15 June 2017
The prostate is a walnut sized gland located below the bladder and just in front of the rectum. Enlargement of the prostate gland affects virtually all men over 50 and the majority of men in their 60’s have urinary difficulties due to this enlargement as it compresses the urethra, the pipe which lets urine flow out of the bladder.
Mr Mark Rochester, Consultant Urologist at Spire Norwich Hospital explains "The common symptoms of an enlarged prostate are increased frequency of urination during the day and at night, hesitancy (a delay in starting to pass urine), urgency, weak stream, a sensation of incomplete bladder emptying, intermittent stream and straining to pass urine.
"The diagnosis of an enlarged prostate is made by assessment of the patient’s symptoms, rectal examination of the prostate gland, urine test, electronic measurement of urine flow called uroflowmetry and an ultrasound measurement of the post-void residual to assess bladder emptying. In some cases an endoscopic examination of the bladder, called a flexible cystoscopy, under local anaesthetic is required. In some select patients, bladder pressure and flow studies called uro-dynamic studies are useful.
"Men with mild symptoms are managed with watchful waiting or careful observation and offered lifestyle advice such as avoiding excessive intake of caffeinated drinks. Patients suffering from moderate prostatic symptoms are treated with oral medication, many see a noticeable difference in their symptoms over 3-6 months, depending on the medication prescribed.
"Surgical treatment is usually indicated for those patients who have severe symptoms and who have symptoms that are inadequately controlled with medical therapy or who elect to receive more definitive treatment. The range of surgical procedures has expanded recently and can include the following.
"TUIP (Transurethral incision of prostate), can be carried out in patients who have a small prostate gland. TURP (Transurethral resection of prostate gland) was until recently the most widely used method of resecting prostate gland. This is carried out under general anaesthetic (meaning you’ll be asleep during the procedure) and requires an average stay in hospital of between 2-3 days.
"A newer procedure called holmium laser enucleation of the prostate (HoLEP) is now available at Spire Norwich Hospital. This procedure allows tissue to be removed with less bleeding and shorter duration of catheterisation (usually just overnight). In most cases this can be performed as a day case (with no overnight stay) and has a lower re-treatment rate than traditional TURP (as low as 1.5% for HoLEP versus 10% for TURP). It is suitable for all men and all sizes of prostate, and in my experience (of nearly 700 procedures in Norwich) has an excellent impact on men’s quality of life. I have trained a number of surgeons in this technique and am passionate about the benefits of this approach over more traditional surgeries.
"Most patients are also candidates for a novel procedure called prostatic urethral lift implant (UroLift) which holds the prostate open rather than removing tissue to improve symptoms. This has the advantage of being performed under sedation or local anaesthetic, with quick recovery and no need for a catheter to be fitted afterwards.
"Open removal of the prostate through an incision in the lower abdomen is only carried out in a very small minority of patients who have an extremely large prostate gland that cannot be treated by laser."
Mr Mark Rochester Concludes, "If you have symptoms related to bladder ageing, a urine infection or another causes for concern, it’s very important to discuss your symptoms with your GP. If your GP is concerned, you may be referred to a consultant urologist for further investigation. It’s always best to check rather than ignore symptoms, don’t take a ‘fingers crossed’ approach."
Benefits of HoLEP procedure:
- Better relief of prostate obstruction, symptoms and urinary flow rate
- Shorter hospital stay
- Suitable for men with a prostate of any size
- Suitable for men with bleeding disorders (i.e those taking blood thinning medication)
- Longer term benefits and less likelihood of further surgery
For further information about prostate gland problems arrange an appointment with your family doctor or call 01603 255614 to make a private appointment with Consultant Urologist, Mr Mark Rochester.
Further details on Mr Mark Rochester you can follow the link at the top of the page.
All surgery carries an element of risk and the content of this page is provided for general information only. It should not be treated as a substitute for the professional medical advice of your doctor or other healthcare professional.