Treatment Options For An Enlarged Prostate
Based on prostate symptoms and test results, doctors may offer a number of treatment options for an enlarged prostate.
1. Watchful Waiting
If your symptoms are mild, your doctor may recommend simply monitoring the situation before taking action.
2. Oral Therapy
Oral therapy has potential for symptom relief. It has the advantage of no surgery. Disadvantages include ongoing medication therapy, risks of side effects, high out of pocket cost, and sometimes over time effectiveness diminishes. Certain men also do not like to take medications.
2.1. Alpha Blocker Drugs
This is the most common way to treat BPH. Medicines like Flomax, Cardura, Hytrin and Uroxatral have proven to be effective in the treatment of most cases. Alpha Blockers relieve the obstruction by trying to stop the process by which the construction occurs. They basically relax the smooth muscle cells in the prostate to relieve urinary obstruction. Like most medicines side effects can occur. They are mild in most cases and include dizziness on standing, feeling fatigued, loss of ability to ejaculate with orgasm.
2.2. Alpha Reductase Inhibitors
Avodart and Proscar are drugs that work by bringing about hormonal changes that actually shrink the prostate. These however must only be used by men who exhibit clear signs of prostate enlargement
, not just LUTS. Side effects include excess hair growth, decrease volume of ejaculation and decreased sexual desire.
3. Minimally Invasive Procedures
These generally tend to be far more effective that the oral medicines but can carry greater risks. They include:
- Urethral Stent
- Transurethral Microwave Therapy (TUMT)
In Thermotherapy, heat is applied to the prostate to destroy the prostate tissue. Heat can be applied using several different sources, including microwave energy as with Thermatrx Dose Optimize Thermotherapy (DOT). The heat causes changes in the prostate tissue and results in improvement of symptoms. There is no cutting or incision. Oral drugs are given to help you relax and the procedure is well tolerated. Most patients have only minor discomfort. You may have a urine drainage catheter 2-5 days after treatment. The Thermatrx system continues to measure the prostate temperature to ensure you are given the optimal “dose of heat”. The procedure is done in the doctor’s office and takes about 90 minutes. No hospital stay is required. No sexual side affects have been reported. Your doctor will perform tests to see if it is the right treatment option for you. Medicare and most private insurance plans cover Thermatrx.
Advantages of Thermatrx include long lasting symptom relief, and it is an alternative to cost, side effects and inconvenience of other therapies. In clinical trials, patients did not report incontinence or retrograde ejaculation as a result of the treatment. It had minor short term side effects only which usually went away on their own and id does not effect one’s ability to take ED medications. It is FDA approved as safe and effective.
Dr. Eid specializes in Thermatrx Dose Optimized Thermotherapy.
3.2. Urethral Stent:
Urethral stent is a mesh tube that holds the urethra open at the point of obstruction. It immediately improves the flow of urine. The stent is placed through the procedure in an out-patient procedure. It has been clinically proven to maintain these results over the long term. No catheter is required after most procedures. It is fully incorporated within the body. This procedure is easy and safe and can be done under local anesthesia but is usually reserved for cases of recurrent stricture of the bladder opening.
3.3 . Transurethral Microwave Therapy (TUMT):
In Transurethral Microwave Therapy, an instrument called an antenna, that send out microwave energy is inserted though the urethra to a location inside the prostate. The temperature becomes high enough inside the prostate to kill the extra tissue. As this part of the prostate heals, it shrinks, reducing the blockage of urine flow. This is an out patient procedure done under general or spinal anesthesia. The main complication of TUMP is the inability to urinate for more than a week but can be treated by inserting a catheter.
4. Surgical Treatment
4.1. Surgical removal of the prostate (Prostatectomy)
If your BPH symptoms are severe and all other treatment options have not been successful, surgery (prostatectomy) may be recommended. These surgeries remove large amounts of prostate tissue. They have to be performed in the hospital, require general anesthesia and carry risks of side effects. (ED and Incontinence being some of them).
4.2. Transuretheral resection of the prostate (TURP)
This is one of the most common surgeries performed. With TURP, the inner portion of the prostate is cut out through the urethra using a cystoscope. It is effective in most cases and can provide long-term relief. It requires a hospital stay. Side effects can include bleeding, loss of ejaculation and in rare instances, incontinence and erectile dysfunction.
4.3. Laser Surgery
This is essentially very similar to the TURP. Where as in the TURP the electric current is used to cut the prostate, here a laser beam is used instead. Laser surgery is a relatively newer treatment and its advantage is that bleeding is markedly reduced and patients can be discharged much sooner. With over 200,000 procedures performed worldwide, the GreenLight procedure is creating a new standard of care.
Comparing a TURP to GreenLight