Currently, the main options to address BPH are: Watchful waiting Medication Surgery prostatic urethral lift, transurethral resection of the prostate, photovaporization of the prostate, open prostatectomy If medications are ineffective in a man who is unable to withstand the rigors of surgery, urethral obstruction and incontinence may be managed by intermittent catheterization or an indwelling Foley catheter which has an inflated balloon at the end to hold it in place in the bladder. The catheter can remain indefinitely it is usually changed monthly.
Watchful Waiting Because the progress and complications of BPH prostate hypertrophie unpredictable, a strategy of watchful waiting prostate hypertrophie no immediate treatment is attempted — is best for those with minimal symptoms that are not especially bothersome. Physician visits are needed about once per year to review the progress of symptoms, perform an examination and do a few simple laboratory tests.
During watchful waiting, the man should avoid tranquilizers and over-the-counter cold and sinus remedies that contain decongestants.
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These drugs can worsen obstructive symptoms. Avoiding fluids at night may lessen nocturia. Medication Data is still being gathered on the benefits and possible adverse effects of long-term medical therapy.
Currently, two types of drugs — 5-alpha-reductase inhibitors and alpha-adrenergic blockers — are used to treat BPH.
In some men, finasteride can relieve BPH symptoms, increase urinary flow rate and shrink the prostate, though it must be used indefinitely to prevent recurrence of symptoms, and it may take as long as six months to achieve maximum benefits.
An analysis of six studies found that finasteride only improved BPH symptoms in men with an initial prostate volume of over 40 cubic centimeters — finasteride did not reduce symptoms in men with smaller glands. Since finasteride shrinks the prostate, men with smaller glands are probably less likely to respond to the drug because the prostate hypertrophie symptoms result from causes other than physical obstruction for example, smooth muscle constriction. Finasteride use comes with some side effects.
Finasteride may also decrease the volume of ejaculate.
Another adverse effect is gynecomastia breast enlargement. A study from England found gynecomastia in 0.
Because it is not clear that the drug causes gynecomastia or that it increases the risk of breast cancer, men taking finasteride are being carefully monitored until these issues are resolved.
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Men exposed to finasteride or dutasteride are also at risk of developing post-finasteride syndrome, which is characterized by a constellation of symptoms, including some that are sexual reduced libido, ejaculatory dysfunction, erectile dysfunctionphysical gynecomastia, muscle weakness and psychological depression, anxiety, suicidal thoughts. These symptoms can persist long term despite discontinuation of finasteride. The fall in PSA levels, and any adverse effects on sexual function, disappear when finasteride use is stopped.
To obtain the benefits of finasteride for BPH without compromising the detection of early prostate cancer, men should have a PSA test before starting finasteride treatment. Subsequent PSA values can then be compared to this baseline value. If a man is already on finasteride and no baseline PSA level was obtained, the prostate hypertrophie of a current PSA test should be multiplied by two to estimate the true PSA level.
Any increase in PSA levels while taking finasteride also raises the possibility of prostate cancer. Alpha-Adrenergic Blockers These drugs, originally used to treat high blood pressure, reduce the tension of smooth muscles in blood vessel walls and relax smooth muscle tissue in the prostate.
As a result, daily use of an prostate hypertrophie drug may increase urinary flow and relieve symptoms of urinary frequency and nocturia. Some alpha-l-adrenergic drugs — for example, doxazosin Carduraprazosin Minipressterazosin Hytrin and tamsulosin selective alpha 1-A receptor blocker — Flomax — have been used for this purpose.
Lower daily doses of terazosin 2 and 5 mg did not produce as much benefit as the 10 mg dose. Possible side effects of alpha-adrenergic blockers are orthostatic hypotension dizziness upon standing, due to a fall in blood pressurefatigue and headaches.
In this study, orthostatic hypotension was the most frequent side effect, and the authors noted that taking the daily dose in the evening can mitigate the problem. An advantage prostate hypertrophie alpha blockers, compared to finasteride, is that they work almost immediately. They also have the additional benefit of treating hypertension when it is present in BPH patients. When the two drugs were compared in a study published in The New England Journal of Medicine, terazosin appeared to produce greater improvement of BPH symptoms and urinary flow rate than finasteride.
But this difference may have been due to the larger number of men in the study with small prostates, who would be more likely to have BPH symptoms from smooth muscle constriction rather than from physical obstruction by excess glandular tissue.
Symptoms of benign prostate enlargement
Doxazosin was evaluated in three clinical studies of men with BPH. Patients took either a placebo or 4 mg to 12 mg of doxazosin per day. Despite the previously held belief that doxazosin was only effective for mild or moderate BPH, patients with severe symptoms experienced the greatest improvement. Among men treated for hypertension, the doses of anti-hypertension drugs may need to be adjusted due to prostate hypertrophie blood-pressure-lowering effects of an alpha-adrenergic blocker.
Phosphodiesterase-5 Inhibitors Phosphodiesterase-5 inhibitors, such as Cialis, are commonly used for erectile dysfunction, but when used daily, they also can relax the smooth muscle of the prostate and overactivity of the bladder muscle. Studies examining the impact of daily Cialis use compared to placebo demonstrated a reduction in International Prostate Symptom Score by four to five points, and Cialis was superior to placebo in reducing urinary frequency, urgency and urinary incontinence episodes.
Prostate gland hypertrophy
Surgery Surgical treatment of the prostate involves displacement or removal of the obstructing adenoma of the prostate. Surgical therapies have historically been reserved for men who failed medical therapy and those who developed urinary retention secondary to BPH, recurrent urinary tract infections, bladder stones or bleeding from the prostate.
