Methods of Treatment for Prostate Enlargement
There are three ways you can go when dealing with this problem: watchful waiting, medications and prostate surgery. However, no matter what method you choose – be surgical intervention or prostate treatments – you should discuss your decision with your doctor.
“Watchful Waiting”
This is the easiest and for some people the best variant – if your symptoms do not bother you too much, you can simply visit your doctor regularly and monitor the condition of your prostate gland. There is nothing you need to do – just make sure the growth doesn’t continue making your life difficult.
Medications as Prostate Treatments
Alpha-blockers. These prostate treatments relax the muscles surrounding the bladder and increase the urine flow. These drugs are highly effective – more than 70% of patients respond to them after just a few weeks, and significant improvement is reported. However, alpha-blockers are likely to cause side effects, such as low blood pressure, fatigue and dizziness. The most popular alpha-blockers are terazosin (Hytrin), doxazosin (Cardura), alfuzosin (UroXatral) and tamsulosin (Flomax).
In many patients 5-alpha reductase inhibitors (testosterone blockers) can also have positive effects on the size of the prostate: it shrinks and the urine flow is partially or completely restored. The downside of this treatment for prostate enlargement is that it may take some time to feel its effects – from three months to half a year. Another complication is the development of impotence in 4% of the patients. The most common 5-alpha reductase inhibitors are dutasteride (Avodart) and finasteride (Proscar).
Prostate Surgery
Although this is the method with the highest percentage of effectiveness, it is also the most dangerous one, as a number of complications can develop as a result. Therefore, prostate surgery should be first discussed with your doctor to make sure no other methods can help. Prostate biopsy can be ordered by your health care provider to make sure the diagnosis is accurate. There are several kinds of surgery:
1. Transurethral resection of the prostate (TURP). This surgery is the most common one. It is performed with the help of an electrical loop inserted through the urethra all the way to the prostate. The loop burns the tissue blocking the urethra and makes it less narrow. The whole procedure lasts about an hour and a half and is performed under a general or spinal anesthesia. This surgery has one side effect called retrograde ejaculation. Retrograde ejaculation involves incorrect flow of the semen: it flows into the bladder which results in so-called “dry orgasms.”
2. Transurethral incision of the prostate (TUIP). TUIP is a different surgery: small cuts are made in the bladder opening instead of burning the prostate tissue. This surgery is safer as it has a much lower complication rate and doesn’t require the patient to stay in hospital overnight. However, there are some long-term effects that can be the matter of concern for some patients.
3. Transurethral microwave thermotherapy (TUMT). TUMT is a procedure performed with the help of a microwave antenna inserted into the urethra. The antenna heats the prostate destroying the tissue that has grown. Even though the procedure is safer than the previous ones and costs less, every second patient will need another surgery within three to four years.
4. Transurethral needle ablation of the prostate (TUNA). This surgery is performed with a heated needle and burns away small amounts of prostate tissue. TUNA has fewer complications and side effects than other surgeries as it targets smaller portions of the growth.
5. Transurethral ultrasound-guided laser-induced prostatectomy (TULIP). This method involves the use of ultrasound: the surgeon uses a laser beam to remove the tissue that impedes the urine flow. Prostate prognosis is highly positive.
6. Visualized laser assisted prostatectomy (VLAP) is a procedure similar to TULIP with a telescope used instead of ultrasound.
7. Open surgery. In some cases when the condition has been long time neglected and the prostate is too big, a more serious operation is required. An incision above the pubic bone is performed and the tissue is removed. In some cases this is the only way to prevent serious complications, such as bladder damage.
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