Grade 4 BPH Treatment

What happens in a Grade 4 BPH surgery?

Diagnosis

Before a surgery, it is likely that your urologist may perform a series of tests and diagnostics to assess your overall health and if you require any additional care and precautions either during surgery or during recovery. If you suffer from any pre-existing conditions such as diabetes or hypertension, they could pose significant risk of complications during surgery. Some of the commonly performed diagnostic tests before a grade 4 BPH surgery include: 

• IPSS test: An IPSS test is a simple and commonly performed questionnaire that your urologist will likely perform to understand the severity of your condition. Your urologist will simply ask you some questions regarding the symptoms you may be facing and depending on the result on the questionnaire, your urologist will be able to determine the grade and severity of your prostate enlargement. 
• Digital rectal examination: In this test, your urologist will insert a gloved, lubricated finger inside your rectum to physically feel the shape and size of your prostate gland. The urologist may also look for any bumps or other abnormalities to rule out the possibility of prostate cancer.
• Cystoscopy: A cystoscopy test is usually performed to inspect the inner lining on your prostate gland, urethra and urinary bladder by using a thin, tube-like instrument called a cystoscope. 
• PSA test: A PSA test is a simple blood test that your urologist may perform to analyse and evaluate the PSA levels in your blood. If the PSA levels in your blood are more than normal, it is an indicator that you may have some level of prostate enlargement.
• Transrectal ultrasound: A transrectal ultrasound is a test that your urologist may perform to accurately determine the size of your prostate. Your urologist may also perform this test to rule out any possibilities of prostate cancer. 

During diagnosis, it is also important to disclose all information about any medications or supplements you may be taking. You can usually continue taking your prescribed medications but your doctor may instruct you to temporarily stop taking certain medications that could pose risk of complications during surgery. 

Treatment

A surgery is almost always important in case of a grade 4 BPH. The following treatments are the most commonly performed surgical procedures to treat BPH. 

• TURP: A TURP surgery or Transurethral Resection of the Prostate is a commonly performed surgery to treat any grade of BPH. In a TURP surgery, the urologist uses a thin, tube-like instrument called a resectoscope that will be inserted into the urethra through the small opening at the tip of your penis. This resectoscope is also fitted with a small surgical tool and once the resectoscope is in place, the surgeon will use the surgical tool to cut away and remove pieces of enlarged prostate tissue to reduce the pressure that is being affected on the urethra and affecting urine flow. The removed pieces of the prostate accumulate in the bladder which will later be removed through the urethra.
• TUIP: A Transurethral Incision of the Prostate is another surgical procedure that is usually recommended to younger patients. In a TUIP procedure, the surgeon inserts a resectoscope through the opening at the tip of your penis to reach the prostate but instead of removing enlarged pieces of the prostate, the surgeon makes 1-2 incisions at the area connected to the urethra and prostate. These incisions help the urethra widen and allow better flow of urine. Unlike the other procedures, the chances of retrograde ejaculation or erectile dysfunction, a common side-effect of BPH surgery, are very minimal. 
• HoLEP: HoLEP or Holmium Laser Enucleation of the Prostate is a minimally invasive procedure to effectively treat any grade of BPH. HoLEP follows almost the exact same procedure as TURP but instead of using a surgical tool to remove or cut away pieces of enlarged prostate tissue, a HoLEP procedure uses a holmium laser to enucleate the enlarged tissue. The removed pieces of tissue accumulate in the bladder and similar to TURP, will be removed later on. HoLEP is a more advanced procedure as compared to TURP and as a result carries less chance of any major side effects or complications as well.

Benefits of BPH surgery?

Some benefits of undergoing a BPH surgery generally include: 

• Relief from severe urinary symptoms
• Severe urinary symptoms can significantly affect your daily life. However, undergoing a BPH treatment will help you get back to your normal routine. 
• While grade 4 BPH usually accompanies complications such as bladder stones and UTI, delayed treatment can cause these complications to worsen as well.