Tokushukai Medical Group

Treatment of Disease

Treatment of Disease

Urological Disease:Prostatic Enlargement

Symptoms are “frequent urination”, ”hard to produce urine”.

Prostatic Enlargement, as the name suggests, is a disease which prostate is enlarged, and it is said that 1 out of 5 males over 55 of age are affected.

Prostate is the organ that is only in male and located just under the bladder with covering urethral tube around. Therefore, once prostate becomes hypertrophic, it may cause a deleterious effect for the symptom or daily life. Typical symptoms are; “frequent urination”, “hard to produce urine”, or “feeling of residual urine”. True cause of prostatic enlargement is still unknown, but it is at least known that the aging or male hormone do relate to this disease.

Prostatic Enlargement will never evolve toward prostate cancer, but the symptoms are similar so that it is necessary to pay an attention. In case of symptom is mild, it can be followed by chemotherapy but is difficult to have complete cure, and when it becomes hypertrophic, status changes into no urination possible. Hence the insertion of rubber made catheter tube becomes inevitable then it may cause to develop infection disease like infection of the urinary tract accompanied with high fever, or there may be a case of dysfunction of kidneys (uremia) by the occurrence of functional disorder of the kidneys.

At the diagnosis, it is distinguished from other disease like cancer.

To distinguish and diagnose prostatic enlargement, there are; questionnaire to evaluate the subjective symptoms, bladder diary to record urination status, medical examination that puts a finger from the rectum (important for diagnosing prostate cancer), residual urine examination which detects remained urine in the bladder after urination, measurement of urine flow to measure urinary stream, and echography to measure prostate size. Urine test or PSA examination (Blood Test) which is effective for cancer diagnosis also becomes necessary.

It is necessary to have a medical check, with visiting anywhere hospital with urological department. There are many diseases onset disorder of urination prostate available. They are the cancer or other disease other than prostatic enlargement so that it becomes very important to start treatment with distinguishing other diseases.

Procedure Hospitals
Reference
Screening and examination for prostatic enlargement at Asahi Kasei Pharma HP.

Surgical operation when excretion of urine is difficult.

Treatment is conducted in accordance with Prostatic Enlargement Guideline.

Reference
Prostatic Enlargement Guideline

Oral medicine treatment is available but in case where excretion of urine is difficult, surgical treatment becomes necessary. In regard to oral medicine treatment, select medicine in accordance with each symptoms then treatment begins.

As for surgical treatment, endoscope treatment is mainly conducted.

Transurethral Resection of the Prostate (TUR-P)
Surgical method which is conducted under lumber (lower body) anesthesia. But it also conducted under full anesthesia. In this method, endoscope is inserted from urethral tube, prostate tissue is scraped finely by cautery knife and finely scraped tissue of prostate are removed from the bladder. Surgery is completed with inserting rubber catheter tube inside the urethral tube. In few days later when bloody urine is paled out, catheter is extracted, then patient is released from hospital. Surgical duration, depend on the size of prostate, is finished in one and half hour to two and half hours.
Transurethral Holmium Laser Enucleation of Prostate (HoLEP)
Transurethral Holmium Laser Enucleation of Prostate (HoLEP)
Endoscope insertion from urethral tube itself is the same as transurethral resection of the prostate (TUR-P), but laser light is used instead of cautery knife. Because of less bleeding or pain, this method makes surgery easy for the patient with less burden for the patient. As shown in the figure, surgery is conducted with laser fiber inserted between inside (inner gland) and outside (outer gland) of the prostate. With irradiating holmium YAG laser, resect the enlarged inner gland (adenoma) out from outer gland (enucleation). Enucleated adenoma into the bladder is extracted by threading/ vacuuming using other equipment. Surgery takes approximately two to three hours (varies depend on the size of prostate).
Because transurethral resection of the prostate conducted to prostatic enlargement until now has scraped adenoma off by cautery knife, scraping (resection) and hemostasis (clotting) should be made alternately, so that it is unable to prevent for certain amount of bleeding for the case of large prostatic enlargement. Holmium YAG laser has advantages, such as, the merit of scraping and clotting can be made at the same time, and bleeding itself is less because it is an enucleation method which does not damage inner gland.

Able to be discharged from hospital in about a week.

As for the postoperative, process is about the same as transurethral resection of the prostate. Urethral tube catheter is inserted in urethral tube for 2 to 3 days in order to keep wound site at rest. Normally, patient can walk from next day of the surgery. Meals normally start from the dinner on the surgical day.

Also, check the existence of prostate cancer in the hollowed tissue with taking approximately two weeks. Upon finding the result, it is explained.

After decannulation of urethral tube catheter, in case with no fever, status of bloody urine is mild, and when doctor has judged that micturition pain or difficulty in micturition are possibly disappear naturally, patient is discharged from hospital. Normally, it is in 5 to 7 days.

How about other surgical treatment?

The followings are the list of surgical method other than TUR-P or HoLEP.

Prostate hypertrophy Surgery by Laparotomy
Comparing with endoscopic surgery, laparotomy gives a large amount of stress to patient body, also it takes quite time after the surgical operation. The merit of Prostate Hypertrophy Surgery is surgical time is shorter than endoscopic surgery, in case of enormously large prostate or handling of endoscope from urethral tube is difficult, or in case of multiple occurrence of large bladder calculus.
Urethral Stent Detention
Because of the case where internal medicine treatment has no effect, or surgery is difficult with reason of complicating disease of brain, heart or lung, there is a treatment where short tube, a metal stent, is inserted only to the prostate portion of urethral tube. This may be conducted for the limited patient only.
Prostate Hyperthermia
Prostate Hyperthermia

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