Treatment of enlarged prostate

Most men stop growing by age 18, but after 40, they often start growing elsewhere — especially of their prostate gland. Benign prostatic hyperplasia (BPH), also often called an enlarged prostate, affects about 50 percent of men ages 51 to 60 and 90 percent of men over 80.

As the prostate grows, it presses on the urethra, the tube that carries urine out of the body (see picture). For about half of men with BPH, it causes urinary problems. Common problems include hesitancy, obstruction, or a weak urine stream. dribbling after urination; A sense that the bladder just isn't completely empty; and more frequent urination. Some men also develop urinary tract infections or urinary incontinence, the involuntary lack of urine.

First line options

Three varieties of drugs are approved to treat BPH: alpha-blockers, corresponding to alfozosin (Uroxetine) and tamsulosin (Flomax); 5-alpha-reductase inhibitors dutasteride (Avodart) and finasteride (Proscar); and the PDE5 inhibitor tadalafil (Cialis), which is popular as an erectile dysfunction (ED) drug.

These medications work in other ways to alleviate symptoms. Your doctor may prescribe a number of, because they work well together. For example, alpha-blockers chill out certain muscles within the prostate and bladder to enhance urination, and 5-alpha-reductase inhibitors shrink the prostate, so it presses against the urethra and lower bladder. doesn't put Tadalafil helps chill out the bladder neck (which connects the bladder to the urethra), reducing the flow of urine.

Help needed

But lifestyle changes can only accomplish that much, and sometimes medications don't work. “You often know if the medication is helping after a few months,” says Dr. Catherines. If problems persist, the subsequent step is a surgery. Here are two commonly beneficial ones.

Transurethral resection of the prostate (TURP). TURP involves inserting a skinny tube through the urethra and into the prostate. At the tip of the tube is a loop of electrical wire, which pulls away the prostate tissue to remove the urinary obstruction. Pieces of tissue are removed with a tube. “TURP is effective in about 85% to 90% of men,” says Dr. Catherines.

Still, TURP can have sexual unintended effects, corresponding to ED or retrograde ejaculation (during which semen travels backwards into the bladder as a substitute of coming out). Other less common problems are infections and urinary incontinence.

Photoselective vaporization of the prostate (PVP). With PVP, the surgeon guides a skinny optic fiber through the urethra to the prostate. The fiber laser fires energy that breaks up the surplus prostate tissue, and the remnants leave the body within the urine.

The success rate of PVP is comparable to that of TURP. One advantage of PVP is a reduced risk of bleeding, which is good for men on blood thinners. The downside is that since the tissues are destroyed, they can not be examined for cancer. Also, the laser can have difficulty reaching some tissue if the prostate has moved too far into the bladder, during which case TURP is a greater option. “PVP is still a relatively new procedure, so it's not yet clear if prostate tissue will grow back after 10 years,” says Dr. Catherines.

If you could have an enlarged prostate gland or are considering more definitive treatment, your doctor may recommend a prostatectomy, during which the inside the gland is removed. There are several ways to perform this surgery, some less invasive than others.

Minimal movements Minimally invasive options can be found for BPH, unless your prostate gland could be very large (weighing lower than 80 grams). Two popular decisions are the prostatic urethral lift and water vapor thermal therapy (known by the brand name Rezum). In a prostatic urethral lift procedure, a tool called a urolift is inserted into the prostate through the urethra. It pushes the obstructing tissue aside and provides small implants that lift and hold the tissue in place in order that urine can flow more easily. The procedure requires no tissue removal, so recovery is minimal, and there aren't any sexual unintended effects. However, effectiveness decreases over time. With Rezum, a skinny tube is passed through the urethra to the prostate, where it delivers short bursts of steam that kill prostate cells. This causes the enlarged tissues to regularly shrink. Rezum doesn't cause sexual unintended effects. Because Rezum is recent, it's unknown if one other procedure might be needed in the longer term.

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