Benign prostatic hyperplasia (BPH) is a condition that affects the prostate gland in men. The prostate is a gland found between the bladder (where urine is stored) and the urethra (the tube urine passes through). As men age, the prostate gland slowly grows bigger (or enlarges). As the prostate gets bigger, it may press on the urethra and cause the flow of urine to be slower and less forceful. "Benign" means the enlargement isn't caused by cancer or infection. "Hyperplasia" means enlargement.

Most symptoms of BPH start gradually. One symptom is the need to get up more often at night to urinate. Another symptom is the need to empty the bladder often during the day. Other symptoms include difficulty in starting the urine flow and dribbling after urination ends. The size and strength of the urine stream may decrease.

These symptoms can be caused by other things besides BPH. They may be signs of more serious diseases, such as a bladder infection or bladder cancer. Tell your doctor if you have any of these symptoms, so he or she can decide which tests to use to find the possible cause.

You may first notice symptoms of BPH yourself, or your doctor may find that your prostate is enlarged during a routine checkup. When BPH is suspected, you may be referred to a urologist, a doctor who specializes in problems of the urinary tract and the male reproductive system. Several tests help the doctor identify the problem and decide whether surgery is needed. The tests vary from patient to patient, but the following are the most common.

Digital Rectal Examination (DRE)

This examination is usually the first test done. The doctor inserts a gloved finger into the rectum and feels the part of the prostate next to the rectum. This examination gives the doctor a general idea of the size and condition of the gland.

Prostate-Specific Antigen (PSA) Blood Test

To rule out cancer as a cause of urinary symptoms, your doctor may recommend a PSA blood test. PSA, a protein produced by prostate cells, is frequently present at elevated levels in the blood of men who have prostate cancer.

Rectal Ultrasound and Prostate Biopsy

If there is a suspicion of prostate cancer, your doctor may recommend a test with rectal ultrasound. In this procedure, a probe inserted in the rectum directs sound waves at the prostate. The echo patterns of the sound waves form an image of the prostate gland on a display screen. To determine whether an abnormal-looking area is indeed a tumor, the doctor can use the probe and the ultrasound images to guide a biopsy needle to the suspected tumor. The needle collects a few pieces of prostate tissue for examination with a microscope.

Urine Flow Study

Your doctor may ask you to urinate into a special device that measures how quickly the urine is flowing. A reduced flow often suggests BPH.

Cystoscopy

In this examination, the doctor inserts a small tube through the opening of the urethra in the penis. This procedure is done after a solution numbs the inside of the penis so all sensation is lost. The tube, called a cystoscope, contains a lens and a light system that help the doctor see the inside of the urethra and the bladder. This test allows the doctor to determine the size of the gland and identify the location and degree of the obstruction.

After your doctor takes a complete history of your symptoms, a rectal exam is the next step. This exam allows your doctor to actually feel the size of the prostate gland.

It might not be possible for your doctor to be sure that your prostate problem is benign just by taking a history and performing a physical exam. Your doctor might need to look at a sample of your urine for signs of infection. Your doctor may also do a blood test. An ultrasound exam or a biopsy of the prostate may help your doctor make the diagnosis.

Once your doctor is sure that your symptoms are caused by benign growth of the prostate gland, treatment can be recommended. However, your doctor may suggest that you wait to see if your symptoms get better because sometimes mild symptoms get better on their own. If your symptoms get worse, your doctor may suggest another treatment option.

Surgery is considered the most effective treatment and is used in men with strong symptoms. This is also the best way to diagnose and cure early cancer of the prostate. Surgery is usually done through the urethra, leaving no scars. Surgery does have risks, such as bleeding, infection or impotence. These risks are generally small.

Drug treatments are available. Finasteride makes the prostate shrink, but it does not help all patients. The side effects of finasteride are rare and mild, but they usually have to do with sexual function. They go away when the medicine is stopped. The prostate will enlarge again when the medicine is stopped, so another treatment may have to be tried.

