of very large glands.
  2. The period for which the patient needs indwelling catheter is less (24-36 hours) as compared to other procedures wherein the patient needs to remain hospitalized for a longer period of time.
  3. Early discharge from hospital is an indicator of quicker recovery and earlier resumption of usual productive work.

Since most of these patients are elderly, they usually do have associated medical problems like diabetes, high blood pressure, heart diseases etc. Therefore surgical intervention must be carried out at a place where there are comprehensive medical and surgical intensive care units.

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