Transurethral resection of the prostate Health Dictionary

The surgical removal of tissue.... resection

This is an accessory sex gland in males which is wrapped round the URETHRA as this tube leaves the URINARY BLADDER. Opening into the urethra, the gland secretes an alkaline ?uid during ejaculation and is a constituent of SEMEN. The gland grows during adolescence and is sensitive to the concentrations of sex hormones.... prostate gland

An operation to remove part or all of the PROSTATE GLAND. The most common method is transurethral prostatectomy (TURP) carried out during cytoscopy. A very enlarged prostate may need to be removed by a retropubic prostatectomy. After several weeks, most patients are able to resume normal activity including sexual intercourse.... prostatectomy

This is a walnut-sized gland that surrounds the beginning of the urethra in men. It secretes the alkaline transport fluid that mixes with sperm from the testes to form semen. The prostate needs adequate anabolic steroid stimulation for its health and growth, especially testosterone. Because of diminished healthy hormone levels, pelvic congestion, and decreased blood (and hormone) circulation, or because of sexually transmitted or urinary tract infections, a male may get prostatitis. (See BPH.)... prostate

Disease of the PROSTATE GLAND can affect the ?ow of URINE so that patients present with urological symptoms.

Prostatitis This can be either acute or chronic. Acute prostatitis is caused by a bacterial infection, while chronic prostatitis may follow on from an acute attack, arise insidiously, or be non-bacterial in origin.

Symptoms Typically the patient has pain in the PERINEUM, groins, or supra pubic region, and pain on EJACULATION. He may also have urinary frequency, and urgency.

Treatment Acute and chronic prostatitis are treated with a prolonged course of antibiotics. Patients with chronic prostatitis may also require anti-in?ammatory drugs, and antidepressants.

Prostatic enlargement This is the result of benign prostatic hyperplasia (BPH), causing enlargement of the prostate. The exact cause of this enlargement is unknown, but it affects 50 per cent of men between 40 and 59 years and 95 per cent of men over 70 years.

Symptoms These are urinary hesitancy, poor urinary stream, terminal dribbling, frequency and urgency of urination and the need to pass urine at night (nocturia). The diagnosis is made from the patient’s history; a digital examination of the prostate gland via the rectum to assess enlargement; and analysis of the urinary ?ow rate.

Treatment This can be with tablets, which either shrink the prostate – an anti-androgen drug such as ?nasteride – or relax the urinary sphincter muscle during urination. For more severe symptoms the prostate can be removed surgically, by transurethral resection of prostate (TURP), using either electrocautery or laser energy. A new treatment is the use of microwaves to heat up and shrink the enlarged gland.

Cancer Cancer of the prostate is the fourth most common cause of death from cancer in northern European males: more than 10,000 cases are diagnosed every year in the UK and the incidence is rising by 3 per cent annually.

Little is known about the cause, but the majority of prostate cancers require the male hormones, androgens, to grow.

Symptoms These are similar to those resulting from benign prostatic hypertrophy (see above). Spread of the cancer to bones can cause pain. The use of a blood test measuring the amount of an ANTIGEN, PROSTATE SPECIFIC ANTIGEN (PSA), can be helpful in making the diagnosis – as can an ULTRASOUND scan of the prostate.

Treatment This could be surgical, with removal of the prostate (either via an abdominal incision, total prostatectomy, or transurethrally), or could be by radiotherapy. In more advanced cancers, treatment with anti-androgen drugs, such as cyprotexone acetate or certain oestrogens, is used to inhibit the growth of the cancer.... prostate gland, diseases of

An ENZYME produced by glandular tissue in the PROSTATE GLAND. When the gland enlarges (see PROSTATE, DISEASES OF), greater amounts of PSA are secreted, raising the concentration of the enzyme in the blood. This is especially so in cancer of the prostate, and testing the level of PSA is an indicator that the disease may be present. There is much controversy about the use of PSA as a screening test. Its proponents claim that its use reduces deaths from prostate cancer; its opponents suggest that it does this only by bringing to light many cases that needed no treatment and would not have caused death in any case. Further, if the level of PSA is very high, the disease is already advanced; where the result is equivocal it is uncertain whether the bene?ts of treatment outweigh the risks.... prostate specific antigen (psa)