Another kind of medicine, called alpha blockers, also can help the symptoms of BPH. Some of these drugs are terazosin , doxazosin and tamsulosin .Alpha blockers have been used for a long time to treat high blood pressure, but they can also help the symptoms of BPH, even in men with normal blood pressure. These medicines may not work in all men. The side effects of alpha blockers are mild and go away if you stop taking the medicine. The side effects include dizziness, fatigue and lightheadedness.

Prostate cancer is the most common cancer among men and the second leading cause of annual cancer deaths, following lung cancer. One in 10 men will be diagnosed with prostate cancer. More than 70 percent of all prostate cancer cases are diagnosed in men over the age of 65. In addition, prostate cancer has the strongest familial link of all the major cancers.

Often, early stages of prostate cancer do not cause symptoms. But, in some cases, men with prostate cancer may experience any of these problems:

• A need to urinate frequently, especially at night;
• Difficulty starting urination or holding back urine;
• Weak or interrupted flow of urine;
• Painful or burning urination;
• Difficulty in having an erection;
• Painful ejaculation;
• Blood in urine or semen;
• Frequent pain or stiffness in the lower back, hips, or upper thighs.

You should speak with your doctor immediately if you have these symptoms or if you are over 50 and not had a recent prostate cancer screening. If you have a family history of prostate cancer you should consider screening beginning at age 45.

Prostate cancer may be highly curable when detected in its early stages. One in every seven men diagnosed with prostate cancer will die from the disease. In advanced stages of the disease, new data from two large clinical trials suggest chemotherapy extends survival among men who have failed hormone therapy.

Screening for prostate cancer is a relatively simple procedure. While others may begin with a visit to the urologist. Urologist will be able to help you learn more about the screening process.

The first analysis many physicians will perform is a

• PSA test. Prostate specific antigen (PSA) is an enzyme produced in the prostate that is found in the seminal fluid and the bloodstream. To measure the PSA level, a small vial of blood is drawn and sent to a laboratory for evaluation. An elevated PSA level in the bloodstream does not necessarily indicate prostate cancer, since PSA can also be raised by infection or other prostate conditions. Many men with an elevated PSA do not have prostate cancer.
• The digital rectal exam (DRE) should be performed along with the PSA test. The DRE is performed by a physician who will insert a gloved finger into the rectum to feel the peripheral zone of the prostate where most prostate cancers occur. The physician will be checking for hardness of the prostate or for irregular shapes or bumps extending from the prostate - all of which may indicate a problem. The DRE is particularly useful because the PSA test may miss up to 25 percent of cancers, and the DRE may catch some of these.

The DRE and PSA tests cannot diagnose prostate cancer; they merely indicate that further testing is needed.

Abnormal findings in either the DRE or PSA may indicate the need for a biopsy. During a biopsy, ultrasound is used to view and guide a needle (or multiple needles) into the prostate to take small samples of tissue.

Typically, a prostate cancer biopsy employs a multi-needle device that is able to take six or more tissue samples simultaneously from different parts of the prostate to be sure that cancerous tissue is not missed.

This procedure is typically performed using local anesthesia.

A biopsy is the only way to confirm or diagnose the presence of prostate cancer. The biopsy procedure may cause some discomfort or pain, but the procedure is short, and it can usually be performed without an overnight hospital stay on an outpatient basis.

There are a variety of ways to treat prostate cancer including

• Surgery to remove the prostate in its entirety, radiation therapy to kill the cancerous tissue in and around the prostate,
• Hormone deprivation therapy to stop the production of hormones that help prostate cancer cells to grow,
• Chemotherapy to stop the cancer cells from dividing and multiplying,
• "Watchful waiting" which involves no active treatment at that particular time. One or more of these treatment approaches may be used by your doctors at various times and stages of the disease. There are a variety of factors that will be evaluated by your physician to determine the best treatment approach.

