Possible Treatments for Benign Prostatic Hyperplasia

Benign Prostatic Hyperplasia (BPH) is an increase in the size of the prostate gland due to an increase in the number of gland cells and certain other cell types in the prostate gland. In BPH the prostate becomes enlarged as part of the aging process. BPH does not lead to prostate cancer, nor does it increase your chances of developing prostate cancer. BPH often results in difficulty with urination. BPH is generally observed in the middle-aged and elderly men.

The prostate is a gland found between the bladder (where urine is stored) and the urethra (the tube urine passes through) [Fig.1]. The prostate is a male gland that secretes the fluid (a part of the semen) which carries sperm from the testicles during ejaculation. As men age, the prostate gland slowly grows bigger (or enlarges). Usually, the prostate gland starts to enlarge after middle age. When the prostate becomes enlarged, the condition is called BPH, or benign prostatic hypertrophy. As the prostate gets bigger, it may press on the urethra and cause the flow of urine to be slower and less forceful. “Benign” means the enlargement isn’t caused by cancer or infection. “Hyperplasia” means enlargement. It is characterized by hyperplasia of prostatic stromal and epithelial cells, resulting in the formation of large, fairly discrete nodules in the periurethral region of the prostate.

The benign growth occurs when old cells do not die (as they once did) while new cells continue to grow. This accumulation of cells thickens the prostate, which can narrow the urethra, resulting in BPH. The causes of BPH are—aging is considered to be the main cause of BPH; low levels of testosterone leads to the higher proportion of estrogen that promotes the excessive growth of cells in prostrate region causing BPH; and high levels of dihydrotestosterone also contribute to BPH by helping the growth of new cells and allowing the old cells to survive for long time.

Symptoms of BPH include the following:

• Blood in the urine (i.e., hematuria), caused by straining to void
• Dribbling after voiding
• Feeling that the bladder has not emptied completely after urination
• Frequent urination, particularly at night (i.e., nocturia)
• burning sensation or pain during urination
• Hesitant, interrupted, or weak urine stream caused by decreased force
• Involuntary discharge of urinePushing or straining to begin urination
• Recurrent, sudden, urgent need to urinate

The Possible treatments for the BPH are—

1. Surgery

Surgery is considered the most effective treatment and is used in men with strong symptoms that persist after other treatments are tried. Surgery is usually done through the urethra, leaving no scars. Surgery usually offers relief from BPH for at least 15 years. Surgery for BPH leaves behind a good part of the gland, so it is still possible for prostate problems, including BPH, to develop again. Types of surgery done for treating the BPH that are explained as follows:

• Transurethral resection of the prostate (TURP)—In TURP, an instrument called a resectoscope is inserted through the penis. It is then guided to the constricted portion of the urethra within the prostate gland. A wire loop of the resectoscope then cuts the prostate tissue surrounding the urethra and cauterizes the surrounding blood vessels to prevent bleeding. The pieces of tissue are carried by fluid into the bladder and then flushed out at the end of the operation.
• Transurethral incision of the prostate (TUIP)—This process involves making a few small cuts in the prostate gland. This reduces the pressure on the urethra and permits urine to flow more freely. Approximately 80 percent of individuals treated with TUIP have experienced an improvement in the symptoms of BPH.
• Open prostatectomy—In part open prostatectomy the part of the prostate gland is removed and it is performed when transurethral procedures cannot be used. It is last procedure to be undertaken by the doctors and if no other treatment method is working.

2. Medicines

Oral Medicines are the safest and the most effective ways of the BPH treatments. Different medications that are used to treat BPH are as follows:

• Avodart (Dutasteride): Avodart contains Dutasteride that treats the swelling of the prostate that is caused in BPH. Avodart helps in improving the urinary flow and avoids the prostrate surgery. Avodart works by inhibiting the conversion of testosterone into dihydrotestosterone. It can take four to six months to experience the full effects of this drug. About two-thirds of individuals who choose Dutasteride therapy will experience an improvement in the symptoms of BPH. On average, the size of their prostates shrunk about 30 percent.
• Flomax (Tamsulosin): Flomax reduces the risk of acute urinary retention or an absolute blockage of urine. FLOMAX avoids the production of dihydrotestosterone from testosterone.
• Alpha blockers: These are drugs that can inhibit the contraction of the smooth muscle of the prostate gland and bladder neck and, in this way, improve the urinary flow rate. They do not reduce the size of the prostate.

3. Other treatments

• Transurethral needle ablation (TUNA): In this method, two needles are inserted into the prostate gland. Heat energy is then passed through the needles, causing shrinkage in the surrounding prostate tissue and a corresponding increase in the flow of urine.
• Balloon urethroplasty: A tube with a small balloon at the end is inserted through the urethral opening of the penis and guided to the constricted portion of the urethra, where the balloon is inflated. The pressure exerted by the balloon against the inside of the urethral wall increases the diameter of the urethra and improves the flow of urine.
• Laser prostatectomy: The laser energy vaporizes the offending prostate tissue. The laser energy burns the cells that are overgrown and reduces the size of the prostrate.
• Transurethral microwave thermotherapy: With this technique, precisely controlled microwaves are passed through a catheter inserted in the urethral opening of the penis, guided to the prostate gland, and focused on the prostate tissue. The size of the prostrate in reduced by killing the cells that are forming the extra size.

The oral medicines are found to be the best available treatment for the BPH as around 95% of the individuals taking the oral medications have found the relief from the BPH.