If the disease is neglected, there will be a marked retention of urine, and the back pressure of the urine increases more and more, resulting in dilation of the ureters (called hydroureters), as well as of the kidneys (called hydronephrosis). An enormous growth of bacteria will occur in the entire urinary tract, leading to pus formation, and the kidneys will be grossly infected. This is called pyonephrosis ('pyo' means pus, 'nephros' means kidney). Patients can hardly pass urine, and repeated catheterization may be required. Hence, the value of early diagnosis and treatment may be stressed again.



How to establish the diagnosis of benign enlargement of the prostate?

A simple DRE (digital-rectal examination) carried out by a physician/ surgeon is highly useful. In this procedure, a gloved, lubricated index finger is pushed through the anus, after making the patient assume a knee-elbow position, Prior to this examination, the patient is asked to pass urine as much as possible. The finger in the anal canal then feels the prostate. First of all, it must be checked carefully that there is no nodule, or some other feature suggestive of cancer of the prostate. With this examination, one gets a fairly good idea about the extent of enlargement of the prostate, and it should be carried out in all cases systematically.

The above examination should be followed by an ultrasonographic examination of the prostate. It is a very useful as well as accurate test. It gives all the details of the prostate, like its exact size, weight, any nodule suggestive of cancer, or any stone in the prostate, including the exact amount of the residual urine. If need be, a more specialized ultrasonography (trans-rectal prostate sonography), in which a special probe is used, can be carried out to rule out any doubt regarding cancer of the prostate, in selected cases.

If in a case of enlarged prostate, there is an associated infection of the urinary tract/renal failure / renal insufficiency, more tests will be required.

Treatment of a benign enlargement of the prostate

It should be stressed that an enlarged prostate alone is not sufficient indication for an operation. The patient must have symptoms, and, above all, a significant quantity of 'residual urine', for considering medicinal/operative treatment.

In early cases, some of the drugs available may be tried. However, in cases where symptoms are markedly distressing to. the patient, and the 'residual urine' is highly significant, the operation should not be delayed. Above all, what is needed is the quick removal of any obstruction from the passage of the urinary tract, for the prevention of UTI.

If the patient takes care of his enlarged prostate, he can be easily operated on by a transurethral resection of the prostate (TURP), in which no surgical incision is required. The instrument is simply passed through the penis, of course, under anaesthesia, which cuts the prostate into very small/tiny pieces. These can be easily sucked out, and the obstruction in the urinary tract is removed. The results are highly promising.