Diagnosis for Enlarged Prostate (BPH)
Clinical symptoms and physical examination provide the basis
for diagnosis of Enlarged Prostate or Benign Prostatic Hyperplasia. The
physical examination includes a digital rectal examination (DRE).
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.
PSA Test
Blood test to check the levels of prostate specific antigen (PSA) in a patient
who may have BPH helps the doctor to eliminate the diagnosis of prostate
cancer.
Uroflowmetry Test
This is a simple test which records the 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 taken, 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 even 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 indicates blockage.
Laser Treatment for Enlarged Prostate (BPH)
Holmium Laser Enucleation of the Prostate (HoLEP)
Holmium Laser
Enucleation of the prostate (HoLEP) is a modern alternative to the standard
Transurethral Resection of the Prostate (TURP) procedure for bladder outflow
obstruction due to BPH. It requires a short period of hospitalisation and an
anaesthetic. A catheter (a tube which drains the bladder) is also needed
for 1-2 days until the urine clears. Patients are advised to take life quietly
and to avoid straining or heavy lifting for four weeks after the surgery.
Holmium Laser Enucleation of the prostate (HoLEP) is a modern alternative to
the standard Transurethral Resection of the Prostate (TURP) procedure for
bladder outflow obstruction due to BPH. It requires a short period of
hospitalisation and an anaesthetic. A catheter (a tube which drains the
bladder) is also needed for 1-2 days until the urine clears. Patients are
advised to take life quietly and to avoid straining or heavy lifting for four
weeks after the surgery.
What are the advantages of HoLEP
- There is no upper size limit of prostate that can be
dis-obstructed – traditionally men with prostates over 100ml in size
needed major open surgery
- There is often less bleeding than after a TURP
- Discharge is often quicker than after TURP at 1-2 days
- The chance of recurrence requiring further surgery is
very low
- Unlike greenlight laser operations, large quantities of
prostate tissue are sent for pathological analysis
- The PSA generally drops to very low levels after HoLEP
operations
