Benign Prostatic Hyperplasia (BPH) is a common, age-related condition that affects many men. It involves the non-cancerous enlargement of the prostate gland. This article explores the current and advanced treatment options available for managing this condition.
Understanding Enlarged Prostate
The prostate gland sits below the bladder, surrounding the urethra. As men age, the prostate can undergo a second growth phase, potentially leading to BPH. When the prostate enlarges, it can press against the urethra, obstructing the flow of urine. This obstruction can cause various lower urinary tract symptoms.
Common symptoms of BPH include a frequent or urgent need to urinate, especially at night. Men might also experience a weak urine stream, a stream that stops and starts, or difficulty initiating urination. The feeling of incomplete bladder emptying and dribbling at the end of urination are also common indicators.
Non-Surgical and Medical Therapies
For men with mild symptoms, initial management of BPH often begins with watchful waiting, where symptoms are monitored without immediate active treatment. Lifestyle modifications can also play a role in managing mild BPH symptoms, including reducing fluid intake before bedtime and avoiding bladder irritants like caffeine and alcohol.
Medical therapies are a common next step when symptoms become bothersome. Alpha-blockers, such as tamsulosin, work by relaxing the muscles in the prostate and the bladder neck. This improves urine flow without shrinking the prostate. These medications can provide relatively quick symptom relief.
Another class of medications, 5-alpha reductase inhibitors (5-ARIs), including finasteride, work differently. These drugs inhibit the enzyme 5-alpha reductase. By reducing DHT levels, 5-ARIs can shrink the prostate gland over time, leading to improved urine flow and a reduced risk of BPH progression. These medications may take several months to show their full effect.
Minimally Invasive Procedures
When medical therapies do not provide sufficient relief or are not preferred, several minimally invasive procedures are available. These procedures are often performed in an outpatient setting with less invasiveness than traditional surgery.
The UroLift System treats BPH without cutting, heating, or removing prostate tissue. Small, permanent implants lift and hold enlarged prostate tissue away from the urethra, opening the urinary channel. This procedure typically results in a quick recovery, preserves sexual function, and provides symptom relief within weeks.
Rezum Water Vapor Therapy uses sterile water vapor to treat excess prostate tissue. Controlled steam bursts shrink targeted tissue, opening the urethra and reducing BPH symptoms. This option is minimally invasive, can be performed in a doctor’s office, and preserves sexual function, with benefits appearing within three months.
Aquablation Therapy uses a waterjet to remove prostate tissue. Real-time imaging creates a customized map for precise removal of obstructive tissue without incisions or heat. Aquablation reduces symptoms while minimizing incontinence and sexual dysfunction. Patients typically experience a quicker recovery, often staying in the hospital for only one night.
Advanced Surgical Options
For more severe cases of BPH or when other treatments have been unsuccessful, advanced surgical options provide definitive solutions. These modern techniques offer effective relief.
Holmium Laser Enucleation of the Prostate (HoLEP) uses a holmium laser to precisely remove enlarged prostate tissue. This technique removes the entire obstructive portion of the prostate through the urethra. HoLEP is suitable for prostates of all sizes, offers excellent long-term outcomes with minimal blood loss, and results in shorter hospital stays and catheterization times.
Photoselective Vaporization of the Prostate (PVP), commonly known as GreenLight Laser, uses laser energy to vaporize excess prostate tissue. This procedure benefits patients at higher bleeding risk due to its hemostatic properties. GreenLight laser treatment provides effective symptom relief and improved urine flow, often with reduced hospitalization and catheterization times. It has demonstrated durability and efficacy comparable to traditional methods.
Transurethral Resection of the Prostate (TURP) has historically been considered a benchmark surgical treatment for BPH. It involves inserting a resectoscope through the urethra to trim excess prostate tissue. TURP continues to be a viable and effective option, particularly for moderate to severe symptoms, significantly improving symptoms and urinary flow rates.