Enlarged prostate: Prostate Laser Surgery

The prostate is a small gland present only in men and located just below the bladder. It is usually about the size of a walnut. The gland is made of two lobes or regions, enclosed by an outer layer of tissue. Scientists do not know all the prostate's functions, although it has many functions for sure. Main function is conducting the sperm from the sperm ducts to the urethra, and producing the small amounts of alkaline secret that is being mixed up with sperm to form the ejaculate. It also squeezes fluid into the urethra. The problem with this small gland is that it usually begins to enlarge at mid-life. Because the process doesnt stop spontaneously, as men age, the prostate continues to grow and may push in on the urine passage, which is the most common complication.

Enlargement of the prostate

When a prostate gland is larger than normal, it is usually called hypertrophic prostate gland. Medically, the condition is called benign prostatic hypertrophy or simply BPH. The enlarged prostate doesnt necessarily indicate the presence of prostate cancer. The enlargement caused by aging is inevitable. The right cause of this enlargement is still unknown but it is believed that it has something to do with sexual hormones and their decreasing with age. As men age, the amount of active testosterone in the blood decreases. From birth to young adulthood, the prostate gland grows from the size of a pea to about the size of a walnut. As the prostate enlarges, the layer of tissue surrounding the prostate stops it from expanding which is causing the pressure against the urethra. Bladder starts to contract more strongly and with time, eventually, the bladder weakens and loses the ability to empty itself. Benign prostatic hyperplasia (BPH) is common and causes obstructive symptoms in 40% of men in their 50s and 90% of men in their 80s.

Symptoms of prostate enlargement

There are several symptoms that could be caused by enlarged prostate and every man, especially those older then 50 should think of this condition first. Depending on the size of the prostate, there are several complications that could occur.

* A moderately enlarged gland is about the size of a plum and in most cases it doesnt cause any symptoms; * a very enlarged gland is about the size of an apple or orange; * An extremely enlarged gland can reach the size of a grapefruit. Most common symptoms are: * Weak urine stream. * Hesitancy when starting to urinate. * Stopping and starting of urine stream. * Sensation of incomplete emptying of the bladder. * Frequent daytime urination. * Recurrent urinary tract infections. * Urgency with or without leakage of urine. * Getting up at night to urinate.

Testing for benign prostatic hypertrophy

1. Physical examination - The evaluation of prostate enlargement should always begin with a physical examination, which is done by a rectal exam. Via rectal exam, doctor should estimate the size of the prostate gland. 2. Laboratory tests - Beside physical examination, laboratory tests are also very useful for the proper diagnosing and they include urinalysis and a blood test for PSA. What exactly is PSA? PSA is a substance produced by the prostate, which may be increased in the presence of prostate problems. 3. Uroflowmetry - Uroflowmetry is a diagnostic tool that has also proved to be very effective and useful. This diagnostic tool measures the force of the urine stream and the amount of urine passed. 4. Ultrasound The ultrasound is usually done to detect the presence of urine left in the bladder after urinating. An ultrasound examination of the prostate is useful to determine the exact size of the gland and to check for any areas suspicious for cancer.

5. Cystoscopy Before this procedure, injected solution numbs the inside of the penis so all the sensation is lost. During this exam, the doctor inserts a small tube through the opening of the urethra in the penis. The tube is called a cystoscope and contains a lens which enables the doctor to see the inside of the urethra and the bladder.

The presence of residual urine in the bladder may lead to urinary tract infections, which may travel up the urinary tract to the kidneys.

Treatment of the prostate enlargement

The prostate enlargement can be treated in many ways, but it could be hard to decide what to do. The key is to know the pros and cons of each treatment option. Different treatments provide different degrees of relief. Medication treatment Many researches have been done in order to find a way to shrink or stop the growth of the prostate without using surgery. Therefore, there are several drugs, which are proven to have these effects. * Finasteride * Dutasteride Both of these drugs inhibit production of the hormone DHT, which is involved with prostate enlargement. * Terazosin * Doxazosin * Tamsulosin * Alfuzosin

All four drugs act by relaxing the smooth muscle of the prostate and bladder neck to improve urine flow and reduce bladder outlet obstruction. Minimally invasive therapy 1. Transurethral microwave procedure - This method is done by a device that uses microwaves to heat and destroy excess prostate tissue. The device sends microwaves through a catheter to heat selected portions of the prostate to at least 111 degrees Fahrenheit. 2. Transurethral needle ablation - The Special system delivers low-level radiofrequency energy through twin needles to burn away target regions of the enlarged prostate.

