Enlarged prostate (BPH) with insignificant PVR

Benign Prostatic Hyperplasia (BPH), Enlarged Prostate

Surgical BPH Treatment:

Surgery involves removing the enlarged part of the prostate that constricts the urethra. It is
recommended for patients who experience serious complications, such as the following:

 Bleeding through the urethra as a result of BPH

 Damage to the kidneys caused by urine backing up
 Frequent urinary tract infections
 Inability to urinate
 Stones in the bladder

The prostate is a gland about the size of a walnut that is only present in men. It is located just below the
bladder and surrounds the urethra, the tube through which urine flows from the bladder and out
through the penis. One of the main functions of the prostate gland is to produce prostatic fluid, one of the
components of semen. A man's prostate gland usually starts to enlarge after he reaches 40 years of age.
This condition is called benign prostatic hyperplasia (BPH). It is not cancer, and it does not raise your risk
for prostate cancer.
Benign Prostatic Hyperplasia (BPH) is mistaken to be simply a case of too many prostate cells. In reality,
there is no cure for BPH and once prostate growth starts, it often continues, unless medical therapy is
started. Prostate grows in two different ways. In the first type of growth, cells multiply around the
urethra and squeeze it, much like you can squeeze a straw. The second type of growth is the middle-lobe
prostate growth, in which cells grow into the urethra and the bladder outlet area. This type of growth
typically requires surgery.
RG Stone And Super Speciality Hospital
510-L, Model Town
Ludhiana - 141 002 (India)
Tel: +91-161-4618585, 4618686
Fax: +91-161-5022228
Email: [email protected]

RG hospital offers the facility of Holmium Laser Enucleation of Prostate (HOLEP) for the
treatment of Benign Prostatic Hyperplasia (BPH). They are the largest and the most advanced
super speciality urology institute in India.

Causes of Enlarged Prostate

The actual cause of prostate enlargement is unknown. It is believed that factors linked to aging and the
testicles themselves may play a role in the growth of the gland. Men who have had their testicles
removed at a young age (for example, as a result of testicular cancer) do not develop BPH.
Throughout their lives, men produce both testosterone, an important male hormone, and small amounts
of estrogen, a female hormone. As men age, the amount of active testosterone in the blood decreases,
leaving a higher proportion of estrogen. Studies done on animals have suggested that BPH may occur
because the higher amount of estrogen within the gland increases the activity of substances that promote
cell growth.
Another theory focuses on dihydrotestosterone (DHT), a substance derived from testosterone in the
prostate, which may help control its growth. Most animals lose their ability to produce DHT as they age.
However, some research has indicated that even with a drop in the blood's testosterone level, older men
continue to produce and accumulate high levels of DHT in the prostate. This accumulation of DHT may
encourage the growth of cells. Scientists have also noted that men who do not produce DHT do not
develop BPH.

Signs & Symptoms

Many men with an enlarged prostate have no symptoms. Common symptoms may include the following:
 Blood in the urine (i.e. haematuria), caused by straining to void.
 Dribbling after voiding.
 Feeling that the bladder has not emptied completely after urination.
 Frequent urination, particularly at night (i.e. nocturia).
 Hesitant, interrupted or weak urine stream caused by decreased force.
 Leakage of urine (i.e. overflow incontinence).
 Pushing or straining to begin urination.
 Recurrent, sudden, urgent need to urinate.

In severe cases of BPH, another symptom i.e. Acute Urinary Retention (inability to urinate), can
result. Acute Urinary Retention causes severe pain and discomfort. Catheterization may be
necessary to drain urine from the bladder to obtain relief.

RG hospital offers the facility of Holmium Laser Enucleation of Prostate (HOLEP) for the treatment of
Benign Prostatic Hyperplasia (BPH). We are the largest and the most advanced super speciality urology
institute in India. RG hospital is the first super speciality urology institute in India to introduce 100 watt
Holmium Laser treatment for enlarged prostate/Benign Prostatic Hyperplasia.

