Treating an enlarged prostate (BPH)

OK, you have an enlarged prostate, and you have some of the symptoms. At some stage you'll probably need some treatment, whether drug, surgery, massage, natural, alternative or whatever, but there's no need to rush into things. In as many as one third of all mild cases the symptoms of BPH clear up naturally without treatment. So many doctors take a "wait and see" approach, suggesting regular check-ups to catch any problems early.

In any event, a doctor will probably prescribe antibiotics first to try to clear up any possible urinary tract infections (like prostatitis) that could be causing the symptoms before getting around to treating the enlarged prostate itself. Of course, if your symptoms get materially worse and become a real nuisance, you'll be recommended to proceed with a range of treatments. There are also some "alternative treatment" and natural herb options.

Self-care for an enlarged prostate

You may not be able to actively reduce your enlarged prostate by yourself, but you can often control your enlarged prostate symptoms by making a few lifestyle changes - and you may prevent your condition from worsening. Here are a few guidelines from the doctors:

Limit what you drink in the evening. If you don't drink water and other beverages after 7 p.m. (at least to some degree), you'll cut down your need to use the toilet at night. In particular, beverages like coffee and tea that contain caffeine will increase your urine production, cause bladder irritation and aggravate your symptoms (I know, I like expresso too).
Empty your bladder. Go often and well. Avoid letting your bladder get full. Try to urinate all that you can each time you use the toilet. For some men, sitting down makes things easier. Try following a daily time schedule for urinating, like you have to do when you're making a long trip or taking a tour on vacation.
Limit alcohol. Alcohol increases urine production and irritates your bladder (yes, I know, but...).
Watch out for over-the-counter decongestants. You may not credit this, but these drugs can cause the ring of muscles that control urine flow from your urethra (urethral sphincter) to tighten, making urination more difficult.
Keep moving. Activity is not only good for your health, but inactivity causes you to retain urine. Even a small amount of exercise can reduce urinary problems caused by an enlarged prostate. So get off that couch!
Stay warm. Cold weather can lead to urine retention and increase your urgency to urinate. I personally find icy air-conditioning in cinemas a real nuisance, how about you?

Drug treatments to reduce an enlarged prostate

The drug companies have spent a fortune trying to find a way to shrink or at least stop the growth of the prostate without surgery. Currently in the USA the FDA has approved six drugs to relieve common symptoms associated with an enlarged prostate.

Most doctors use medication as their the first-line treatment to reduce enlarged prostate symptoms. But there are drawbacks, drugs must be taken once or twice a day for the rest of a patient's life, and they're not cheap. Over time, the cost can become a heavy expense and the drugs don't work for everyone. What's more side effects can include fatigue, headache, dizziness, impotence and loss of sex drive.

Saw Palmetto: an alternative treatment for enlarged prostate?

Health food stores carry a number of herbal treatments that are marketed to treat prostate enlargement, including red clover, saw palmetto and a range of vitamin supplements. But only saw palmetto has been studied in large, long-term trials and proved to show some effectiveness. However, scientific data is still lacking.

Saw palmetto is extracted from the ripened berries of the saw palmetto shrub, has been used by millions of men to ease BPH symptoms and is often recommended as an alternative to drug-based medication. A fat-soluble saw palmetto extract with 85-95% fatty acids and sterols is the usual form taken. The most common dosage is 160 mg. twice daily if you have prostate trouble. The daily dosage range is 80 - 320 mg.

Note: a well-conducted study published in the February 9, 2006 edition of the New England Journal of Medicine found that saw palmetto was no better than a dummy pill in relieving the signs and symptoms of BPH.

Minimally Invasive Therapy (MIT)

Drugs don't work for everyone though, and of course they sometimes have unacceptable side-effects. In recent years a number of procedures have been developed that relieve BPH symptoms but are less invasive than conventional surgery. They all involve using heat to destroy the excess tissue in the enlarged prostate:

Transurethral microwave procedures (TUMT). This procedure uses microwaves to heat and destroy excess prostate tissue. It takes about 1 hour and can be performed on an outpatient basis without general anesthesia. So far there have been no reports of erectile dysfunction or incontinence after TUMT.