Surgical treatment The fact is that most doctors recommend removal of the enlarged part of the prostate as the best long-term solution for patients with prostate enlargement. There are several types of surgical treatments and approaches! Laser surgery is the newest and the most effective method! Pros Cons Surgery is still the most effective and longRecovery takes longer. lasting treatment for BPH. Symptom relief is often quicker and lasts longer Stay in the hospital for a couple of days. than with non-surgical treatments. Serious side effects, including erection After surgery, you're less likely to need a reproblems, incontinence and permanent treatment for your symptoms. narrowing of your urethra Some surgical techniques allow prostate tissue to Surgery isn't perfect. You may still have be checked for signs of prostate cancer. symptoms afterward.

Prostate laser surgery

The bottom line is that the laser surgery uses a high-energy laser to destroy enlarged prostate tissue. The good thing about this method is that the laser doesn't penetrate tissue deeply, so surrounding tissue isn't harmed. All laser operations are done under general or spinal anesthesia. There were many problems with the lasers before, because they were high penetrating and thus causing many side effects. The modern laser therapies use a high-energy and low-penetration laser that destroys prostate tissue on contact. The laser also seals off blood vessels and reduces the risk of bleeding. There are four types of laser surgery:

1. Transurethral evaporation of the prostate (TUEP). With this method, the prostate tissue is destroyed by laser energy. It is generally a safe procedure, and causes small amount of bleeding. 2. Visual laser ablation of the prostate (VLAP). This treatment uses great amounts of laser energy to dry up and destroy excess prostate cells. It can cause some complications and patients may also experience a burning sensation during urination for days or even weeks. 3. Photosensitive vaporization of the prostate (PVP). This is one of the newest forms of laser treatment for prostate gland enlargement and one of the most effective ones. PVP uses laser energy to destroy prostate tissue. Problem is that, it can be very complicated to perform this procedure if the prostate is too enlarged. In general, PVP is better for smaller prostates. 4. Holmium laser enucleation of the prostate (HoLEP). This is also a newer laser procedure which has shown to provide results similar to classical surgical methods, but with less chance of bleeding and a shorter recovery time.

What's best about the laser operations?

They often provides immediate symptom relief, although you may experience painful urination for days or even weeks. Compared with classical invasive operations, laser surgery causes little blood loss and you recover more quickly. Retrograde ejaculation is also a common side effect of laser surgeries, which means that the ejaculate is being held in prostate, and cannot come out to urethra. However, its also possible that the surgery can damage nerves or blood vessels causing erection problems. The good thing is that these erection problems are not permanent. Classic surgery methods 1. Transurethral resection of the prostate (TURP) - Very common procedure used in almost all prostate surgeries. An instrument called a resectoscope, which is about 12 inches long and 1/2 inch in diameter is inserted through the penis. The resectoscope contains an electrical loop that cuts enlarged prostate tissue. 2. Transurethral incision of the prostate (TUIP) - This procedure is done in order to widen the urethra by making a few small cuts in the bladder. TUIP typically is an outpatient procedure that takes 20 minutes. 3. Open surgery When none of these transurethral procedures cannot be used, open surgery may be the only solution. Open surgery requires an external incision and it is done when the gland is greatly enlarged.

Related content Treatment of the Enlarged Prostate Gland With Laser Therapy
The prostate gland is a walnut sized organ below the bladder, which surrounds the urethra. For reasons not completely understood, the prostate gland begins to grow around age 50 and causes symptoms affecting urination. The enlarged prostate gland is a non-cancerous condition that affects nearly 14 million men over age 50. The symptoms of the enlarged prostate include frequency of urination, getting up at night to urinate, urgency to urinate, decrease in the force and caliber of the urine stream and feeling that the bladder is not emptying. The treatment for enlarged prostate includes medication to shrink the prostate gland or to relax the muscles in the prostate to relieve the obstruction. Surgical therapy includes transurethral resection of the prostate (TURP) or open surgery for very large prostate glands. Recently laser therapy has become available for treating the enlarged prostate gland and is considered minimally invasive therapy.