Urologists, radiation oncologists and medical oncologists all play a vital role in the treatment of prostate cancer.

By measuring levels of a substance called prostate-specific antigen in the blood, your physician can measure disease progression. If you are receiving treatment for prostate cancer and your PSA numbers keep rising, it may be a sign that your therapy isn't working and you may need to consider a more aggressive treatment.

Most men whose cancer returns after local treatment or are diagnosed with advanced disease are treated with hormone therapy. However, at some point, hormone therapy may stop working and the PSA levels will begin to rise again. At this point it is particularly important to seek the advice of a medical oncologist who can work with the rest of your healthcare team to determine the best treatment for you at this stage of the disease.

The presentation of symptoms depends upon the location, size, and shape of the stone. Many times they are symptom free. They are called silent stones. Common symptoms are as follows:

1. Sudden, severe pain- starting in the flanks and moving towards groins. Typically, described as ureteric colic and loin to groin pain
2. Nausea and Vomiting.
3. Blood in Urine.
4. Increased Urinary frequency.
5. Burning sensation on passing Urine.
6. Infection in Urine.

1. People who tend to form stones have certain factors in common.
2. Those who stay in the hot environmental condition, such as tropical area.
3. Positive family history of the stone disease in first blood relation.
4. Decreases fluid intake, which reduces urine output, and forms supersaturated urine.

Various factors play a role in the formation of kidney stone in a susceptible individual. These factors are diet, water intake, urinary output, climate, occupation, and heredity, radical and family background.

1. Diet- Ingestion of excessive amount of calcium, oxalates, purines (uric acid), phosphates and other elements often results in excessive excretion of these components in the urine. The stone formation can be precipitated by high intake of calcium in the form of milk, ice creams, cheese, chocolates, cocoa, calcium containing drugs or vitamin D.
2. Water Intake and Urinary Output- It has been well established that increased water intake and increased urinary output decrease the incidence of urinary stone in patients predisposed to the disease.
3. Climate- High environmental temperature increases sweating, which may result in increased concentration of urine. This hyper concentration may contribute to stone formation.
4. Occupation- Stone disease is more likely to be found in individuals with sedentary occupation like professionals and managerial class rather than unskilled and partly skilled labourers.
5. Genetic Disorders- Like Gout, Cystinuria, primary Oxaluria, metabolic disorders like bowl, endocrine and kidney problems that increase blood and urine calcium and oxalates can promote the tendency for stone formation. Other rarer conditions like rickets, hyperparathyroidism and demineralization of bone may lead to stone formation.
6. Obstruction and Infection- Due to stricture or enlarged prostate may cause stagnation of urine leading to stone formation. Chronic infection in the kidney may also allow stone formation around the debris in the urine.

Stones form due to many reasons
Common causes of the stone formation are:

• Supersaturation of urine by decreases intakes of water and or hot environmental condition where there is loss of body fluid in atmosphere by perspiration, and in breathing.
• Urine infection where crystals deposit themselves on and around the infection causing organism, and the stone grows over the period in the supersaturated urine.
• Diet rich in oxalates, Uric acid, can increase the incidence of stone formation.
• Functional or structural obstruction of the urinary system can precipitate the stone formation. Like Pelviureteric junction obstruction, Ectopic kidney, Horseshoe kidney.

Yes. Water helps in the flushing out the stones. But unfortunately not all stones, stones which are in the size range of 3-6 mm can be passed out with the increased in take of water

If you find a stone, bring it in to your doctor for analysis. The type of stone you have, will determine the diet and prevention programme your doctor recommends. You may need additional tests and X-ray in future to ensure that new stones do not form.

Knowing the fact that you are harbouring the stone you should not ignore that. You should go for check up for the stone size every 6 months and should notice for increase in the size of the stone. Increase in size is the indication that stones need some intervention.

There is high chance of the repeated urinary tract infection because of the stone. Above all symptomatic obstructing stone can lead to kidney failure.

