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Enlarged Prostate (BPH)

Benign Prostatic Hyperplasia

Enlarged Prostate (BPH) Bothersome Symptoms Can Be Relieved Benign Prostatic Hyperplasia, or “BPH,” is the non-cancerous enlargement of the prostate gland and the enlargement of the tissue that surrounds the urethra. (The urethra is the urinary channel that runs through the middle of the prostate and extends from the bladder to the penile urethra.) When BPH occurs, the patient can experience significant urinary symptoms including the need to urinate at night, the need to urinate frequently or urgently, and a weak stream of urine. These symptoms are bothersome, and men experiencing BPH usually request treatment. The kind of treatment recommended depends upon the severity of the symptoms, as well as on the level of prostate enlargement.

BPH Symptom Index Test

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Medical Management of BPH
There are oral medications available by prescription for treating BPH. These products include Uroxatral, Flomax, Cardura and Hytrin. These agents work by relaxing the muscles within the prostate, resulting in less pressure on the urethra and a more efficient flow of urine. Other medications treat prostate enlargement by blocking certain hormones related to testosterone or dihydrotestosterone. These oral medications include Proscar and Avodart; they may cause the prostate to gradually shrink, improving symptoms for some patients; but this shrinking or “downsizing” of the prostate may take from six to twelve months, and not all patients respond well to this treatment.

Surgical Treatment of BPH
Surgical treatment for BPH is known as transurethral resection of prostate, or “TURP.” This technology uses electrocautery to remove enlarged tissue (“prostatic hyperplasia”) from the prostate. The Use of TURP requires experience in application to prevent such problems as bleeding, loss of urinary control, incontinence or erectile dysfunction (which the ability of the penis to become firm for sexual intercourse). It is more invasive than some other options, with some risk of side affects, but it rapidly brings about a more efficient urine flow through a larger and more efficient urethra.

Minimally Invasive Treatments for Enlarged Prostate (BPH)
Other treatments are less invasive, relying upon the slow heating of prostate tissue with radiant heat such as that generated in microwave or radiofrequency therapy. With the application of heat, changes occur to the cells in these areas—over a period of days or weeks, they shrink. One such treatment is known as “TUNA” (transurethral needle ablation of the prostate) or Prostiva. It involves using a scope to pass a pair of fine needles through the lining of the prostatic urethra. Once the needles are in place, a radiofrequency signal passed through them to gently heat the region. This shrinks the prostate tissue, causing the prostatic urethra to enlarge; the result is a higher and more efficient flow of urine. TUNA can be provided in a physician’s office, is widely available and is effective for appropriately-selected patients.

Another BPH treatment involves using laser light to treat the prostate. High intensity light is focused on target prostate tissues, causing tissue cell to vaporize. The two most commonly-used type of laser are the PVP (or “Green Light Laser”) and the Holmium Laser. One benefit of the Green Light Laser is its light is of a frequency that coagulates blood upon exposure, minimizing blood loss. The Holmium Laser is thought to penetrate tissue to a lesser depth; some believe it to be gentler on tissues and cause minimal voiding side affects.

Benefits and Risks
Medications help many men with urinary outlet obstruction symptoms. But these medications must be taken every day and can cause a drop in blood pressure or dizziness. If the obstruction in the prostatic urethra is too great, these medications may not work.The transurethral resection (or “TURP”) is a more invasive treatment and has some associated risks; however, it rapidly brings about a more efficient urine flow though a larger and more efficient urethra. Men with larger prostates or significant obstruction benefit most from this therapy.The benefits of Green Light and Holmium Laser treatments are similar in many respects to those of TURP.

The laser treatments demand less operative time, bleeding is less (particularly with the Green Light Laser) and healing tends to be faster, with a patient able to return to normal activities sooner. The variety of minimally-invasive treatments can be quite efficient for medium- to small-sized prostates, but may be less effective for treating larger prostates. Overall, these treatments are very effective at relieving symptoms for appropriately-selected patients.

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