An operation, usually done under local anaesthetic, in which the lining membrane of the UTERUS (womb) is excised using a type of LASER or DIATHERMY surgery that utilises a hysterescope (a variety of ENDOSCOPE) through which the operator can visualise the inside of the uterus. The operation is done to treat MENORRHAGIA (heavy blood loss during MENSTRUATION) and its introduction has reduced the need to perform HYSTERECTOMY for the condition.... transcervical resection of endometrium (tcre)

The use of a special CYSTOSCOPE (a resectoscope) inserted through the URETHRA to resect the PROSTATE GLAND or bladder tumours. (See also RESECTION.)... transurethral resection

An operation to correct a deviated nasal septum.... submucous resection

surgical excision of the anal sphincter, rectum, and part of the sigmoid colon because of cancer involving the anal canal or the lower third of the rectum. The remaining length of sigmoid colon is brought through the abdominal wall (see colostomy; stoma). This procedure may be performed using abdominal and perineal incisions or laparoscopically; it is indicated for tumours close to the anal canal and in patients with poor sphincter function.... abdominoperineal resection

(IPSS) a self-administered questionnaire, completed by men with *lower urinary tract symptoms, which consists of seven questions based on the extent of symptoms and a single quality-of-life question. It gives a numerical score, on a scale of 0 to 35, to indicate the severity of the patient’s symptoms. A score of 0–7 indicates mild symptoms, 8–19 moderate symptoms, and 20–35 severe symptoms. The quality-of-life question is scored from 0–6.... international prostate symptom score

Adeno-carcinoma. A hormone-related tumour in elderly men. Enlargement of the gland may be benign or carcinomatous. Fibrosis (hardening) may arise from inflammation. Obstruction of the outlet of the bladder through swelling of the gland (prostatism) may cause uraemia.

Symptoms. Bladder irritability; increased frequency during the night. Feeble forked stream of urine. Sometimes blood. Three quarters of such tumours are located in the posterior lobe of the prostate gland – readily accessible to the examining finger through the front wall of the rectum. Rectal examination reveals a hard rugged prostate. Cystoscopy confirms. Bone pains in the low back or pelvis reflect a stage where the tumour has already spread. Anaemia, weight loss, urgency.

All symptoms are worse by alcohol and spicy foods.

Harvard University scientists report: heavy consumption of animal fat, especially the fat in red meat appears to increase the chance that a man will develop advanced prostate cancer.

Of therapeutic value. Comfrey, Echinacea, Horsetail, Poke root, Thuja, Cornsilk, Goldenseal.

Tea. Combination. Comfrey leaves, Horsetail, Cornsilk. Equal parts. 2-3 teaspoons to each cup boiling water. Drink freely.

Formula No. 1. Echinacea 2; Comfrey 1; Poke root half; Thuja half. Mix. Dose: Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. Thrice daily in water or cup of Cornsilk tea.

Formula No. 2. (Alternative) Echinacea 2; Goldenseal 1; Gotu Kola 1; Poke root half. Mix. Dose: Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons in water or cup of Cornsilk tea.

Bee pollen. Of value.

Garlic. Of value.

Diet. See: DIET – CANCER.

There is a very low incidence of prostate cancer in countries where Soya products are widely consumed – Soya contains a female hormone which is a protector factor.

Supplements. Morning and evening.

Vitamin A 7500iu or more. Large doses may be required. Vitamin C 1-2g. Vitamin E 200iu. Calcium 500mg. Selenium 100mcg. Zinc.

Study. Men with prostate cancer may not need to undergo radical prostatectomy (removal of the prostate gland). A 10-year follow-up study of men with early prostate cancer left untreated showed that 10 years later only 8.5 per cent of the 223 patients had died from prostate cancer. The survival rate of 86.8 per cent in the untreated group was nearly identical to a subgroup who met all the conditions for radical prostatectomy. (Journal of American Medical Association, 22/29 April 1992)

Commonly treated with female sex hormone or by orchidectomy.

It would appear that surgical removal of the gland offers little benefit, and possibly a disadvantage to patients wishing to leave well alone, particularly the elderly. Treatment by a general medical practitioner or oncologist. ... cancer – prostate gland

A cancerous growth in the prostate gland, of unknown cause. One of the most common cancers in men, it mainly occurs in elderly men.

