As a man ages, his prostate becomes more likely to enlarge, clinically known as benign prostatic hyperplasia (BPH). Enlarged prostate becomes a problem when it causes an obstruction or some other kind of irritation, which can cause urinary symptoms such as frequent urination. If symptoms are moderate to severe, the physician will consider one of the following treatment methods:
- Medications;
- Surgical procedures; or
- Minimally invasive procedures.
WHEN IS IT INDICATED?
Treatment for enlarged prostate is dictated by the severity of symptoms. When a man begins to notice symptoms, his physician will consider treating the enlarged prostate.
PRE-TREATMENT GUIDELINES
Tests that may be conducted before a patient undergoes treatment include:
- Urinalysis;
- PSA;
- Digital rectal exam;
- Transrectal ultrasound;
- Renal ultrasound;
- Voiding velocity;
- Post-void residual;
- Cystoscopy;
- Urine flow study; and
- Urethral pressure profile.
The physician may request the patient discontinue use of anticoagulants, for example aspirin or warfarin (Coumadin).
WHAT TO EXPECT
Medications
When symptoms are moderate, the physician may recommend alpha-blockers or finasteride (Proscar).
Surgery
When a man’s symptoms from an enlarged prostate worsen despite medication use, he may be a candidate for surgery.
Transurethral resection of the prostate (TURP). During the procedure a surgeon inserts an instrument called a resectoscope into the penis through the urethra to the prostate. The resectoscope shaves away layers of prostatic tissue and seals blood vessels that are blocking the urethra.
Transurethral incision of the prostate (TUIP). Using a laser inserted through the penis and urethra, a surgeon cuts the bladder neck and prostate gland to relieve obstruction without actually removing any tissue.
Open prostatectomy. This surgery completely removes all obstructive tissue of the prostate through an incision in the abdomen.
Laser surgery. In this procedure, also known as interstitial laser coagulation therapy, a fiber optic device is inserted through a cystoscope through the penis to the prostate. A laser tip on the fiber optic device delivers energy to the prostate, destroying the parts of the oversized prostate tissue. The body naturally absorbs the destroyed tissue.
Minimally Invasive Procedures
Transurethral microwave thermotherapy (TUMT). Also called microwave therapy, TUMT is a procedure in which a catheter (a thin, flexible tube) inserted into the urethra administers microwave energy to kill excess prostate tissue.
Transurethral needle ablation (TUNA). Just before the procedure, the patient is given a local anesthetic. During the procedure, two radiofrequency-transmitting needles, the tips of which are tiny electrodes, are slid through the urethra from a cystoscope to the prostate. Radiofrequency energy sent through the needles heats the specified area of the prostate and destroys the excess prostate tissue.
Water-induced thermal therapy. This procedure is relatively new. After a local anesthetic is applied, a physician inserts a catheter through the urethra to the point where the prostate surrounds the urethra. A balloon at the end of the catheter is filled with circulating hot water that kills prostate tissues.
Alternative Therapy
The alternative therapy that has shown the most promise with enlarged prostate is saw palmetto (Serenoa repens). The extract is the oil from the berry, which mainly includes fatty acids and sterols.
The patient should discuss treatment with any herbal substance with his physician beforehand. Information on the effects of herbs and how they interact with conventional medication is limited.
POST-PROCEDURE GUIDELINES AND CARE
Surgery
TURP. After TURP, men stay in the hospital for 1 to 2 days and require a catheter to drain urine for 2 to 3 days. The physician will instruct the patient to avoid strenuous activity for approximately 3 weeks.
TUIP. Following this procedure, a catheter is inserted through the urethra into the bladder and may remain for 1 to 3 days.
Open prostatectomy. After the surgery, men will remain in the hospital between 7 and 10 days. The physician will insert a catheter to drain urine during that time. The physician may also prescribe antibiotics to prevent infection.
Physicians encourage patients to drink a lot of water during recovery to flush out the bladder and speed healing.
Laser therapy. The physician may require the patients to remain in the hospital overnight. Once discharged, the patient may leave with a catheter inserted for drainage. If left in place, the catheter may remain for 5 to 7 days following the procedure. The physician will prescribe antibiotics to the patient to be taken as long as the catheter is in place and for 3 to 5 days after it has been removed. The patient will be instructed to return for a follow-up visit 5 to 7 days following the procedure.
Minimally Invasive Procedures
TUMT. Immediately following the procedure, the patient is sent home if he is able to urinate.
TUNA. A catheter is usually inserted following the procedure and may remain in place for 1 to 3 days. The physician will usually prescribe antibiotics for 3 to 5 days after the catheter has been removed. Patients may not notice a change in symptoms for 2 to 6 weeks.
Water-induced thermal therapy. A catheter is usually inserted to help drain urine. The catheter may be left in place for 1 week; after removal, the patient’s urinary functions are monitored.
POSSIBLE COMPLICATIONS
Medications
Side effects of alpha-blockers may include:
- Dizziness;
- Fatigue; and
- Headaches.
Side effects from finasteride can include:
- Impotence;
- Decreased libido;
- Reduced semen release during ejaculation; and
- A decrease in PSA level.
Surgery
TURP. A patient may experience the following complications:
- Inability to urinate;
- Infection;
- Impotence;
- Loss of bladder control; and
- Retrograde ejaculation.
TUIP. Possible complications that may occur following TUIP may include:
- Retrograde ejaculation;
- Erectile dysfunction; and
- Incontinence (rare).
Open prostatectomy. A patient may experience one or more of the following complications:
- Bleeding;
- Formation of a urine filled cyst;
- Erectile dysfunction;
- Retrograde ejaculation;
- Infection (rare); and
- Non-urinary related complications (rare), such as deep vein thrombosis, pneumonia, pulmonary embolism, and heart attack.
Laser therapy. Complications that may follow laser therapy may include:
- Bleeding;
- Prolonged catheter drainage;
- Urinary tract infection;
- Epididymitis; and
- Narrowing of the urethra.
Minimally Invasive Procedures
TUMT. Complications following this procedure may include:
- Infection;
- Urinary retention;
- Incontinence;
- Erectile dysfunction; and
- Heart attack.
Patients are instructed to contact the physician immediately should any of the following occur:
- Inability to urinate;
- Painful urination;
- Fever; and
- Abdominal pain.
TUNA. Following transurethral needle ablation, a patient may experience one or more of the following complications:
- Urinary retention;
- Painful urination;
- Blood in the urine;
- Urinary tract infection;
- Urethral stricture; and
- Erectile dysfunction (rare).
