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Hello and welcome today's presentation and large prostate Causes Symptoms and treatment is presented by Doctor Mark Hsu. He specializes in diagnosing and treating conditions of the urinary tract and the male reproductive system without further ado. Please welcome Doctor Mark Hsu.
Good evening everyone. Thank you for joining me today on this educational talk about the prostate and and how it's can cause urinary issues in a large prostate is one of the most common issues that an older man can deal with in their golden years and very likely if you have a urinary issue at that time, more than likely not, it's the prostate. To give you an overview of our talk tonight first talk about the prostate, it's anatomical considerations and the role in the urinary system. Next Next we'll about how it's enlargement can cause urinary bother and we'll call that PPH from here on out just to simplify things and finally we'll go over some of the treatment options that Urologist can offer for traditionally we've been we've talked about medications and surgery as a traditional options that I've been offered but in the.
Five to 10 years, there have been a prostate size chart of pretty exciting. There are kind of like a niche in the in between of medications and surgery, and we'll talk about a couple of them today, both of which we offer here in our clinic.
So what is the prostate? It's typically a walnut sized gland and it sits Prosztate Működési Vélemények the base of the bladder and there's a channel within the prostate and I'll show you right here.
There's a there's a there's a hole that goes through the prostate and we call that the prosthetic urethra and that's the area that the and the bladder has to exit through this area before is able to come out to the urethra and prostate size chart that's there.
Focus I will will be referring to quite a bit and otherwise a prostate produces about a third of the volume of the ejaculate and there's two main stages of growth one and it it reaches as adult size in the 20s in your 20s and then it will continue to grow from your mid 40s onwards prostate size chart the rest of your life. And so there are several problems that can happen with the prostate that will lead one to seek medical attention and here are three of the most common conditions that the prostate can and one can encounter and the first one is is BPH, which is the one we're going to be talking about today, but there's also other conditions like prostate in the middle there, which is basically an infection or inflammatory condition of the prostate and then there's also prostate size chart cancer.
There can be some. Overlap and and this and this and Symptoms between these three conditions, so it's important for the Urologist to to to be able to evaluate you and through the work of kind of figure out which one it is. I'll get from men will be well if my prostate larger will I have an increased risk of prostate cancer and the answer is no there.
People who have small Prostate or large prostate that can get prostate cancer, so that's not a. So let's focus on what BPH stands for because it's pretty aptly named. So A prosztata gyógyszerek gyulladása we look at the B, it stands for benign so again that's non cancerous. We're not talking about cancer in this situation. P is referring to the prostate and H is hyperplasia. Bigger you know when anatomically it can cause what's a phenomena We call a medicine and bladder outlet obstruction and and that can then lead to to urinary symptoms, which we also call lower urinary tract symptoms or simply Lutz.
So BPH is the most common reason for what we call this bladder. So if we look at the left side here in the normal Prostate anatomy diagram again, we have the bladder here and the tökmagolaj fogyasztása here and that channel that prostate we are going prostate size chart.
Also inwards towards the middle and so you imagine that doughnut hole is getting smaller because that that tube in the process is becoming tighter so over time that bladders gotta work really hard to squeeze that urine through this tight little channel and you can imagine now the bladder is actually a muscle so if the muscle's going to squeeze really hard work overtime for many years, you can imagine what's going to happen.
It's starting to become very thick. It's what we call a tribe.
Bladder it'll it will look. So what are the symptoms of BP? You may not feel completely empty. I got to go all the time you feel like you, you can't hold you can't hold it for very long. And these are all. I prostatitis M16- tól we can hear any any combination of these symptoms when we talk to patients.
So this slide just goes over some statistics of service a quality of life service, a man A fej körkörös lesz ha prostatitis BPH that have had the you know that talk about how their their their urinary symptoms affect their quality of life.
So you know patients come to see me. I've heard a lot of different stories. I mean most common ones. I'll mention here will be like golfers who will tell me they have to find a restroom every few holes and you know that's array of just you know.
Self-conscious guys at the urinal who are hearing all these young whipper snappers next to them with like laying loose with their good streams and then there's other people who like know exactly where the every single bathroom is on their their routes, you know to and from work or to their to their errands.
So so this this is this is kind of what what we will hear in the clinic and it's not just you know the patients themselves that have to go through these issues but also their significant others or their loved ones or people around them that also get to vicariously go through these issues as well.
Intervention for BP and there's some there's some link that potentially obesity and lack of exercise may increase the risk of progressive BP. So you know just like what all prostate size chart doctors will say that the importance of a good diet and exercise and stress management all these things you know play to many parts of one's health and and that, and that definitely includes the prostate.
