Prostate Disorders Bph Treatment

If you have BPH, a number of treatment options are available, including medication and enlarged prostate surgery. Often, however, symptoms are manageable without treatment.

Watchful Waiting

Only fifty percent of men with enlarged prostates actually require treatment for their symptoms. The other fifty percent engage in “watchful waiting.” Watchful waiting is a term used by urologists in circumstances when no treatment of BPH is necessary. BPH symptoms are monitored with regular checkups, and treatment begins only if the symptoms worsen. Men who are practicing watchful waiting can help reduce existing symptoms by practicing the following:

  • Limit fluids before bedtime.
  • Limit beverages containing caffeine and alcohol.
  • Empty the bladder as completely as possible when urinating.
  • Don’t wait to urinate: go as soon as you can.

Medication Options: The Alpha Blockers

Terazosin, Doxazosin and Tamsulosin

Alpha-blockers, such as terazosin (brand name Hytrin®) and doxazosin (brand name Cardura®), were originally used to treat high blood pressure, or hypertension. Researchers discovered that these alpha blockers also relax the bladder and portions of the prostate, allowing for easier urine flow. Tamsulosin (brand name Flomax®) is the first alpha blocker designed specifically to treat BPH. Symptoms are often reduced within days of using any of these alpha blockers.

Common Hytrin, Cardura, and Flomax side effects are dizziness, fatigue, and headaches. Specific Flomax side effects can include ejaculation difficulties.

Finasteride and Libido

Finasteride is a testosterone 5-alpha reductase inhibitor. The medication works by inhibiting levels of the prostate hormone DHT, which is derived from testosterone. By inhibiting the testosterone-based DHT, finasteride reduces the size of the prostate.

Unlike the other alpha-blockers, finasteride does not work immediately. Improvements in symptoms may take up to six months. The medication works best for men with very enlarged prostates.

Finasteride affects testosterone-derived hormones, which explains many of its possible side effects, which include reduced libido or sex drive, tender or swelling breasts, and erectile dysfunction. The medication can also cause a reduction in the prostate protein PSA.

Enlarged Prostate Surgery

Transurethral Resection of the Prostate (TURP)

Transurethral resection of the prostate, or TURP, is the most common form of enlarged prostate surgery, accounting for over ninety percent of BPH surgeries. Under local anesthetic (usually a spinal block), a fiber optic tube is threaded up the urethra to where the prostate presses on the urethral passage. The tube contains a lens that relays a picture back to the surgeon and a tiny surgical blade.

The surgeon uses the blade to remove obstructing urethral lining tissue and excess prostate tissue. This expands the urethral passageway, allowing for urine to flow more easily. The patient is hospitalized with a catheter for several days after the procedure.

In ten percent of TURP operations a second operation is required if the prostate continues to grow. Scarring of the urethra, which can block urine, is possible. A TURP procedure carries a five percent risk of impotence or incontinence. More common than impotence is a condition known as retrograde ejaculation in which semen is ejected into the bladder instead of down the penis shaft. Libido is not affected by retrograde ejaculation, and orgasm and erections are still possible, but the man is unable to conceive naturally.

Transurethral Needle Ablation (TUNA)

Transurethral needle ablation, or TUNA, is a relatively new BPH outpatient treatment. Under local anesthetic, a catheter is inserted into the urethra. The catheter contains needles that transmit radiofrequency energy to the prostate, killing excess prostate cells. Ablation has relatively few side effects.

Other Surgical Options

In addition to TURP and TUNA, a number of other surgical options are available. Transurethral incision of the prostate (TUIP) makes one or two small cuts in the prostate tissue to increase urine flow. Transurethral microwave thermotherapy works much like TUNA, except that it uses microwaves to kill cells. Both procedures can be performed as an outpatient, and are increasingly selected as a surgical treatment option.

An open prostatectomy, which involves removal of the entire gland through a surgical incision made in the abdomen, is used to treat cancer more often than BPH. However, five percent of BPH cases involve large amounts of growth, and have to be removed abdominally.

Under Study: Saw Palmetto and Prunus

Research into benign prostatic hyperplasia treatment continues, and some scientists are investigating alternative measures. Saw palmetto (a member of the palm family) and prunus (an African evergreen) are plants that have been used to treat BPH. The effectiveness of saw palmetto and prunus are currently under investigation through clinical trials.

Resources

National Library of Medicine. (Updated 2002). Benign prostatic hyperplasia (BPH). Retrieved January 19, 2003, from www.nlm.nih.gov/medlineplus/ency/article/000381.htm#Treatment.

National Library of Medicine. (Updated 2001). Tamsulosin. Retrieved January 19, 2003, from www.nlm.nih.gov/medlineplus/druginfo/medmaster/a698012.html#side-effects.