Diagnosis:
A physical examination and evaluation of symptoms provide the basis for a diagnosis of Benign Prostatic
Hyperplasia. The physical examination includes a digital rectal examination (DRE), and symptom
evaluation is obtained from the results of the AUA Symptom Index.
 Digital Rectal Examination (DRE)
DRE typically takes less than a minute to perform. The doctor inserts a lubricated, gloved finger
into the patient's rectum to feel the surface of the prostate gland through the rectal wall to assess
its size, shape, and consistency. Healthy prostate tissue is soft, like the fleshy tissue of the hand
where the thumb joins the palm. Malignant tissue is firm, hard, and often asymmetrical or stony,
like the bridge of the nose. If the examination reveals the presence of unhealthy tissue, additional
tests are performed to determine the nature of the abnormality.
 AUA Symptom Index
The AUA (American Urological Association) Symptom Index is a questionnaire designed to
determine the seriousness of a man's urinary problems and to help diagnose BPH. The patient
answers seven questions related to common symptoms of benign prostatic hyperplasia. How
frequently the patient experiences each symptom is rated on a scale of 1 to 5. These numbers
added together provide a score that is used to evaluate the condition. An AUA score of 0 to 7
means the condition is mild; 8 to 19, moderate; and 20 to 35, severe.
 PSA Test
Blood test to check the levels of prostate specific antigen (PSA) in a patient who may have benign
prostatic hyperplasia helps the Doctor to eliminate a diagnosis of prostate cancer.
 Uroflowmetry Test
This is a simple test performed which records urine flow to determine how quickly and
completely the bladder can be emptied. With a full bladder, the patient urinates into a device that
measures the amount of urine, the time it takes for urination, and the rate of urine flow. Patients
with stress or urge incontinence usually have a normal or increased urinary flow rate, unless
there is an obstruction in the urinary tract. A reduced flow rate may indicate BPH.
 Post-Void Residual (PVR)
This test measures the amount of urine that remains in the bladder after urination. The patient is
asked to urinate immediately prior to the test and the residual urine is determined by ultrasound.
PVR, less than 50 ml. generally indicates adequate bladder emptying and measurements of 100 to
200 ml. or higher often indicate blockage.

Treatment for Enlarged Prostate

Men who have BPH with symptoms usually need some kind of treatment at some time. However, a
number of researchers have questioned the need for early treatment when the gland is just mildly
enlarged. The results of their studies indicate that early treatment may not be needed because the
symptoms of BPH clear up without treatment in as many as one-third of all mild cases. Instead of
immediate treatment, they suggest regular checkups to watch for early problems. If the condition begins
to pose a danger to the patient's health or causes a major inconvenience to him, treatment is usually
recommended.

Since BPH can cause urinary tract infections, a doctor will usually clear up any infection with antibiotics
before treating the BPH itself. Although the need for treatment is not usually urgent, doctors generally
advise going ahead with treatment once the problems become bothersome or present a health risk.

Self-Care at Home
Some precautions can help to avoid worsening of symptoms of prostate enlargement and complications.
Do not delay to urinate once you experience an urge. Urinate as soon as you feel the urge, and empty the
bladder completely. Avoid alcohol and caffeine, especially after dinner. Don't drink a lot of fluid all at
once. Spread out fluids throughout the day. Avoid drinking fluids within 2 hours of bedtime. Keep warm
and exercise regularly. Cold weather and lack of physical activity may worsen symptoms.

Drug Treatment
There are two main classes of prescription medicines that are used to treat BPH: alpha-blockers and 5-
alpha-reductase inhibitors. Alpha-blockers relax muscle fibres that control the tension in the prostate
gland. They can reduce the pressure on the urethra and increase the flow of urine. They do not cure BPH
but may help to alleviate some of the symptoms.

