Some researchers question the need for early treatment when the gland is just mildly enlarged. The results of studies indicate that such treatment may not be needed because as many as one-third of all mild cases become asymptomatic without treatment. They suggest regular checkups to watch for early problems. If the condition begins to cause a major problem for the patient, then treatment will be recommended. Since BPH can cause urinary tract infections,it is best to clear up infection before treating the BPH itself.
Treatments commonly used for BPH:
The FDA has approved several drugs to relieve common symptoms associated with an enlarged prostate. Finasteride (Proscar) and dutasteride (Avodart) inhibit production of the hormone DHT Terazosin (Hytrin), doxazosin (Cardura), tamsulosin (Flomax) and alfuzosin (Uroxatral) act by relaxing the smooth muscle of the prostate and bladder neck
Minimally Invasive Therapy
When drugs are ineffective, one may consider a number of procedures that relieve BPH symptoms but are less invasive than conventional surgery. Approved in 1996, transurethral microwave procedures use microwaves to heat and destroy excess prostate tissue. Called "transurethral microwave thermotherapy" (TUMT), the device sends computer-regulated microwaves through a catheter to heat selected portions of the prostate. The procedure takes about an hour and can be performed on an outpatient basis in the urologist's office. TUMT does not appear to produce erectile dysfunction or incontinence.
Also in 1996, FDA approved "transurethral needle ablation" (TUNA) for the treatment of BPH. The system delivers low-level radiofrequency energy through twin needles to burn away a well-defined region of the enlarged prostate. No incontinence or impotence has been observed.
"Water-induced thermotherapy" uses heated water to destroy excess tissue in the prostate. A catheter is positioned in the urethra so that a treatment balloon rests in the middle of the prostate and computer controls the temperature of the water which flows into the balloon to heat the surrounding prostate.
The best long-term solution for patients with BPH involves removal of the enlarged part of the prostate. Only the tissue that is pressing against the urethra is removed. Surgery usually relieves both the obstruction and incomplete bladder emptying.
"Transurethral resection of the prostate" (TURP) is used for most BPH prostate surgeries. An instrument called a resectoscope is inserted through the penis. It contains a light, valves for controlling irrigating fluid, and an electrical loop that cuts tissue and seals blood vessels. The surgeon removes the obstructing tissue one piece at a time. Transurethral procedures are less traumatic than open forms of surgery and require a shorter recovery period. A possible side effect of TURP is retrograde ejaculation wherein semen flows backward into the bladder during climax instead of out the urethra.
When transurethral procedure cannot be used, open surgery may be done. This is usually reserved for cases where the gland is greatly enlarged, when there are complicating factors, or when the bladder has been damaged and needs to be repaired.
In1996, the FDA approved a surgical procedure that employs side-firing laser fibers and Nd: YAG lasers to vaporize prostate tissue. The doctor passes the laser fiber through the urethra into the prostate using a cystoscope and then delivers several bursts of energy, destroying prostate tissue. Among the advantages of laser surgery over TURP are the less blood loss and quicker recovery.
A newer laser-based treatment allows doctors to relieve BPH on an outpatient basis. "Photoselective vaporization of the prostate" (PVP) uses a high-energy laser to destroy prostate tissue and seal the treated area.
TUVP - Transurethral electrovaporization of the prostate - Plasma Button, is the latest invasive procedure for BPH. Compared with the TURP there was less perioperative bleeding, shorter catheterization time, and a shorter hospital stay.
Though patient's requiring hospitalization will feel pretty well when leaving the hospital, it takes a couple of months to heal completely. During the recovery period, certain problems can occur, including:
» Voiding difficulties- the urinary stream is stronger right after surgery, but can take awhile before you can urinate completely normally again. Patients may feel a sense of urgency when they urinate, but this will gradually lessen.
» Incontinence- there can be temporary problems controlling urination, but long-term incontinence rarely occurs.
» Bleeding- In the first few weeks after transurethral surgery, the scab inside the bladder may loosen, and blood may suddenly appear. The bleeding will usually stop after a short period of bed rest aided by the drinking of fluids. If your urine is so red that it is difficult to see through it (or if it contains clots), the patient should contact the doctor.
Many men worry about whether surgery will affect their ability to enjoy sex. Some believe that sexual function is rarely affected, but others claim that TURP can cause problems in up to 30 percent of cases. While it may take some time for sexual function to return fully, most men are able to enjoy sex again. The exact length of time depends on how long after symptoms appeared surgery was done.
Patients able to maintain an erection shortly before surgery will most often be able to have erections afterward. However, surgery cannot usually restore function that was lost before the operation. A prostate procedure frequently does make men sterile by causing retrograde ejaculation, or "dry climax." Most men find little or no difference in the sensation of orgasm, or sexual climax, before and after surgery.