Benign Prostatic Hypertrophy

Seventy-five percent of men over the age of 50 have some symptoms arising from BPH. Essentially 20-40% of these meri will require some form of therapy, most commonly transurethral resection of the prostate (TURP). The etiology of BPH has yet to be defined.

Although TURP is an ideal therapy for BPH, there is considerable impetus for the development of alternative therapies for this disease. Current and future alternatives are being discussed.

CURRENT TREATMENT ALTERNATlVES

Watchful Waiting

Patients adopting a "watchful waiting" strategy are those who are generally tolerant of their symptoms and elect no treatment after being informed of all the options and associated risks. This is a decision made by the patient, his physician, and his urologist after he has been evaluated as an unlikely candidate for an occult malignancy or "silent prostatism".

Transurethral Resection of the Prostate (TURP)

TURP is the "gold standard" to which all forms of BPH therapy must be compared. Although the procedure is considered extremely safe, there is a finite postoperative mortality or morbidity associated with it as there is with any surgical procedure. The overall safety and efficacy of TURP remains quite high

Transurethral Vaporization of the Prostate

This therapy is very similar to transurethral resection of the prostate except a higher energy is used along with a different resecting instrument that actually vaporizes the prostatic tissue with only minimal bleeding. The advantage of this procedure is that it requires a shorter hospital stay (usually 24 hours or less) and continues to produce good long-term results.

Open Prostatectomy

Open removal of the BPH is an effective and safe alternative usually reserved for patients with extremely large obstructing glands.

Medication Therapy for BPH

Medication can be effective in the early stages of prostatic enlargement.

Terazosin (Hytrin) and doxazosin (Cardura) are selective alpha-1 blocking agents which can provide objective relief of BPH symptoms by relaxing the bladder neck. These medications may prevent the need for surgery in some patients with BPH.

Proscar (finasteride) is a potent alpha reductase inhibitor which reduces the concentration of dihydrotestosterone in the prostate cell. The prostate cell "shrinks" and plasma levels of testosterone remain normal. In clinical trials, the prostate will shrink an average of 30% and will help many patients avoid surgery. Indications should be discussed with your physician.

Combination Medical Therapy

Combination medical therapy is possible with an alpha-1 blocking agent and Proscar.

Microwave Thermotherapy

Microwave thermotherapy is an outpatient microwave energy treatment performed using only local anesthesia that is extremely safe. This treatment has been widely used in Europe and Japan for many years. For many patients, it has proven to be an effective alternative to surgery and long-term medications. Physician evaluation is necessary before a patient can be determined eligible for this treatment.

TransUrethral Needle Ablation of the Prostate (TUNA)

The TransUrethral Needle Ablation of the Prostate, or TUNA, procedure utilizes low levels of radiofrequency energy to selectively ablate the obstructing portion of the prostate. This can be done as a simple and quick outpatient treatment and is easily tolerated by patients. Also, studies have shown that the TUNA procedure can be as effective as the TURP in relief of symptoms.

Radiofrequency Energy

Low-level radiofrequency energy is used to heat the enlarged inner part of the prostate and selectively ablate the obstructing portion of the prostate. This can be done as a simple and quick outpatient treatment and is easily tolerated by patients.

Prostatic Stents

The UroLume Endoprosthesis is a flexible braided stent that is inserted into the urethra using a minimally-invasive procedure. The stent acts like an internal scaffolding to hold open the area of the urethra obstructed by the enlarged prostate.

Laser Surgery

Laser fibers heat the prostate gland and cause the tissue to die and be sloughed off in the urine. There appears to be less postoperative bleeding with this method when compared to traditional surgical methods; the symptom relief seems comparable. The long-term efficacy of the treatment remains unknown at this time.

Transurethral incision of the prostate (TUIP)

TUIP is used when the enlargement of the prostate and the obstruction to the urethra are moderate. TUIP involves making one or two small cuts in the prostate to reduce pressure on the urethra.

Which Treatment is for Me?

This is best determined after a urologic consultation.

An evaluation by a urologist is essential to rule out occult malignancy or "silent prostatism" before treatment begins.

A patient with symptomatic BPH should be evaluated by a urologist who can inform him of all the treatment alternatives.

If you would like more information on this topic, please contact us.

< Back to Resources

One Location. Complete Urologic Care.

Urological Associates, Inc. is dedicated to being your tri-state leader in urologic care.
Contact us today for an appointment.