Benign Prostatic Hyperplasia (BPH) Treatment Methods

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Benign Prostatic Hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland, commonly affecting older men. Treatment options are categorized into medication, surgery, and non-surgical therapies.

Medication

  1. Alpha Reductase Inhibitors:
    • These medications inhibit the conversion of testosterone to its active form, dihydrotestosterone (DHT), which can help reduce the size of the prostate.
    • Side Effects: Loss of libido, erectile dysfunction, breast enlargement and tenderness, decreased sperm count.
  2. Alpha-Blockers:
    • These drugs relax the smooth muscles in the bladder neck and prostate, easing urine flow.
    • Administration: Taken orally once a day.
    • Side Effects: Headache, dizziness, fatigue, weakness, and a drop in blood pressure.

Surgical Treatment

  1. Transurethral Resection of the Prostate (TURP):
    • The most common surgical method for BPH. Under general or spinal anesthesia, a special instrument (resectoscope) is inserted through the urethra to remove prostate tissue.
    • Procedure: The resectoscope uses electrical current to cut prostate tissue, which is then removed by vacuum. A catheter is placed post-surgery for 2-3 days to aid in urination.
    • Recovery: Short hospital stay and relatively quick recovery.
  2. Open Prostatectomy:
    • This surgery is used for significantly enlarged prostates. It involves making an incision in the lower abdomen to remove the prostate tissue.
    • Procedure: Under general or spinal anesthesia, an incision is made in the lower abdomen, and prostate tissue is removed. Catheters may be placed to drain the bladder post-surgery.
    • Recovery: Longer hospital stay and recovery period compared to TURP.
    • Indications: Used for very large prostates, presence of bladder stones, or when TURP is not feasible.

Non-Surgical Treatment: Thermotherapy

Thermotherapy is a modern, minimally invasive treatment for BPH, avoiding the risks of surgery and anesthesia.

  • Procedure:
    • A catheter-like device is inserted into the prostate through the urethra under local anesthesia.
    • The device emits energy to heat and reduce prostate tissue, typically in a 60-minute session.
    • Can be performed in outpatient settings without the need for hospitalization.
    • Patients can urinate immediately post-procedure and return home the same day.

Advantages of Thermotherapy:

  • No need for general or spinal anesthesia.
  • Minimal side effects, making it suitable for high-risk patients (e.g., those with heart disease, Alzheimer’s, stroke, on anticoagulants, or using permanent catheters).
  • Effective for younger, low-risk patients fearful of surgery.
  • Useful in treating chronic prostatitis.

Effectiveness and Safety:

  • Endorsed by the European Urology Association (EUA) and American Urology Association (AUA) as an alternative to surgical interventions.
  • Studies comparing thermotherapy with TURP show a symptom reduction score of 65% for thermotherapy and 77% for TURP. The near-equivalent efficacy with fewer risks and side effects underscores the benefits of thermotherapy.
  • Avoids potential complications of surgery, such as mortality, urethral stricture, and erectile dysfunction.

Accessibility:

  • Thermotherapy is a convenient, outpatient procedure, making it accessible for patients from various regions without the need for hospitalization.

Conclusion

BPH treatment options range from medications to surgery and non-surgical therapies like thermotherapy. The choice of treatment depends on the severity of symptoms, prostate size, patient’s health status, and preference for less invasive options. Consulting with a healthcare provider can help determine the most appropriate treatment plan.

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