Though alpha-blockers are likely to help, they don't work for everyone. If your symptoms don't improve
within a couple of months, your doctor may suggest trying an alternative treatment. There are several
different alpha-blockers that may be prescribed for BPH. Some of these drugs can also be used to treat
high blood pressure.

5-alpha-reductase inhibitors block production of a hormone called dihydrotestosterone (DHT). This can
reduce the size of the prostate by up to 30 percent. Finasteride (Proscar) and dutasteride (Avodart) are
examples of 5-alpha-reductase inhibitors. 5-alpha-reductase inhibitors are able to reverse BPH to some
extent and so may delay your need for surgery.

Surgery for Enlarged Prostate

There are a number of surgical options for BPH. Generally, surgery is considered for men who don't get
relief from symptoms using drug treatments.

Transurethral resection of the prostate (TURP) is the most common operation for BPH. Your surgeon
inserts a thin, tube-like telescope (a resectoscope) into the urethra. The resectoscope includes a camera
and specially adapted surgical instruments. This allows the surgeon to see the prostate clearly. A wire
loop attachment that carries an electric current is used to "chip away" at the prostate. For further
information, please see separate Bupa health factsheet, TURP.

Transurethral incision of the prostate (TUIP) may be appropriate for men who have a less enlarged
prostate. It is a quicker operation than TURP and instead of "chipping away" a portion of the prostate,
small cuts are made in the bladder neck and the prostate to improve the flow of urine.

Open prostatectomy is only recommended for men whose prostate is very large. It is a major operation
carried out under general anaesthesia and may require up to a week in hospital. An incision is made in
the lower abdomen in order to remove part of the prostate.

Fatty liver
Fatty liver is a common problem seen in many urban parts of India. Most of the time it goes untreated or
doctors fail to advice on this condition. This does not produce any visible symptoms , but can put you at
the risk of liver inflammation which ultimately can lead to jaundice (hepatitis), liver failure and liver
cancer. Initially it stays as a benign condition and is really harmless. But it can progress to a potential
slow killer.
Commonly seen in overweight persons and mostly above the ages of 30 and any liver problems are
associated with alcohol. But Non Alcoholic Fatty Liver Disease (NAFLD) is commonly seen rather than
the Alcoholic Fatty Liver Disease. So non alcohol drinkers too can get afflicted.
In this condition, the liver consists of excess of fat and the healthy tissues are replaced by unhealthy fats.
This makes the liver larger and heavier. This can possibly lead to gall stones.
What can be the various causes for a person to have fatty liver?
 Being Overweight or obese especially in the abdominal area
 Poor diet- high sugar intake, high fat intake
 Elevated cholesterol levels and triglycerides in the blood
 If suffering from metabolic syndrome
 Diabetic for over a long period of time and taking medications for the same
Now the question arises whether is it possible to reverse it?
Yes, it is definitely possible to reverse the condition of fatty liver if the following tips are followed.
Diet modifications
 Reduce the intake of refined carbohydrates in your diet such as white bread, white rice, pasta,
noodles, cakes, biscuits, desserts, soft drinks, sweetened fruit juices and also that of table sugar.
Avoid breakfast cereals too.
 Increase the amount of fruits and vegetables in the diet.
 Eat whole grains such as brown rice, whole wheat products, oats, ragi, bajra, jowar etc and Pulses
and legumes.
 Avoid all kinds of fried food, processed food, high fat foods in general all junk food.
 Avoid red meats such as mutton, beef, pork and opt for fat trimmed meats and white meats such
as fish, chicken, turkey. Avoid processed meat or cured meats.
 Switch over to low fat milk products from full cream or full fat milk products.
 Avoid margarine, mayonnaise as much as possible.
 Avoid artificial sweeteners as well. They do not help in the long term.
 Use oils which provided monounsaturated fatty acids.
Other influences
 Control diabetes with diet, medications and exercise.
 Keep your cholesterol levels in check and reduce triglycerides in the blood.
 Avoid alcohol as much as possible.
Exercise daily to reduce weight and to keep weight in check. Reduce the abdominal fat content by eating
smaller meals and by exercising daily by walking, jogging and also bu incorporating yoga in your diet.

