Prostate Surgeries in Rural Areas

Background

Prostate Gray1152The prostate gland is a male sexual organ that contributes the bulk of secretions during sexual intercourse. It is situated near the junction of the urinary bladder with the urinary passage called the urethra. Near the gland is the sphincter (or valve) that prevents leakage of urine under normal circumstances. The gland starts growing around the age of forty and can cause obstruction to the urinary passage as men grow older.

Analysis of patients undergoing surgical treatment for the prostate shows that about one third of them present with acute painful retention or a sudden inability to pass urine (1). It is estimated that ten percent of men in their seventies and thirty percent of men in their eighties will have acute retention of urine in the next 5 years (2). Patients in rural areas are not usually worried about their symptoms but present only when they have severe difficulty in passing urine.

Symptoms of Prostate Gland Enlargement

As the prostate grows in size, which starts around the age of 40, there is increasing block to the passage of urine. Normally, the bladder has to generate a pressure of about 60 cm of water to initiate opening of the valve effect of the prostate, and the time to do this increases as the pressures needed increase. With further increase in pressure, the urinary stream becomes weak. Increasing pressure then causes what is called intermittency, or the stream alternatively becoming weak and strong as the bladder muscles try to cope with the obstruction. Ultimately, the bladder muscles cannot take it anymore, and there is incomplete voiding. This residual urine in the bladder increases the frequency of voiding, both at night and during the day, which leads to frequent urinary tract infections. At later stages, there would be urgency too. We have devised a low-cost method of testing the bladder pressures (3).

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