Enlarged Prostate

Prostate gland enlargement is common in men as they grow older. For men above 50, the most common prostate problem is prostate enlargement. 50% of men by age 60 suffer from this problem and over 90% of men suffer from this problem when they are 80 plus. Enlarged prostate is also known as prostatic hypertrophy, benign prostatic Hyperplasia or prostate gland enlargement.

Enlarged prostate is a benign enlargement and is non- cancerous. This condition often induces urinary problems. If left untreated, the problem can block the flow of urine out of the bladder and cause urinary infection, kidney and bladder problems. The prostate gland is located beneath the bladder; this tube passes through the center of the prostate and transports urine from and out of the penis. Therefore when the prostate is enlarged, it obstructs the flow of urine. With time, the bladder muscles thicken severely and become over sensitive thus forcing the person to urinate frequently as the bladder can't hold even small amount of urine.

Symptoms of prostate gland enlargement

• Increased frequency of urination at night.
  
• Unable to empty the bladder completely
  
• Urinary tract infection
  
• Reduced kidney function
  
• Frequent or urgent need to urinate
  
• Weak urine stream
  
• Strain to urinate
  
• Bladder stone
  
• Difficult to start, stop and restart urination.

Diagnosis includes:

Physical examination and understanding the patient's medical history.
Rectal examination to identify if the prostate is enlarged.
Urine tests.
Urine flow test.
PSA (Prostate Specific Antigen) test in blood.
Trans rectal ultrasound to measure prostate.
Neurological examination to identify reasons other than prostate enlargement for urinary incontinence etc.
Post void residual volume test, to identify if the patient can empty the bladder completely.
Prostate biopsy.
CT urogram to identify blocks in urinary bladder.
Cystoscopy to check bladder and urethra.

Intravenous pyelogram

Intravenous pyelogram or IVP is a diagnostic test that refers to an X ray exam of kidneys, bladder and ureters. This test is also known as excretory urogram and is essentially performed to assess disorders related to the urinary tract.

IVP test is performed by injecting iodinated contrast dye into the patient's veins. It enters the blood stream and pools in the kidneys and the urinary tract thus producing brighter images of the organs. As the dye travels through the urinary system, the IVP test provides useful information regarding the functioning of the kidneys, bladder and ureters. Any delay in the fluid flow indicates blockage in the urinary system. Intravenous pyelogram is performed to diagnose the following disorders:

• Blockage or obstruction in the normal flow of urine.
  
• Kidney stone or bladder stone
  
• Enlarged prostate gland
  
• Injuries and congenital disorders of the urinary tract
  
• Kidney tumor
  

As the dye travels through the urinary system, a series of x-ray images are taken at frequent intervals. The visualization of the fluid flow will help understand the efficiency of the kidney functioning and as well as to diagnose the obstruction, if any.

Before the procedure

1.Patient should not consume any food 5 to 6 hours prior to the procedure. The day before the procedure, patient may be given a laxative to clear the bowels.

2. Pregnant women must not take this test.

3. Diabetic patients should inform the doctor about their medical condition and adjust their insulin dosage as per the instructions given by the doctor.

4. If the patient is allergic to coloring agents, the same should be informed to the doctor so that an anti-allergic medication is prescribed to be taken before the procedure.

Risks of Intravenous pyelogram

IVP is a safe procedure and there are rarely any complications associated with the intravenous pyelogram. Yet on few occasions, a patient may experience hot flushes, itching, nausea and vomiting. Very rarely patient develops allergic reaction to the dye and may experience breathing difficulty, choking sensation and swelling of the lips and tongue. Blood pressure may drop to alarming levels and patient may also lose consciousness.