Laser therapy is a procedure performed with a small fiber that is inserted into the urethra, the tube in the penis that allows urine to go from the bladder to the outside of the body. The fiber delivers high-powered laser energy, which quickly heats the prostate tissue, which causes the tissue to dissolve or vaporize. This process is continued until all of the enlarged prostate tissue has been removed. The end result is a wide-open channel for urine to pass through the urethra. Laser therapy can be performed in a hospital outpatient center or an ambulatory treatment center. Usually no overnight stay is required. However, in some cases when a patient comes from a great distance, has associated medical problems such as heart disease, diabetes, or severe hypertension, or is in frail condition, an overnight stay may be recommended. After the procedure Most men will go home within a few hours after treatment. If a tube or catheter was inserted after the procedure, it will usually be removed the next day after the procedure. Most patients experience marked improvement in their urinary symptoms immediately after the procedure. This improvement typically occurs within the first 24 hours after the procedure. However, the past medical history, health condition and other factors can influence treatment recovery. Some men may experience mild discomfort such as slight burring during urination and small amounts of blood in the urine for a week or two. Also, depending upon the condition of a mans bladder, he may experience greater frequency and urge to urinate. This will resolve over time as the bladder adjusts now that the obstruction has been removed. There is no change in a mans sexual function after the procedure. His ability to engage in sexual intimacy after the procedure is unchanged. Most men can begin sexual activity two weeks after the procedure. Approximately 25% of men will have a decreased or absence of ejaculation at the time of orgasm. The fluid is still there but goes backwards into the bladder and passes in the urine the next time the man urinates. What are the risks of the laser procedure? Every medical treatment may have side effects. The same is true for the laser treatment. The most common side effects include: blood in the urine, bladder spasms, and urgency of urination. These symptoms are usually temporary and will subside in a few days or weeks. Bottom Line: Enlarged prostate gland is a common condition that affects most men after age 50. Treatment options include medications, surgery and minimally invasive treatment using lasers. The laser treatment produces a rapid improvement in urine flow, a quick return to normal activities, short or no hospitalization.

Chloroplast

Simplified structure of a chloroplast

Chloroplasts ( /klrplsts/) are organelles found in plant cells and other eukaryotic organisms that conduct photosynthesis. Chloroplasts capture light energy, store it in the energy storage molecules ATP and NADPH and use it in the process called photosynthesis to make organic molecules and free oxygen from carbon dioxide and water.[1] Chloroplasts are green because they contain the chlorophyll pigment. The word chloroplast () is derived from the Greek words chloros (), which means green, and plastis (), which means "the one who forms". Chloroplasts are members of a class of organelles known as plastids.

Contents

1 Evolutionary origin 2 Structure 3 Transplastomic plants

Evolutionary origin

Chloroplasts visible in the cells of Plagiomnium affine Many-fruited Thyme-moss

A model chloroplast

Chloroplasts are one of the many different types of organelles in the plant cell. They are considered to have originated from cyanobacteria through endosymbiosis. This was first suggested by Mereschkowsky in 1905[2] after an observation by Schimper in 1883 that chloroplasts closely resemble cyanobacteria.[3] All chloroplasts are thought to derive directly or indirectly from a single endosymbiotic event (in the Archaeplastida), except for Paulinella chromatophora, which has recently acquired a photosynthetic cyanobacterial endosymbiont which is not closely related to chloroplasts of other eukaryotes.[4] In that they derive from an endosymbiotic event, chloroplasts are similar to mitochondria, but chloroplasts are found only in plants and protista. The chloroplast is surrounded by a double-layered composite membrane with an intermembrane space; further, it has reticulations, or many infoldings, filling the inner spaces.