However, a large number prostate hypertrophie men are poorly compliant with medical therapy due to side effects. Surgical therapy can be considered for these men to prevent long-term deterioration of bladder function. Prostate hypertrophie surgical options include monopolar and bipolar transurethral resection of the prostate TURProbotic simple prostatectomy retropubic, suprapubic and laparoscopictransurethral incision of the prostate, prostate hypertrophie transurethral vaporization of the prostate TUVPphotoselective vaporization of the prostate PVPprostatic urethral lift PULthermal ablation using transurethral microwave therapy TUMTwater vapor thermal therapy, transurethral needle ablation TUNA of the prostate and enucleation using holmium HoLEP or thulium ThuLEP laser.
Thermal Treatments Thermal procedures alleviate symptoms by using convective heat transfer from a radiofrequency generator. Transurethral needle ablation TUNA of the prostate uses low-energy radio waves, delivered by tiny needles at the tip of a catheter, to heat prostatic tissue.
Retrograde ejaculation occurred in one patient. Another thermal treatment, transurethral microwave therapy TUMTis a minimally invasive alternative to surgery for patients with bladder prostatitis enterococcus kezelés obstruction caused by BPH. Performed on an outpatient basis under local anesthesia, TUMT damages prostatic tissue by microwave energy heat that is emitted from a urethral catheter.
A new form of thermal therapy, called water vapor thermal therapy or Rezum, involves conversion of thermal energy into water vapor to cause cell death in the prostate.
Make a Difference
With thermal therapies, prostate hypertrophie treatment sessions may be necessary, and most men need more treatment for BPH symptoms within five years after their initial thermal treatment. Like transurethral resection of the prostate TURPit is done with an instrument that is passed through the urethra. But instead of removing excess tissue, the surgeon only makes one or two small cuts in the prostate with an electrical knife or laser, relieving pressure on the urethra.
TUIP can only be done for men with smaller prostates. It takes less time than TURP, and it can be performed on an outpatient basis under local anesthesia in most cases.
A lower incidence of retrograde ejaculation is one of its advantages. Prostatic Urethral Lift UroLift In contrast to the prostate hypertrophie therapies that ablate or resect prostate tissue, the prostatic urethral lift procedure involves placing UroLift implants into the prostate under direct visualization to compress the prostate lobes and unobstruct the prostatic urethra.
The implants are placed using a needle that passes through the prostate to deliver a small metallic tab anchoring it to the prostate hypertrophie capsule. Once the capsular tab is placed, a suture connected to the capsular tab is tensioned and a second stainless steel tab is placed on the suture to lock it into place. The suture is severed. View a video of the UroLift procedure. It involves removal of the core of the prostate with a resectoscope — an instrument passed through the urethra into the bladder.
A wire attached to the resectoscope removes prostate tissue and seals blood vessels with an electric current.
A catheter remains in place for one to three days, and a hospital stay of one or two days is generally required. TURP causes little or no pain, and full recovery can be expected by three weeks after surgery.
Benign Prostate Hypertrophy
In carefully selected cases patients with medical problems and smaller prostatesTURP may prostate hypertrophie possible prostate hypertrophie an outpatient procedure. Improvement after surgery is greatest in those with the worst symptoms. The mortality from TURP is very low 0. Prostatectomy Prostatectomy is a very common operation. Aboutof these procedures are carried out annually in the U.
A prostatectomy for benign disease BPH involves removal of only the inner portion of the prostate simple prostatectomy. This operation differs from a radical prostatectomy for cancer, in all prostate tissue is removed. Simple prostatectomy offers the best and fastest chance to improve BPH symptoms, but it may not totally alleviate discomfort. For example, surgery may relieve the obstruction, but symptoms may persist due to bladder abnormalities.
The frequency of these complications depends on the type of surgery. Surgery is delayed until any urinary tract infection is successfully treated and kidney function is stabilized if urinary retention has resulted in kidney damage.
What is benign prostatic hyperplasia?
Since the timing of prostate surgery is elective, men who may need a transfusion — primarily those with a very large prostate, who are more likely to experience significant blood loss — have the option of donating their own blood in advance, in case they need it during or after surgery.
This option is referred to prostate hypertrophie an autologous blood transfusion. Open Prostatectomy An open prostatectomy is the operation of choice when the prostate is very prostate hypertrophie — e. However, it carries a greater risk of prostate hypertrophie complications in men with serious cardiovascular disease, because the surgery is more extensive than TURP or TUIP.
In the past, open prostatectomies for BPH were carried out either through the perineum — the area between the scrotum and the rectum the procedure is called perineal prostatectomy — or through a lower abdominal incision. Perineal prostatectomy has largely been abandoned as a treatment for BPH due to the higher risk of injury to surrounding organs, but it is still used for prostate cancer. Two types of open prostatectomy for BPH — suprapubic and retropubic — employ an incision extending from below the umbilicus navel to the pubis.
A suprapubic prostatectomy involves opening prostate hypertrophie bladder and removing the enlarged prostatic nodules through the bladder.
In a retropubic prostatectomy, the bladder is pushed upward and the prostate tissue is removed without entering the bladder. In both types of operation, one catheter is placed in the prostate hypertrophie through the urethra, and another through an opening made in the lower abdominal wall. The catheters remain in place for three to seven days after surgery.
The most common immediate postoperative complications are excessive bleeding and wound infection usually superficial. Potential complications that are more serious include heart attack, pneumonia and pulmonary embolus blood clot in the lungs. Breathing exercises, leg movements in bed and early ambulation are aimed at preventing these complications.
The recovery period and hospital stay are longer than for transurethral prostate surgery. Find a Doctor.
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