Here are 5 fat reducing remedies commonly used to treat excess fat in the liver.
Epsom Salts
Epsom salts are sometimes recommended as a type of "liver flush" aimed at removing fats and toxins
from liver tissues. Epsom salts work by solidifying cholesterol into small stones that are then excreted.
This treatment can be done at home although some patients experience discomfort during excretion and
occasionally feel sick afterward.
Milk Thistle
Milk thistle is a herb containing silymarin which is a liver-friendly compound with excellent antioxidant
properties. Milk thistle treatment aims at protecting the liver from damage and toxins and also assists in
regenerating damaged hepatocytes (liver cells). It keeps the liver healthy so the liver can better deal with
conditions like fatty liver and cirrhosis.
Vitamin E and Vitamin C
The third liver remedy is vitamin E and vitamin C supplements. Much like silymarin in milk thistle, these
serve as antioxidants to protect the liver from damage and deterioration.
Prescription Drugs
A wide variety of drugs have been prescribed as ways to treat fatty liver. They generally aim at
combating problems resulting from a damaged liver. These include drugs like:
Orlistat Metformin Rosiglitazone Pioglitazone Gemfibrozil Atorvastatin
Pravastatin
Diet And Exercise
By far the most common and widely accepted treatment for reducing fat in the liver is proper diet and
exercise. This remedy also still has the most positive results for improving and sometimes even reversing
the condition.
Controlling excess fat in the liver through this method focuses on a combination of removing fatty foods
from the diet and following an exercise program for gradual weight reduction. This method improves
overall health and not just the health of your liver.

Fatty liver patient should carefully use medicine to reduce blood cholesterol, because not all fatty liver
patients have high blood cholesterol level. Normally fatty liver is divided into two types, the one is
alcoholic fatty liver, and just a small number of this kind of patient is suffering high blood cholesterol.
Another type is non alcoholic fatty liver, and its cause of disease is quite various, such as adiposity,
diabetes, high cholesterol, drugs and genes, and nearly 40% unknown cases. Therefore, the medicine of
cholesterol should be carefully used unless whose cause of fatty liver is high cholesterol, and the diet for
fatty liver could be used for all types of fatty liver.

Because of that, the diet for fatty liver is becoming popular. Identifying the do’s and don’ts could let you
organize the diet for fatty liver in a right way.

Here are the do’s:

Oat: “Oat is healthy”, this becomes a common knowledge around the world. Its properties make it the
first choice of human food for cholesterol and triglyceride lowering.
Maize: It is rich in calcium, selenium, lecithin, vitamin E and etc, also helpful for cholesterol lowering.
Laminaria japonica Aresch: It is rich in taurine, could reduce the cholesterol level of blood and gall.
Apple: Lower “bad cholesterol”, higher “good cholesterol”, keep blood pressure in a safe range.
Almond: Lower blood cholesterol lever, keep your heart strong and young.
Here are the don’ts:
1. Absolutely no alcohol.
2. Choose no fat or low fat milk, or yogurt.
3. Never eat more than 2 eggs a day.
4. No animal oil: and vegetable oil less than 20 grams.
5. No plucks.
6. No fried foods.
7. No chocolates.
8. Eat low oil bean products and noodles.
9. Eat 500 grams of fresh green vegetables per day.
10. Reduce main food after having fruits. Reduce main food 50 grams if having an apple every day.
11. Potato, yam, taro should be changed with rice and wheat some time.
12. Use less than 5-6 grams of salt every day.
13. Could eat spring onion, garlic, ginger and chili, but never eat too much.
14. Eat seafood, like fish and prawn.
15. Eat less on dinner, never eat food before sleeping.
16. Cook 30 grams of Crataegus Pinnatifida and 15 grams of Semen Cassiae with 1 liter water for tea.
17. Carefully use nutrition products, such as fish oil.