This health video will focus on the wide array of traditional options to treat an enlarged prostate or BPH (Benign Prostatic Hyperplasia).
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Edward J. Mueller: Early on when the BPH just starts there are some good medications that can help. The common ones we use are the alpha blockers which will relax the muscles in the process, the prostate has muscle and the capsule will be prostated in the tissue of the prostate as well as at the bladder neck, where the bladder and prostate come together. There is an internal swing too there and the alpha blockers relax the alpha nerve fibers, the alpha nerve fibers constrict muscles. So they will constrict the muscle in the prostate and tighten it up, taking the alpha blocker medications will relax those muscles and open up the prostate a little bit and then we have the 5alpha-reductase medications and 5alpha-reductase is an enzyme that converts testosterone to dihydrotestosterone. Dihydrotestostrone is the main testosterone that function in the prostate to cause the enlargement, by blocking that you will have testosterone which is a much weaker stimulant of prostate growth and you can decrease the growth of the prostate that way. So sometimes combining those two medications, can be fairly effective when the patient symptoms aren’t too bad, but when the patient gets large prostate and there is a large obstruction, those medications aren’t going to help too much. Edward J. Mueller: Heat therapies are new minimally invasive therapies where you don’t actually remove tissue what you do is you heat up the tissue to appoint where it won't vaporize but the cells will die. Barry Stein: In some way, the temperature change can cause the tissue to die to coagulate, to vaporize, sometimes we think we cause the nerves to be damaged. So the heat depending on how it’s delivered, what source it’s delivered, what temperature it’s delivered too, the heat is very different in everyone of these. Edward J. Mueller: The theory is they will sluff and the die and the prostate will open up and usually right after this has done, you are going to get a lot of swelling, so the symptoms will get worst. Frequently patients will have a catheter in for three four weeks afterwards and then lot of times they don’t get a lot better because you don’t get the necrosis and the shrinking that you hope for. Sometimes you get moderately good results and if the patient’s symptoms aren’t that bad, they can work fairly well, but there is a lot of risk involved in that. Barry Stein: And the most important ones would be a microwaves therapy and Transurethral Needle Ablation Therapy, both of those are out ablation therapies and they are both very different. One is done with catheters in probes of that level and the other is done through a scalp with needles. Both of them use heat to warm the prostate and both of them have the same disadvantage that they do not remove tissue. In fact although there are several working theories, nobody is really totally sure how either one actually works. Edward J. Mueller: Prostate swells and a lot of patients have to have a catheter afterwards for quite a while, sometimes they get a lot of irritating symptoms because of the cells that are dying and their causing irritation, giving you urgency and frequency as it heels, but the major side effect is the swelling that occurs and they need to have a catheter for quite a length of time after the procedure. Barry Stein: Both of them have high recurrence rates and a lot of the patients end up back on their medical therapy or eventually another type of surgical therapy. Edward J. Mueller: Basically a TURP is a procedure where you go in and you use a hot loop to cut out these overgrowth of tissue that constricts down your urethra. They open up the channel and the patient will urinate much, much better. Barry Stein: It’s been around for 75 years, so we all have a lot of experience in using it, everyone was trained in using it. So one of the major pros is the familiarity and the experience with it, the cons is that requires hospitalization and that there are more complications than other transurethra