BPH (Enlarged Prostate)
Traditional Treatment Methods for Enlarged Prostate
Gentlemen, if trips to the restroom require sudden dashes or are marked by difficulty urinating, your prostate may be enlarged. You’re not alone—an estimated 50 percent of men in their 50s have an enlarged prostate. The prostate, the gland that produces the fluid that carries sperm, grows larger with age. An enlarged prostate, or benign prostatic hyperplasia (BPH), can block the urethra from transporting urine from the bladder and out of the penis.
Read more to learn about traditional treatments for BPH.
BPH Treatment Options
Don’t resign yourself to living with BPH. Addressing your symptoms now can help avoid problems later. Untreated BPH may lead to urinary tract infections, acute urinary retention (you can’t go at all), kidney and bladder stones and, in severe cases, kidney damage. Treatment options include medications and surgery. When you evaluate these choices, you and your doctor will consider how much your symptoms interfere with your life, the size of your prostate, your age, overall health, and other medical conditions you have.
Alpha Blockers for BPH
This class of medications works by relaxing the bladder neck muscles and the muscle fibers in the prostate. The muscle relaxation makes it easier to urinate. If you take an alpha blocker for BHP, within a day or two, you can expect an increase in your urine flow and the less frequent need to urinate. Drug names include:
- alfuzozin (Uroxatrol)
- doxazosin (Cardura)
- siludosin (Rapaflo)
- tamsulosin (Flomax)
- terazosin (Hytrin)
5 Alpha Reductase Inhibitors for BPH
These drugs shrink the prostate gland by blocking testosterone from converting to dihydrotestosterone, or DHT. DHT is the hormone that spurs prostate gland growth. Converting testosterone to DHT requires the enzyme 5 alpha reductase. The medications dutasteride (Avodart) and finisteride (Proscar) inhibit the production of this enzyme. You’ll generally have to wait three to six months for symptom relief with alpha reductase inhibitors.
A drug combination of an alpha blocker and a 5 alpha reductase inhibitor provides greater symptom relief than taking either one of these drugs by itself, according to a data analysis of multiple studies on BPH. When researchers looked at data from 1976 through 2008, they found that combination therapy was most effective in men with larger prostate size and more severe symptoms. A combination of dutasteride and tamsulosin is available in the brand Jalyn.
Stand the Heat
When drug therapy isn’t enough to relieve BPH symptoms, minimally invasive surgery options include transurethral microwave thermotherapy or TUMT. During this outpatient procedure, microwaves destroy prostate tissue with heat.
TUMT will not cure BPH, but the procedure cuts down urinary frequency, makes it easier to urinate, and reduces weak flow. It does not solve the problem of incomplete emptying of the bladder.
TUNA stands for transurethral needle ablation. High-frequency radio waves, delivered through twin needles, burn a specific region of the prostate in this procedure. TUNA results in better urine flow and relieves BPH symptoms with fewer complications than invasive surgery.
This outpatient procedure can cause a burning sensation, which can be managed by using an anesthetic to block the nerves in and around the prostate.
Getting in Hot Water
With water-induced thermotherapy, hot water is delivered through a catheter to a treatment balloon that sits in the center of the prostate. This computer-controlled procedure heats a defined area of the prostate while neighboring tissues are protected. The heat destroys the problematic tissue, which is then either excreted through urine or reabsorbed in the body.
Invasive surgery for BPH includes transurethral surgery, which does not require an external incision, or open surgery, which does. In 90 percent of all surgeries for BPH, the surgeon performs transurethral resection of the prostate, or TURP. Using a resectoscope inserted through the penis, the surgeon removes prostate tissue obstructing the urethra. With TUIP, transurethral incision of the prostate, the surgeon makes incisions in the neck of the bladder and in the prostate. This serves to widen the urethra and increase urine flow.
Laser surgery for BPH involves inserting a scope through the penis tip into the urethra. A laser passed through the scope removes prostate tissue by ablation (melting) or enucleation (cutting). In photoselective vaporization of the prostate (PVP), the laser melts excess prostate tissue.
Holmium laser ablation of the prostate (HoLAP) is similar, but a different type of laser is used. The surgeon uses two instruments for Holmium laser enucleation of the prostate (HoLEP): a laser to cut and remove excess tissue and a morcellator to slice extra tissue into small segments that are removed.
Open Simple Prostatectomy
In complicated cases of a very enlarged prostate, bladder damage, or other problems, open surgery may be required. In open simple prostatectomy, the surgeon makes an incision below the navel or, in laparoscopic surgery, several small incisions in the abdomen. Unlike prostatectomy for prostate cancer when the entire prostate gland is removed, in open simple prostatectomy the surgeon removes only the portion of the prostate blocking urine flow.
Self-Care May Help
Not all men with BPH need medication or surgery. These steps may help you manage mild symptoms:
- Do pelvic-strengthening exercises.
- Stay active.
- Ease up on alcohol and caffeine.
- Space out how much you drink rather than drinking a lot at once.
- Urinate when the urge strikes—don’t wait.
- Avoid decongestants and antihistamines.
Talk with your doctor about the treatment approach that best suits your needs.
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- Greco K & McVary K (2008). The role of combination medical therapy in benign prostatic hyperplasia. Int J Impot Res. 20(3):S33-45. Retrieved October 28, 2013 from http://www.ncbi.nlm.nih.gov/pubmed/19002123
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