ESWL is an absolute safe procedure in almost all cases.

There may be dull aching pain in site of treatment after the procedure for few hrs. Further there will be colic pain due to passage of stone particles. This normally responds to the medication.

There is no damage to the other organs as the shock waves are effective on the targeted point at the junction of solid and liquid, which is stone and urine respectively.

Lithotripsy is safest with above diseases as it is totally non-invasive procedure. However, one should keep these diseases under control when treating with Lithotripsy.

In general, you require surgical intervention if your stones are large enough to obstruct urine flow, if they are potentially harmful to your kidneys or if they are causing symptoms for which medication does not help.

The removal or treatment of a kidney stones by inserting a tube through the skin and into the kidney, under anaesthesia.

You will not be allowed to eat or drink for at least six hours before the procedure.

The area across your side and loin will need to be free from hair and so may need to be shaved.

WHAT IS DONE?

Whilst watching on an x-ray/ultrasound screen, the surgeon passes instruments into the kidney through the side of the body, via a small incision, to extract or shatter the stones. At the end of the procedure a tube is left in the kidney, called a nephrostomy tube. This drains to the outside to allow blood and the shattered stone to drain out. It will also drain urine since the kidneys produce urine.

Any person with a family history of stones may be at higher risk. Stone disease in a first degree relative, such as a parent or sibling, can dramatically increase the probability for you. In addition, more than 70 percent of people with certain rare hereditary disorders are prone to the problem. Those conditions include cystinuria, an excess of the amino acid, cystine, that does not dissolve in urine and instead forms stones of cystine; and primary hyperoxaluria, an excess production of the compound oxalate, which also does not dissolve in urine, forming stones of oxalate and calcium.

Uro-laparoscopic surgery

Laparoscopic surgery is what is commonly known as key hole surgery. This is done by special instruments and a video - camera system, where the operation is done by seeing it on a TV screen.

This gives an enlarged view of structures and the operation can be done more cleanly. The surgeon's hands remain outside, a long cut it not required for accommodating the surgeon's hands.

Since the cut is small, the pain is minimized to a great extent. The cut sometimes is enlarged only for removal of organ or the part of it, which can be done by few centimeter incision. The cut for any open or conventional operation for kidney is about 15 to 25 centimeters. When repair of some defects is done, i.e. organ is not removed; the largest cut is not more than 1.5 cm.

All the advantages are related to much smaller cut on the body and clear and enlarged vision under which the surgery is performed.

This means :-

• Less amount of pain killers.
• Early start of activity.
• Early discharge.
• Early recovery and early return to the work.
• Much less chances of wound infection and hernia.
• Better body image
• Less blood loss, since the vision of operative area is better.

The increased cost of equipments is compensated by

• saving on duration of hospital stay
• need for less medicines

For most kidney operations, laparoscopy has already become the operation of choice. These are -

• Removal of damaged kidney due to any cause, (Nephrectomy)
• Removal of kidney due to cancer
• Removal of part of kidney due to small cancer
• Correction of obstruction leading to swelling of kidney - Pyeloplasty for UPJ obstruction.
• Large Cysts
• Special situations for stone like large ureteric stone.

• Operation on adrenal gland
• Operation for Cancer Bladder and Cancer Prostate.
• Varicocoele operation in cases of male infertility.
• Reconstructive surgery on ureter or bladder.

It is a myth that disease / organ is left behind if done by laparoscopy.

In fact in most situations, the surgeon can do a better job due to improved and enlarged vision by the help of camera and screen. There is less bleeding so the operative area is cleaner. These factors add together for a more complete job.

Fortunately, today, most of the kidney operations can be done by this method. Laparoscopic surgery has replaced open surgery in many situations due to less morbidity i.e. the patients feel less sick for lesser duration.

This makes the experience of undergoing an operation less painful and more convenient. One can easily understand this by seeing the pictures of real patients who underwent laparoscopic operations.