Prostate enlargement. Bladder cancer. OAB. Treated precisely.

Benign Prostatic Hyperplasia (BPH) is a non-cancerous enlargement of the prostate that is extremely common in men over 50. It causes the classic LUTS (lower urinary tract symptoms): a weak urinary stream, difficulty starting to urinate, a need to strain, incomplete bladder emptying, frequent trips to the bathroom at night (nocturia), and urgency. BPH does not become prostate cancer - they are separate conditions - but both can coexist. Treatment is considered when symptoms significantly affect quality of life, when urine flow studies show severe obstruction, when the bladder is not emptying properly (raised post-void residual), or when complications arise (recurrent UTI, bladder stones, urinary retention). Many mild cases are managed with lifestyle measures and medication (alpha-blockers, 5-alpha reductase inhibitors). Surgery is recommended when medication fails or complications develop.

TURP (Transurethral Resection of the Prostate) has been the gold standard for BPH surgery for decades. A resectoscope passes through the urethra and chips away prostate tissue with electrical current. It is highly effective for moderate-sized prostates. HoLEP (Holmium Laser Enucleation of the Prostate) is a newer laser technique that can treat prostates of any size - including very large glands where TURP is less suitable. HoLEP involves removing the entire inner portion of the prostate (enucleation), which means lower recurrence rates. Both are performed without any external cuts. Dr. Nitin will recommend the appropriate procedure based on your prostate size, flow studies, and overall health.

Not necessarily. PSA (Prostate-Specific Antigen) is produced by the prostate gland itself, not by cancer alone. BPH, prostatitis (prostate infection or inflammation), and recent sexual activity, vigorous cycling or a urinary catheter can all elevate PSA. However, a consistently elevated PSA, or one that is rising rapidly over serial tests, warrants investigation. The PSA level, its rate of change (PSA velocity), the PSA density (PSA relative to prostate volume), and the free-to-total PSA ratio together give a much clearer risk picture than a single number. If the assessment suggests significant risk, a prostate MRI (mpMRI) and then a targeted biopsy - rather than a blind systematic biopsy - is the modern approach Dr. Nitin follows.

A prostate biopsy involves taking small tissue samples from different parts of the prostate through a thin needle, which is guided by ultrasound and increasingly by MRI targeting. The procedure is typically performed under local anaesthetic as a day procedure. Modern mpMRI-guided (fusion) biopsy focuses sampling on the suspicious area identified on MRI, which improves cancer detection while reducing the number of unnecessary cores. After the biopsy, the tissue goes to pathology and results are usually available within 7–10 days. Temporary blood in the urine, stool and semen is normal for a few days to weeks. Serious complications are uncommon but include infection - always disclosed and managed with prophylactic antibiotics.

Bladder-preserving treatment is possible for some patients. Superficial (non-muscle-invasive) bladder cancer - which makes up approximately 75% of new diagnoses - is managed with TURBT (a camera procedure that removes visible tumour through the urethra) followed by intravesical BCG or chemotherapy instilled directly into the bladder. These patients keep their bladder and are followed with regular cystoscopy. However, once cancer invades the bladder muscle (muscle-invasive bladder cancer), the standard treatment is radical cystectomy - removal of the bladder - with urinary diversion. Bladder-sparing chemoradiotherapy is an alternative in specific patients who are not suitable for surgery. Dr. Nitin will discuss all options with a multidisciplinary team.

The following symptoms need a urology assessment - not just a course of antibiotics: blood in the urine (haematuria) - even once, even painless; inability to pass urine at all (acute urinary retention) - emergency; a markedly weak urinary stream with straining; recurrent urinary tract infections (more than two per year); pain in the lower abdomen or pelvis combined with urinary symptoms; nighttime urination that has recently worsened dramatically; and any urinary change that has developed in a man over 50. These symptoms could represent BPH, bladder cancer, prostate cancer, or other treatable conditions - all of which benefit from early assessment.

Overactive bladder is a syndrome characterised by a sudden, compelling urge to urinate that is difficult to suppress (urgency), often with frequency (urinating more than 8 times per day) and nocturia. It may or may not be accompanied by urgency incontinence (leaking on the way to the toilet). OAB is common in both men and women and is typically caused by involuntary contractions of the bladder muscle (detrusor overactivity). First-line treatment is bladder retraining, fluid management, and pelvic floor exercises. Second-line treatment includes anticholinergic or beta-3 agonist medications. For refractory cases, Botox injection into the bladder or sacral neuromodulation offers significant relief. Dr. Nitin manages the full OAB pathway.