The prostate is a small gland located between the bladder and the male penis, it is part of the male reproductive system that is responsible for secreting about 70% of seminal fluid, the prostate surrounds the male urethra which is the tube that carries urine and semen from the bladder to outside the body. In some men the prostate starts to enlarge which leads to difficulty in urination , and with time this problem may increase to inability to empty the bladder and may reach to urine retention.
Prostatitis
Prostatitis ( prostate inflammation ): it is a disease that affects men at all ages, but it is more prevalent among those in their thirties to fifties. A Aman may develop prostatitis suddenly or in stages, according to the cause of the inflammation. In some cases, the inflammation improves with treatment or without treatment, while some types of inflammation persist. for several months.
Prostatitis causes
Infection with a bacterial infection, where bacteria move from the urine to the prostate, and this condition is treated with antibiotics. In some cases, the bacteria are not completely eliminated, the infection may recur and be difficult to treat, turning into a chronic bacterial infection. In some few cases of inflammation it might be without any bacterial cause which is called ( Non-bacterial prostatitis )
Damage to some urinary tract nerves as a result of surgery or trauma may increase the chances of prostatitis.
BENIGN PROSTATIC HYPERPLASIA /Enlargement (BPH / BPE )
BPH is the most common prostate problem in men. Almost all men will develop some enlargement of the prostate as they grow older. By age 60, 50% of men will have some signs of BPH; by age 85, 90% of men will have signs of the condition. About half of these men will develop symptoms that need to be treated.
What are BPH symptoms in men ?
* Pain when urinating or in the lower abdomen.
* Irregular urination, as well as decreased urine output.
* Involuntary urination.
* Feeling of pain in different places of the back and abdomen.
* Having difficulty urinating.
* Continuous dribbling of urine after urination
* Pain in the penis or testicles.
* Pain when ejaculating.
Treatment options:
1- active servielance
Where the patient has prostatic enlargement with No serious or bothersome symptoms that really needs treatment In this stage the patient is followed up regularly with regular doctor examination , Radiological and laboratory investigations
2. Medical treatment
A BPH patient should know that he is dealing with a chronic disease which in most cases will require chronic treatment Alpha blockers are the most commonly used medication in treating BPH Recently some new drugs have been added to treatment guidelines giving the BPH patient the chance to live a better quality of life together with improvement of his medical condition
3. Surgical treatment
There are many treatment options to treat BPH surgically which include either: A. Endoscopic procedures
1. TURP
It is the conventional method in endoscopic BPH treatment
2. TURis ( Plasma Vaporization of prostate )
It is similar to TURP but using bipolar electric current that decrease the incidence of complications that usually happens with conventional TURP.
3. Laser prostatectomy
it is the ideal method of BPH treatment in patients with heart disease and in those patients who are required to use anticoagulation drugs that can NOT be stopped
B. Open surgical prostatectomy Which include removal of the enlarged prostate through an incision in lower abdomen
prostatectomy
It is a process during which all or part of the prostate gland is removed as a treatment option in treating pathological causes that affect the prostate after failure of medical treatment. The most common of which are benign enlargement of the prostate and prostate cancer. The type of enlarged prostate, whether benign or prostate cancer is the main factor in choosing the proper operation
When does the doctor decide to Surgically remove your prostate?
In cases when medical management has failed to treat the symptoms of prostatica enlargement and improve the patient’s condition.
Repeated urinary retention, which requires the application of a urinary catheter. When prostate enlargement causes recurring bladder infections or stones in the bladder as a result of not passing urine easily or bleeding with urine.
Endoscopic prostatectomy operation
This operation is performed under general or regional ( spinal ) anaesthesia by injecting aesthetic into the back. The endoscopic prostatectomy operation starts by inserting a medical scope through the urethra from the opening of the penis to the prostate. This endoscope consists of a camera and a source of light so that the surgeon can see. An electric current is used to heat the prostate and cutting it using special instrument during the removal of the problematic part of the prostate, then the surgeon pumps quantities of water through the endoscope to clean the effects of this surgery, and the operation takes about an hour.
After the operation, What to expect?
After the prostatectomy, the patient has difficulty urinating through the urethra. This is because the urethral canal is swollen after the operation, so a urine catheter is used to enable the patient to urinate easily and to facilitate emptying urine fromthe bladder. A urine catheter is also used to pump quantities of water into the bladder to wash it from any blood clots or sediments as a result of the operation.
The urinary catheter is removed after the urethra is healed and the patient urinates normally. The patient can return home 48 hours after the operation. The patient may still feel some pain and burning sensation during urination. The doctor may have to temporarily re-position the urinary catheter until the patient’s condition improves. .
What are the advantages of Endoscopic prostatectomy?
The Endoscopic prostatectomy is as good as open surgical prostatectomy in treating BPH with much less hospital stay as well as shorter over all recovery periods. Most cases can leave the hospital after two or three days of the operation, and he can return to his normal life within a week.
Operation cost
The cost of prostatectomy in Egypt depends on several factors:
The type of excision: the cost of the operation varies according to the size that is being excised and the condition. Sometimes part of the gland is removed, and sometimes the patient’s condition requires excision of the entire gland.
Reason for eradication: One of the main factors in determining the cost of the operation is the reason for removing the gland, is it because of a cancerous tumour, and does the doctor need to remove some tissue Surrounding the tumor as a preventive measure to prevent the spread of the tumor
Procedures accompanying surgery: These include procedures for preparing the patient before the operation, as well as procedures that follow the operation. Finally, the doctor’s experience, competence and scientific standing are among the most important factors in determining the cost of the operation, as well as the level and equipment of the medical center or hospital in which the operation is performed, and the level | of medical care that it provides.
The diseases that affect the reproductive system in men are sensitive diseases and have a great impact on men and their psychological state. Therefore, when experiencing any disease symptoms, you must go to a specialized doctor with experience and competence, and you must search for the best urologist in Egypt or go to the best specialized medical centers. Dr. Mohammed Metwally Sadeaq, Consultant of Urology, Andrology and Infertility is one of the best centers that use the latest treatment techniques.