An enlarged prostate (see prostate, enlarged) may cause symptoms including difficulty in starting to pass urine, poor urine flow, and increased frequency of urination. Urine flow may eventually cease altogether. When there are no urinary symptoms, the first sign may be pain in the bones from secondary cancers. Screening tests detect blood levels of a protein called prostate specific antigen;

if above a certain level, it may indicate prostate cancer.

Rectal examination allows a doctor to assess the size and hardness of the gland.

Ultrasound scanning and a biopsy confirm the diagnosis.

Blood tests and a bone scan (see radionuclide scanning) may also be done.

In an elderly man with a small prostate cancer that has not spread, no treatment may be recommended.

For younger men, prostatectomy or radiotherapy may be performed.

Widespread disease is usually controllable for some years with orchidectomy or drugs.... prostate, cancer of

An increase in the size of the inner zone of the prostate gland, also known as benign prostatic hypertrophy. It is most common in men over 50. The cause is unknown. The enlarging prostate compresses and distorts the urethra, impeding the flow of urine. Eventually the bladder is unable to expel all the urine (see urine retention) and becomes distended, causing abdominal swelling. There may also be incontinence and frequency of urination (see urination, frequent).

Prostate enlargement is detected by a rectal examination.

Tests may include a blood test, ultrasound scanning, urography, and a recording of the strength of urine flow.

Mild cases do not require treatment, but more severe ones usually require prostatectomy.

Alternatively, drug treatment with alpha-blocker drugs or androgen drugs may be given.... prostate, enlarged

(PVP) a technique to vaporize the prostate by means of a high-energy laser, used to relieve *lower urinary tract symptoms due to benign prostatic hyperplasia (see prostate gland). It is associated with less blood loss and a shorter hospital stay than a traditional TURP (see resection), but can only be used on smaller prostates.... photoselective vaporization of the prostate

see prostatectomy.... robotic prostatectomy

see apicectomy.... root end resection

(TCRE) an operation, which is performed under local anaesthetic, in which the membrane lining the uterus (see endometrium) is cut away by a form of *electrosurgery using a *resectoscope, which is introduced through the cervix. Like *endometrial ablation, TCRE is used as an alternative to hysterectomy to treat abnormally heavy menstrual bleeding as it results in fewer complications and shorter stays in hospital.... transcervical resection of the endometrium

(TUVP) a technique that vaporizes (rather than resects) prostate tissue; it is associated with less bleeding during the procedure. TUVP is used to treat *lower urinary tract symptoms thought to be due to benign prostatic hyperplasia (see prostate gland) or urinary retention.... transurethral vaporization of the prostate

a malignant tumour (*carcinoma) of the prostate gland, a common form of cancer in elderly men. In most men it progresses slowly over many years and gives symptoms similar to those of benign enlargement of the prostate (see prostate gland). Before it was possible to test for *prostate specific antigen (PSA), the tumour had often invaded locally, spread to regional lymph nodes, and metastasized to bone before clinical presentation. By checking elevated levels of PSA or *PCA3, prostate cancer can be detected 5–10 years before the tumour would present symptomatically. If the disease is confined to the prostate, the patient may be offered active surveillance or radical *prostatectomy, radical radiotherapy, or *brachytherapy; *cryotherapy or *HIFU are available in specialized centres. In elderly patients, it may be enough to monitor the tumour growth. If the disease is outside the prostate, androgen deprivation therapy may be used; this may be achieved by *gonadorelin analogues, *anti-androgens, surgical castration, or oestrogen therapy.... prostate cancer

(PSA) a protease enzyme produced by the glandular epithelium of the prostate. Its effect is to liquefy the semen within the ejaculate. Overall PSA has a half-life of 2–3 days. Increased quantities are secreted when the gland becomes enlarged or inflamed, and levels of PSA in the blood are significantly elevated in cancer of the prostate. Although there is no clear ‘cut-off’ level for normality, over 4 ng/ml in the blood is associated with a 20% risk of prostate cancer, even in patients with normal-feeling prostates on rectal examination. Age-specific PSA reference ranges are often used. Newer PSA assays can measure free PSA and compare it to the total PSA in the blood. Low free:total PSA ratios indicate a greater risk of prostate cancer and improve the discrimination between cancer and benign disease in men with a PSA in the range 4–10 ng/ml. PSA levels tend to be much higher in advanced prostate cancer and the rate of fall on treatment (e.g. after radical prostatectomy or radiotherapy) is a good prognostic indicator of response.... prostate specific antigen