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How can benign prostatic hypertrophy be treated?

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In brief: Treatments of Benign prostatic hypertrophy

The mainstays of treatment for BPH are drugs or surgery.
However, some men with mild symptoms opt for watchful waiting, where no treatment is undertaken but instead your condition will be monitored closely with routine check-ups. If your condition deteriorates you can then opt for treatment.

Drug treatment
There are two main classes of drugs that are prescribed for BPH:
• Alpha-blockers
• Five alpha reductase inhibitors (often written 5 alpha-reductase inhibitors)


Alpha-blockers work by relaxing the muscles at the neck of the bladder and in the prostate. In this way they reduce the pressure on the urethra and so help increase the flow of urine. They do not cure BPH but help to alleviate some of the symptoms. Around 60% of men find their symptoms improve significantly within the first 2-3 weeks of treatment with an alpha-blocker. There are several different five alpha blockers. Currently, these are doxazosin (Cardura), terazosin (Hytrin), tamsulosin (Flomax), alfuzosin (Xatral) and prazosin (Hypovase). They can also be used to treat high blood pressure. The most common side-effects of alpha-blockers are tiredness, dizziness and headache.


5 alpha-reducatase inhibitors work by inhibiting the production of a hormone called DHT, which contributes to prostate enlargement. Finasteride (Proscar) is the mostly commonly used drug of this type for BPH. Unlike alpha blockers, 5 alpha-reductase inhibitors are able to reverse BPH to some extent and so may delay your need for surgery.


Potential side-effects of finasteride include a reduced sex drive and difficulty in maintaining an erection. Several months of treatment may be needed before improvement is noticed.

Plant extracts
A range of plant extracts claim to alleviate BPH, although formal evidence that they are effective is often scanty. However, there is some scientific evidence that an extract of saw palmetto (called Serenoa repens) can be beneficial and it is a popular treatment for BPH, especially in Germany. If you decide you want to try a plant remedy, it’s always best to discuss this first with your doctor or pharmacist as interactions with conventional medicines are possible.

Surgery
There are three main surgical options for BPH:
• Transurethral resection of the prostate (TURP)
• Transurethral incision of the prostate (TUIP)
• Open prostatectomy


Transurethral resection of the prostate (TURP) is the most common operation for BPH. The procedure usually takes place under a general anaesthetic. A long thin instrument called a resectoscope is passed into the urethra. With a light source and lens on the end, it acts like a telescope, allowing the surgeon to view the prostate either directly or on a video monitor. A precisely controlled electric current, applied by a loop of wire at the end of the resectoscope, is used to shave off sections of the enlarged prostate.


TURP is an effective procedure with over 90% of men reporting an improvement after the operation. However, as with any surgical procedure, there is a risk of side-effects and complications. The most common side-effect (an unwanted effect that accompanies a successful treatment) of this procedure is retrograde ejaculation - where semen passes into the bladder during orgasm instead of out of the penis. This is sometimes called a dry orgasm. This is usually not a problem although it may reduce fertility. Complications of the operation can include some urinary incontinence or damage to the urethra, resulting in a stricture that can cause difficulty in passing urine.


Transurethral incision of the prostate (TUIP) may be appropriate for men who have a smaller enlarged prostate. It is a quicker operation than a TURP and involves removal of less tissue. It is performed under general or spinal anaesthetic. As with a TURP an instrument is passed up through the penis, but instead of removing a portion of the prostate, small cuts are made in the neck of the bladder and the prostate. This reduces the obstruction of the flow of urine.


Open prostatectomy is only recommended for those men whose prostate is very large. It is a major operation and carried out under a general anaesthetic. An incision is made in the lower abdomen in order to remove the central part of the prostate.

Other treatments
Laser therapy (using a laser probe to cut away prostate tissue) and transurethral microwave thermotherapy (using heat to remove some of the prostate tissue via a probe) are becoming more common in the treatment of BPH.

