Benign Prostate Hyperplasia (BPH)
Today, medications are the most common method for controlling urinating symptoms of BPH. The following section describes the types of treatment that are most commonly used for BPH.
- 5-alpha-reductase inhibitors
Finasteride (Proscar) and Dutasteride (Avodart), inhibit production of the hormone DHT, which is involved with prostate enlargement. The use of either of these drugs can either prevent progression of growth of the prostate or actually shrink the prostate in some men.
- Alpha blockers
Terazosin (Hytrin) , Doxazosin (Cardura), Tamsulosin (Flomax) and Alfuzosin (Uroxatral) .All four drugs act by relaxing the smooth muscle of the prostate and bladder neck to improve urine flow and to reduce bladder outlet obstruction.
- Combination Therapy
The use of both alpha blockers and 5-alpha-reductase inhibitors result in better symptom management and long term benefits than using only one type of drug. However, this may be associated with more side effects.
Most doctors recommend removal of the enlarged part of the prostate as the best long-term solution for patients with BPH. With surgery for BPH, only the enlarged tissue that is pressing against the urethra is removed; the rest of the inside tissue and the outside capsule are left intact. Surgery usually relieves the obstruction and incomplete emptying caused by BPH.
- Transurethral resection of the prostate (TURP)
In this type of surgery, no external incision is needed. After giving anesthesia, the surgeon reaches the prostate by inserting an instrument through the urethra.
An instrument called a resectoscope is inserted through the penis. The resectoscope, which is about 12 inches long and 1/2 inch in diameter, contains light, valves for controlling irrigating fluid, and an electrical loop that cuts tissue and seals blood vessels.
During the 90-minute operation, the surgeon uses the resectoscope's wire loop to remove the obstructing tissue one piece at a time. The pieces of tissue are carried by the fluid into the bladder and then flushed out at the end of the operation.
Transurethral procedures are less traumatic than open forms of surgery and require a shorter recovery period. One possible side effect of TURP is retrograde, or backward, ejaculation. In this condition, semen flows backward into the bladder during climax instead of out the urethra.
- Transurethral incision of the prostate (TUIP)
Instead of removing tissue, as with TURP, this procedure widens the urethra by making a few small cuts in the bladder neck, where the urethra joins the bladder, and in the prostate gland itself. Although some people believe that TUIP gives the same relief as TURP with less risk of side effects such as retrograde ejaculation.
- Open surgery (Prostatectomy)
In the cases when a transurethral procedure cannot be used, open surgery, which requires an external incision, may be used. Open surgery is often done when the gland is greatly enlarged, when there are complicating factors, or when the bladder has been damaged and needs to be repaired. Open prostatectomy for BPH is also performed for a prostate that is too large to remove through the penis. An incision is made in the abdominal wall from below the belly button to the pubic bone. Once the surgeon reaches the prostate capsule, he or she scoops out the enlarged tissue from inside the gland.
- Robotic surgery (prostatectomy)
Robotic prostatectomy combines the best aspects of open prostatectomy (complete removal of obstructing tissue) with the minimally invasiveness of a robotic approach.
Four small incisions are used to insert instruments which the surgeon controls from a console. This differs from robotic radical prostatectomy for prostate cancer in that when done for BPH we do not remove the whole gland, we only shell out the obstructing prostate tissue.
- Holmium Laser Treatment
Holmium laser treatments use laser energy to remove obstructing prostate tissue. A less invasive treatment option, holmium laser treatment provides immediate symptom relief and improves quality of life with little risk of complications.
Holmium laser treatment uses a thin flexible fiber to transmit the laser energy to the prostate with a very high degree of precision.
Your doctor controls the direction and delivery of laser energy by moving the fiber back and forth in a sweeping or 'painting' motion. The laser energy instantly vaporizes the obstructing tissue. The laser also seals the area, resulting in little if any bleeding during and after the procedure. Most patients experience little or no bleeding, and go home without a catheter after a few hours or overnight stay. Pain medication is rarely needed and you can be back to normal activities soon after going home.
- GreenLight Laser Therapy
GreenLight™ Laser Therapy is a procedure performed with a small fiber that is inserted into the urethra through a cystoscope. The fiber delivers high powered laser energy which quickly heats up the prostate tissue, causing the tissue to vaporize. This process is continued until all of the enlarged prostate tissue has been removed. GreenLight Laser Therapy can be performed in a hospital outpatient center, surgical center, or specially equipped physician’s office.
Typically no overnight stay is needed. However, in some cases when a patient travels a long distance, has other medical conditions to consider, or is in frail condition an overnight stay may be recommended.