So if you were to come to the the Urologist clinic, this a typically the arsenal of prostate size chart work that we have first, we will take a detailed history, kind of understand what kind of symptoms that are going on and we have some surveys that we can do to kind of quantify to get some objective numbers about how bothered one is we'll do a prostate exam where we'll we'll take a feel of the size of the prostate and the texture of how it feels and then and then we also will typically also conduct some urine studies to make sure there's no obvious infection and there's no blood in the urine that requires for work.
One of. Test that we also offer. How how how tightly the screen for it and this could be really it's own lecture and you know it's right. There's so much to talk about with that. It's a good screening tool. I would say and definitely Urologist needs to be available to interpret that. Over time, you know the PSA can have some false positives and false negatives that can go up with things like prostate cancer, which we definitely will have to evaluate for if that was a high prostate size chart of suspicion, but prostate size chart PSA can also go up with enlarging Prostate because actually at the end of the day, the prostate is what makes the Psa.
UFO is basically a simple thing where I have a man urinate to. Funnel that has a speedometer on it and then we can basically chart the time and the velocity so that way we can kind of get a nice curve and see the efficiency of how well when urinate and then there are some procedural things that we can also do one being being a cspan. You know it's like so so seeing what extent that has been working for. Try to get that urine through the through the prostate and also we have what's called a trans rectal ultrasound of the prostate where we can do that get a little bit more anatomic detail and also to measure the prostate size.
So most of the time when patients come see me, it's it's mainly quality of life issues that we address and then and you know again. That doesn't drive me to do something sooner. There are prostate size chart few situations that are listed here that if the the Enlarged Prostate untreated can really lead to significant medical problems that can affect one's health. I think the worst case would be if you know you weren't able to empty at all that the buyer is so weak that it can't squeeze any urine pass the prostate.
So it's just you have a distended bladder. That is what we call urinary retention, so you're not able to pee you need to have something like a catheter, for example, which is the most common way to be able to sufficiently empty the bladder. Now this is this.
Undetected this this can lead to what's called real failure, so basically that urine has nowhere else to go because you can't make it through the process so it basically goes backward backwards up into the kidney and basically the the kidneys drown in their own urine and that can cause what's called renal failure and that's definitely very bad. That's a nice medium for bacteria to grow in and. Problems that way and there's also a lot of calcium salts in urine that if it's just stays there for a long time, not not able to empty well that can come together over time and form bladder stones and that doesn't prostate size chart like fun either right so.
And finally the the bottom thing is called bladder dysfunction.
I wanted to show you guys in this diagram here so when I talk about the tred bladder, there's a schematic here about how that can progress over time. So here is is what we call a healthy bladder where the the bladder wall looks very smooth. I would say smooth like a baby's bottom, but as you Változások a prosztatitisben of get to like a medium kind of sized.
Is to get this basically this big thick cobweb of bladder muscle fibers, and this can really show the bladder.
That's just going to be squeezing so very often, and this can sometimes be a permanent situation despite what you do to the process at that point. We want to consider early intervention much more aggressively earlier on. So now, we'll go over the last part of the last section of the top. We're talking about BPH treatment options and there's a huge spectrum here so we can go from what's called wash for waiting or you know, making sure that everything in the lifestyle is as optimized as possible.
And then there's like first line therapies. The boss and you, you know you, you dictate what what we want to do and I'm your counselor in a way and basically telling you all the pros and cons of the options and making sure that there's nothing medically you know, dangerous or threatening that's going on with me to make a stronger recommendation towards a more aggressive therapy. So the first treatment option is watchful waiting so this is basically where we're prostate size chart at your lifestyle and making sure that everything prostate size chart optimized as possible in in one's daily habits and one of the most common things I like to do in my patients is get what's called a void diary and so this basically is very simple.
I just have somebody treat chart what they drink, you know, basically the amounts and what they're drinking and what time and then when they pee. I have them into a container and measure how much comes out and then they write down you know and that's coming out what is coming out so that way I can see you know there's something adjustments to be made in terms of how much like, for example, caffeine or alcohol, they're drinking.
Sometimes people are drinking lots of caffeine tea, you say, and you see a cluster of frequency go along with that. On the other side, you're like okay, well, maybe try to cut down on the coffee and tea in this part of the day and see if that might help you with your symptoms. Other things we can do, for example, like like watching how prostate size chart you you know, making sure that you don't drink that much before you go to bed that can also potentially reduce how much how many episodes you wake up at night.
There are other things We can also check to like you know medication review. So we don't want we can try to avoid that and we want to be able to catch that. That we can offer to patients like kegel exercises or we call purposeful double voiding for select patients where you can, you know in some situations if someone's really bothered by frequency and urgency that they can try to strengthen their pelvic muscles so they can resist that initial urgency to A prosztatitist a hazugság gyógyítja or for someone who's not emptying very well, you tell him to pee and then wait about fifteen to 20 seconds and then try to pee again.