In brief: Treatments of Benign prostatic hypertrophy

The mainstays of treatment for BPH are drugs or surgery.
However, some men with mild symptoms opt for watchful waiting, where no treatment is undertaken but instead your condition will be monitored closely with routine check-ups. If your condition deteriorates you can then opt for treatment.

Drug treatment
There are two main classes of drugs that are prescribed for BPH:
• Alpha-blockers
• Five alpha reductase inhibitors (often written 5 alpha-reductase inhibitors)


Alpha-blockers work by relaxing the muscles at the neck of the bladder and in the prostate. In this way they reduce the pressure on the urethra and so help increase the flow of urine. They do not cure BPH but help to alleviate some of the symptoms. Around 60% of men find their symptoms improve significantly within the first 2-3 weeks of treatment with an alpha-blocker. There are several different five alpha blockers. Currently, these are doxazosin (Cardura), terazosin (Hytrin), tamsulosin (Flomax), alfuzosin (Xatral) and prazosin (Hypovase). They can also be used to treat high blood pressure. The most common side-effects of alpha-blockers are tiredness, dizziness and headache.


5 alpha-reducatase inhibitors work by inhibiting the production of a hormone called DHT, which contributes to prostate enlargement. Finasteride (Proscar) is the mostly commonly used drug of this type for BPH. Unlike alpha blockers, 5 alpha-reductase inhibitors are able to reverse BPH to some extent and so may delay your need for surgery.


Potential side-effects of finasteride include a reduced sex drive and difficulty in maintaining an erection. Several months of treatment may be needed before improvement is noticed.

Plant extracts
A range of plant extracts claim to alleviate BPH, although formal evidence that they are effective is often scanty. However, there is some scientific evidence that an extract of saw palmetto (called Serenoa repens) can be beneficial and it is a popular treatment for BPH, especially in Germany. If you decide you want to try a plant remedy, it’s always best to discuss this first with your doctor or pharmacist as interactions with conventional medicines are possible.

Surgery
There are three main surgical options for BPH:
• Transurethral resection of the prostate (TURP)
• Transurethral incision of the prostate (TUIP)
• Open prostatectomy


Transurethral resection of the prostate (TURP) is the most common operation for BPH. The procedure usually takes place under a general anaesthetic. A long thin instrument called a resectoscope is passed into the urethra. With a light source and lens on the end, it acts like a telescope, allowing the surgeon to view the prostate either directly or on a video monitor. A precisely controlled electric current, applied by a loop of wire at the end of the resectoscope, is used to shave off sections of the enlarged prostate.


TURP is an effective procedure with over 90% of men reporting an improvement after the operation. However, as with any surgical procedure, there is a risk of side-effects and complications. The most common side-effect (an unwanted effect that accompanies a successful treatment) of this procedure is retrograde ejaculation - where semen passes into the bladder during orgasm instead of out of the penis. This is sometimes called a dry orgasm. This is usually not a problem although it may reduce fertility. Complications of the operation can include some urinary incontinence or damage to the urethra, resulting in a stricture that can cause difficulty in passing urine.


Transurethral incision of the prostate (TUIP) may be appropriate for men who have a smaller enlarged prostate. It is a quicker operation than a TURP and involves removal of less tissue. It is performed under general or spinal anaesthetic. As with a TURP an instrument is passed up through the penis, but instead of removing a portion of the prostate, small cuts are made in the neck of the bladder and the prostate. This reduces the obstruction of the flow of urine.


Open prostatectomy is only recommended for those men whose prostate is very large. It is a major operation and carried out under a general anaesthetic. An incision is made in the lower abdomen in order to remove the central part of the prostate.

Other treatments
Laser therapy (using a laser probe to cut away prostate tissue) and transurethral microwave thermotherapy (using heat to remove some of the prostate tissue via a probe) are becoming more common in the treatment of BPH.
Quality HealthCare Team
Quality HealthCare Team
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