Results: reduces urinary frequency, urgency, straining, and intermittent flow. Does not correct the problem of incomplete emptying of the bladder.

Transurethral needle ablation (TUNA) This uses low-level radiofrequency energy through twin needles to burn away a well-defined region of the enlarged prostate.

Results: improves urine flow and relieves symptoms with fewer side effects when compared with transurethral resection of the prostate (TURP). No incontinence or impotence reported to date.

Water-induced thermotherapy. Uses heated water in a mini-baloon in the uretha to focus heat on the precise offending region of the prostate and destroy excess tissue.

Surgery for an enlarged prostate

Today it's used mainly for more severe signs and symptoms or if you have complicating factors, such as:

Frequent urinary tract infections
Kidney damage from urinary retention
Bleeding through the urethra
Stones in the bladder

Most doctors recommend removal of the enlarged part of the prostate as the best long-term solution for patients with BPH, but there are risks. With surgery for BPH, only the enlarged tissue that is pressing against the urethra is removed, not the whole enlarged prostate gland complex itself.

Surgery is usually successful in removing the obstruction and incomplete emptying of the bladder caused by BPH, may be the best option for some patients and can substantially, if not completely, alleviate the disease's symptoms, it comes with potential risks and costs. These include erectile dysfunction (25 percent, on average), incontinence (1 to 3 percent), retrograde ejaculation (75 percent) and blood transfusion (12 percent) [2].

And inevitably, surgery involves the expense and inconvenience of a stay in hospital (usually for one or two days), anaesthesia and a convalescence period of up to six weeks, although the new laser surgery options offer the chance of a major reduction in these timings.

What surgical options are available for enlarged prostate?

The choice of a particular surgical procedure is usually based on how bad your symptoms are and the size and shape of your prostate gland.

Transurethral resection of the prostate (TURP): This is the most common surgical treatment for BPH and is usually very successful. The TURP is performed by inserting a scope through the penis and removing the prostate piece by piece. A 2 to 3 day hospital stay is needed and activities are restricted for 4-6 weeks.
Transurethral incision of the prostate (TUIP): This procedure is similar to TURP, but is usually performed in men who have a relatively small prostate and is usually performed as an outpatient without need for a stay in hospital. Like the TURP, a scope is inserted through the penis until the prostate is reached, but instead of removing tissue,the urethra is widened by making a few small cuts in the bladder neck, where the urethra joins the bladder, and in the prostate gland itself.
Open Prostatectomy: An open prostatectomy is usually performed using general or spinal anaesthesia. An incision is made through the abdomen or perineal area (i.e., through the pelvic floor, including the region from the scrotum to the anus) and the prostate is removed. This is a lengthy procedure, and it usually requires a hospital stay of 5 to 10 days.

Laser Surgery

Laser surgery is a newer procedure basically the same as a TURP except tissue is removed by being removed by the laser "scalpel". There are other similar procedures available, such as those that destroy prostate tissue with heat generated by microwaves or lasers:

Photoselective vaporization of the prostate (PVP). PVP uses a high-energy laser to destroy prostate tissue and seal the treated area.
Interstitial laser coagulation. Unlike other laser procedures, interstitial laser coagulation places the tip of the fiberoptic probe directly into the prostate tissue to destroy it

Laser surgery has several advantages over the normal TURP procedures:

Laser surgery causes little blood loss
Laser surgery allows for a quicker recovery time
Newer laser procedures can be performed on an outpatient basis.

Laser surgery patients are usually released from the hospital within 24 hours and experience quicker recovery times than with TURPs or TUIPs.

Results of enlarged prostate surgery

Most men who have prostate surgery have improvement in urine flow rates and symptoms. But as mentioned earlier, there are risks which should not be discounted. Possible complications include impotence, urinary incontinence, retrograde ejaculation (semen flowing back into the bladder rather than out the penis), infertility, and urethral stricture (narrowing). So make sure your urologist explains them to you clearly, so that you can make a proper judgment on the best treatment for your enlarged prostate - after all, you, not he, will live with the results.