How do I choose Best Treatment for my Enlarged  PROSTATE or BPH

TREATMENT WITHOUT SURGERY BY MOST MODERN METHOD “EMBOLISATION”

Dr. Virender K Sheorain

Senior Consultant

Vascular Specialist & Interventional Radiologist

Prostate is a gland present in every men and it is bound to increase in size & volume with increasing age. When it increases to a size & volume to cause symptoms, the disease is called BPH (Benign Prostatic Hyperplasia). The increase in size of prostate can cause obstruction to the passage of urine ( difficulty in passing urine) and sometimes it can cause irritation with feeling to go for urination every hour especially during night (frequency).

Most patients with BPH are initially treated with medications. However, a lot of patients are not able to tolerate medications for BPH due to their side-effects. If medications fail to relieve symptoms of BPH, most patients are advised to undergo Surgery by Urologists. 

The most commonly performed surgery in India is Transurethral resection of the prostate (TURP). However, most surgeries are associated with some potential risks. Lot of patients fear to get operated because of many risks involved with TURP Surgery.

I am writing this blog for a specific reason to clarify the most important doubt that comes in the mind of a patient suffering from enlarged prostate (BPH). Lot of patients come to me and asks about the best method to treat their prostate problems. These are the patients who have tried various medications for sometime and finally advised surgery by their urologists. I would like to say that “No one treatment fits all”. Some may benefit with medications and few may also need  urgent TURP surgery especially those who present with acute retention of urine (100% block of urine). However, most patients fall in the category where they can choose from multiple available treatment options. TURP is the most commonly offered treatment surgery in India. If TURP had no risks or complication associated with it, then I would say all men with enlarged prostate (BPH) can go for it. But, the truth is not so. There are many risks and complications that are associated with TURP Surgery, which I have tried to explain below. Because of this complications, it is not easy for the patients and their family members to opt for TURP. Please go over carefully through the  below enlisted complications that may happen if a patient undergoes TURP surgery.

Risks of TURP Surgery:

• Retrograde ejaculation can occur in as many as 90% of cases.The semen doesn’t come out of your penis during sex or masturbation but flows backward into your bladder instead. It’s caused by damage to the nerves or muscles surrounding the neck of the bladder. Retrograde ejaculation can affect your fertility, so you should speak to your surgeon if this is a concern.
• Urinary incontinence (Bed wetting or Urine passage without your knowledge) is also quite common after TURP. It is like sudden urge to pass urine and you lose control of your bladder (leakage of urine in trousers) if you do not find a toilet quickly enough.
• Erectile dysfunction Up to 10% of men can have difficulty getting and maintaining an erection (erectile dysfunction)  after surgery. This can be either temporary or permanent.
• Urethral strictures Narrowing of the urethra (urethral strictures) is estimated to develop in up to 4% of cases. It can occur if the urethra is damaged during surgery and becomes scarred.More extensive narrowing may require surgery.
• Bleeding in 2% of cases there may be bleeding during or after the operation that may require blood transfusion.
• Urinary Tract Infection in around 5% of cases, a UTI could develop after surgery; 
• Urinary retention in around 2% of cases, the muscles that control the bladder may be damaged, which can lead to problems fully emptying the bladder; 
• Repeat Surgery In 10% of men prostate may enlarge & will need TURP Operation again within 10 years.

With the advancement in medical science, treatment for enlarged prostate (BPH) has also gone through many research. Many modifications to the existing TURP surgery has taken place, but none is up to the mark. 

The latest & Non surgical (without surgery) method for treatment of enlarged prostate is called Prostatic Artery Embolisation (PAE). It is not a surgery and is just like doing an angiography. It involves blocking the blood flow of small branches of the prostatic arteries using Microparticles injected via a small catheter, to decrease the size of the prostate gland. It is a minimally invasive therapy which can be performed with local anesthesia, as an outpatient procedure. Patient can be discharged home the very same day or next morning. No cuts are required. No need for blood transfusion. There are many benefits of PAE procedure. The best part of PAE procedure is that it can even be performed on patients who are not fit to undergo surgery.

Benefits of PAE 

• No Surgical cut
• Minimally invasive 
• No blood transfusion
• No tissue removed 
• No damage to surrounding nerves and Bladder neck
• Quick recovery 
• Not performed through the urethra / Penis
• No side effects of TURP surgery like retrograde ejaculation, stricture, incontinence etc

Thus, PAE is a great option for patients who have severe symptoms of BPH and who don’t want to take risks involved in TURP. It is also very useful treatment option in patients who have prostate enlargement that is too big to be treated by TURP surgery and for those who have had previous failed TURP surgery without improvement in symptoms.

During your consult with Dr. Sheorain, each and every patients with BPH, is explained in details about all the various treatment options available and their benefits and risks, thus helping them to take correct decision. Dr. Sheorain has performed maximum number of PAE procedure in North India with results at par with international standards.

For further information on PAE procedure please visit www.vasculardoctorindia.com or call 9868887666 to schedule an appointment with Dr. Virender Sheorain.

He is among few best  trained doctor for enlarged prostate treatment without surgery, currently working in Medanta Hospital Gurgaon.