The chloroplast has its own DNA,[5] which codes for redox proteins involved in electron transport in photosynthesis; this is termed the plastome.[6] In green plants, chloroplasts are surrounded by two lipid-bilayer membranes that are thought to correspond to the outer and inner membranes of the ancestral cyanobacterium.[7] Chloroplasts have their own genome, which is considerably reduced compared to that of free-living cyanobacteria, but the parts that are still present show clear similarities with the cyanobacterial genome. Plastids may contain 60-100 genes whereas cyanobacteria often contain more than 1500 genes.[8] Many of the missing genes are encoded in the nuclear genome of the host.[9] In some algae (such as the heterokonts and other protists such as Euglenozoa and Cercozoa), chloroplasts seem to have evolved through a secondary event of endosymbiosis, in which a eukaryotic cell engulfed a second eukaryotic cell containing chloroplasts, forming chloroplasts with three or four membrane layers. In some cases, such secondary endosymbionts may have themselves been engulfed by still other eukaryotes, thus forming tertiary endosymbionts. In the alga Chlorella, there is only one chloroplast, which is bell-shaped. In some groups of mixotrophic protists such as the dinoflagellates, chloroplasts are separated from a captured alga or diatom and used temporarily. These klepto chloroplasts may only have a lifetime of a few days and are then replaced.[10]

Structure
Chloroplasts are observable as flat discs usually 2 to 10 micrometers in diameter and 1 micrometer thick. In land plants, they are, in general, 5 m in diameter and 2.3 m thick.[citation needed] The chloroplast is contained by an envelope that consists of an inner and an outer phospholipid membrane. Between these two layers is the intermembrane space. A typical parenchyma cell contains about 10 to 100 chloroplasts.[citation needed]

Chloroplast ultrastructure: 1. outer membrane 2. intermembrane space 3. inner membrane (1+2+3: envelope) 4. stroma (aqueous fluid)

5. thylakoid lumen (inside of thylakoid) 6. thylakoid membrane 7. granum (stack of thylakoids) 8. thylakoid (lamella) 9. starch 10. ribosome 11. plastidial DNA 12. plastoglobule (drop of lipids)

The material within the chloroplast is called the stroma, corresponding to the cytosol of the original bacterium, and contains one or more molecules of small circular DNA. It also contains ribosomes; however most of its proteins are encoded by genes contained in the host cell nucleus, with the protein products transported to the chloroplast.

TEM image of a chloroplast

Within the stroma are stacks of thylakoids, the sub-organelles, which are the site of photosynthesis. The thylakoids are arranged in stacks called grana (singular: granum).[1] A thylakoid has a flattened disk shape. Inside it is an empty area called the thylakoid space or lumen. Photosynthesis takes place on the thylakoid membrane; as in mitochondrial oxidative phosphorylation, it involves the coupling of cross-membrane fluxes with biosynthesis via the dissipation of a proton electrochemical gradient. In the electron microscope, thylakoid membranes appear as alternating light-and-dark bands, each 0.01 m thick. Embedded in the thylakoid membrane are antenna complexes, each of which consists of the light-absorbing pigments, including chlorophyll and carotenoids, as well as proteins that bind the pigments. This complex both increases the surface area for light capture, and allows capture of photons with a wider range of wavelengths. The energy of the incident photons is absorbed by the pigments and funneled to the reaction centre of this complex through resonance energy transfer. Two chlorophyll molecules are then ionised, producing an excited electron, which then passes onto the photochemical reaction centre.

Recent studies have shown that chloroplasts can be interconnected by tubular bridges called stromules, formed as extensions of their outer membranes.[11][12] Chloroplasts appear to be able to exchange proteins via stromules,[13] and thus function as a network.

Transplastomic plants
Recently, chloroplasts have caught attention by developers of genetically modified plants. In most flowering plants, chloroplasts are not inherited from the male parent,[14][15] although in plants such as pines, chloroplasts are inherited from males.[16] Where chloroplasts are inherited only from the female, transgenes in these plastids cannot be disseminated by pollen. This makes plastid transformation a valuable tool for the creation and cultivation of genetically modified plants that are biologically contained, thus posing significantly lower environmental risks. This biological containment strategy is therefore suitable for establishing the coexistence of conventional and organic agriculture. While the reliability of this mechanism has not yet been studied for all relevant crop species, recent results in tobacco plants are promising, showing a failed containment rate of transplastomic plants at 3 in 1,000,000.[15]