Prostate Enlargement

What Are The Treatment Options For an Enlarged Prostate?

The effectiveness of the various treatments for BPH is determined by:

• How well the urine flow has improved
• A reduction in the number of times or the need to pass urine

In general, the results from surgical treatments have been significantly better than those from medical treatments.

Your doctor can help you determine which treatment option is best for you.

Medical Treatments

Medical treatments for BPH include:

• Watchful waiting. This simply involves careful monitoring, rather than active treatment. This method is elected by most people who have mild to moderate symptoms.

  Because up to one-third of all mild cases clear up spontaneously, the strategy of watchful waiting is a prudent course for many individuals. Over 40 percent of men with mild to moderate symptoms have experienced improvement with this method of management.

• Alpha blocker. These are drugs that can inhibit the contraction of the smooth muscle of the prostate gland and bladder neck and, in this way, improve the urinary flow rate. About 75 percent of individuals who choose alpha blocker therapy have experienced an improvement in the symptoms of BPH,particularly relief from the symptoms of urinary frequency and urgency.

• Finasteride (Proscar®): This drug inhibits production of DHT, the hormone that is thought to cause prostate enlargement, by inhibiting the enzyme 5-alpha reductase. As a result of this, the prostate gland shrinks in size, alleviating the symptoms of BPH.

  It can take six months to experience the full effects of this drug. About two-thirds of individuals who choose finasteride therapy will experience an improvement in the symptoms of BPH. On average, the size of their prostates shrunk about 30 percent.

  Sometimes, finasteride is used in conjunction with an alpha blocker.

Surgical Tteatments

Surgical treatments for BPH include:

• Transurethral incision of the prostate (TUIP). This procedure widens the urethra by simply making a few cuts in the prostate gland and the bladder neck, without actually removing tissue. The procedure is believed to reduce the probability of retrograde ejaculation, a complication of prostate removal, in which the semen is shunted into the bladder instead of directly into the urethra, but the long-term side effects of TUIP have not yet been established.

  Approximately 80 percent of individuals treated with TUIP have experienced an improvement in the symptoms of BPH.

• Transurethral resection of the prostate (TURP). Used in 90 percent of all surgeries performed for BPH, TURP involves inserting an instrument called a resectoscope through the urethral opening of the penis and guiding it to the constricted portion of the urethra within the prostate gland.

  A wire loop of the resectoscope then cuts the prostate tissue surrounding the urethra and cauterizes the surrounding blood vessels to prevent bleeding. The cut pieces of prostate tissue are carried to the bladder by a controlled water stream and flushed out of the bladder in the final phase of the operation.

  Almost 90 percent of individuals who had a TURP have experienced an improvement in the symptoms of BPH.

• Open prostatectomy. Open surgery to remove part of the prostate gland is performed when transurethral procedures cannot be used. This form of surgery, which requires an incision in the skin, is necessary if the prostate gland is greatly enlarged, if there are significant complicating factors, or if the muscular wall of the bladder has been significantly damaged and requires repair.

  Almost 100 percent of individuals treated with open surgery have experienced an improvement in the symptoms of BPH.

Newer Treatment Option

A variety of minimally invasive treatment options seem promising at the present time.

• Laser prostatectomy – A laser guided through the urethra produces energy that is directed at the prostate tissue surrounding the constricted portion of the urethra. The laser energy vaporizes the offending prostate tissue.
• Transurethral microwave thermotherapy – With this technique, precisely controlled microwaves are passed through a catheter inserted in the urethral opening of the penis, guided to the prostate gland, and focused on the prostate tissue. The device that delivers the microwave energy is called a Prostatron.

  The tissue is heated by the microwave energy, causing cell death of the offending prostate tissue, while the surrounding tissues are protected by a cooling system that dissipates the heat. The procedure takes approximately one hour.

  Almost 70 percent of the men treated with microwaves experienced significant relief of symptoms caused by BPH. The recurrence rate over a four-year post-treatment period is slightly over 10 percent. Swelling of the irradiated tissue can result in an inability to urinate for several days, requiring the temporary use of a catheter to drain urine.

• Transurethral needle ablation (TUNA) – Following insertion of an instrument through the urethral opening of the penis, two needles are inserted into the prostate gland. Heat energy is then passed through the needles, causing shrinkage in the surrounding prostate tissue and a corresponding increase in the flow of urine.
• High energy focused ultrasound (HIFU) – Following insertion of an ultrasound probe through the rectum behind the prostate gland, ultrasound energy is focused and used to shrink the size of the prostate gland.
• Prostate stent – A prostate stent is a tubular device inserted through the urethra to the point of constriction, where it is allowed to expand. The pressure exerted by the stent on the inside wall of the urethra widens its bore and reduces the obstruction to urinary flow. However, an increased urgency to urinate may be experienced in the first few days following insertion of the device.
• Balloon urethroplasty – A tube with a small balloon at the end is inserted through the urethral opening of the penis and guided to the constricted portion of the urethra, where the balloon is inflated. The pressure exerted by the balloon against the inside of the urethral wall increases the diameter of the urethra and improves the flow of urine.

  The procedure is a safe alternative to surgery, although the recurrence rate of BPH following this procedure is not yet established. However, almost 60 percent of individuals treated with balloon urethroplasty have experienced an improvement in the symptoms of BPH.