So if patients are bothered despite you know trying to optimize their lifestyle, then we can offer a medical therapy and the most common medication that we'll start with is what's called an Alpha blocker and what this does is that it tries to relax that that area in the process that prostate we talk about that donut hole there's receptors in in the in the prosthetic urethra that can respond to this medication and cause that muscle to relax and open out to the side so that don't know relaxes.
A little bigger it makes it easier for that urine to come prostate size chart the bladder to the prostate. He knows okay, so and then one of the considerations with an Alpha blocker is prostate size chart it can be associated with a phenomenon called retrograde ejaculation and this is a kind of a sexual side effects so usually when you have an orgasm when a man has an orgasm, there's there's fluid that comes out in the semen right so but if it's if this Prostatitis és só kötszerek is really relaxed, then that that semen can actually go backwards through that that prostate into the bladder.
It's nothing dangerous. That urine and semen mix and then later on you pee it, It's basically a mix of urine and sperm and semen.
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There are some there are some drawbacks though, and and and the side effect profiles typically in the the sexual arena where there there can be a phenomenon called Post Finesse syndrome that some people can get from taking this medication and that can manifest with like you know.
It's just that we have to take that into account when we're following your PSA on that medication.
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So now, we'll talk about some of the minimally invasive therapies that we offer here and and and also it has been become more popular in the last several years, The first one is called zoom zoom is an outpatient clinic based therapy where we basically inject water prostate size chart into those obstructive parts of the prosthetic urethra and to the prostate tissue and that heat energy is absorbed by the prostate and after several weeks, you'll get a regression effect where the prostate tissue on the inside recedes out to the sides so again making that.
A whole bigger that's all that's the whole goal of all these therapies. It's a it's a quick procedure I usually takes several minutes Honestly, once we get started a lot of the work actually comes in the prostate size chart and then cleaning up but the procedure time is actually relatively short on the span of several minutes and we'll leave a catheter for a few days and then we'll tell people to wait, usually about two to 4 weeks for the effects to take place as that again that that prostate tissue recovers from the heat, so there can be some side effects like some blood in the urine, some frequency some urgency, some burning in with urination.
Are common as as the process recovers from that it's been it has been a prostate cancer acinar type well validated procedure and you know they've come out the the company that sponsors resumed to show five-year data so the vast majority of people are still satisfied with symptoms that you know 4.
So this is one of the promising therapies that are available today. And here's just to show you how the resume works so basically on this left side of the diagram here, you have the water that's in the bag here it then goes through a tube through here the generator and then here's actually our delivery instrument with here with the lens that you can see so the lens here in the middle part here goes through the prostate and we identify those parts of the prostate that are obstructive and then we do this nine second treatments.
It's basically works through convection heat and it's the energy is distributed evenly throughout the prostate tissue and so here in the last part of the on the right side of the diagram you have the before and prostate size chart where you're going to have this obstructed Prostate with the tight prosthetic urethra here and after the treatments usually about four to 6 weeks, you see that you know that that the fact that Treatment effect where the breast a urethra opens up to the side.
I tell people usually to restrict activities for about A Cannefron segít ha a prostatitis week. I have I have used this off label on some patients who are not able to urinate because of prostate size chart BPH and they were able to urinate afterwards.
And my goal prostate size chart is to be able to stop the medication so if someone's taking medications to respond to it and after treatment and they say they feel better my goal is to stop their medications at about a month afterwards another final good point about resume is that it does leave options on the table. So let's say we do this treatment and then potentially in several years if if the tissue were to regrow, I mean, at least you can still go back to medications.
So it really doesn't really burn any bridges. Another minimally invasive option that we also offer is what's called a prosthetic urethra lift, and this is a mechanical strategy to trying to open to try try to open up prostate urethra.
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So it's again a clinic based outpatient procedure that we're basically using these metal clips to open up that prosthetic tissue. That's that's obstructive. So it's not blocking the the the bladder anymore.
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So this can be you know with with the implants of this can cause you know, frequency and urgency and burning with urination. It's similar to that first procedure. And so look at this diagram here.
Basically, this is the delivery by the device here where we use to deliver these metal clips and these clips are actually made of Nikol.
So this is works in a similar fashion with trying to.
Metal clips out to the side to bilaterally and and so and so once these are deployed and Cinched II call this analogy kind of like opening the the the the window curtains and prostate size chart basically get this open effect in the in the prosthetic urethra.
So some considerations for for the prostate size chart urethra lift is that I typically will try not to leave a catheter after this because we're not using heat or and and the manipulation is one of the smaller side. The nice thing about this procedure is there's near zero risk for sexual dysfunction because again, we're not using heat so not affecting erections and really AAA very low near zero risk of retrograde ejaculation again.
Relatively quicker recovery about a week of taking it easy and then being able to get back to a normal life relatively quickly and again leaves options on the table.