What are the advanced treatment options for an enlarged prostate?

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Enlarged prostate

Benign Prostatic Hyperplasia refers to the development of stromal-glandular hyperplasia in the prostate gland that causes enlargement of the prostate or enlarged prostate and compression of the urethra. 

It is a progressive medical condition that gives rise to several uncomfortable lower urinary tract issues. Some of these may include weakened urinary stream, frequent and urgent urination especially at night, blockage of urine flow, and sensation of incomplete emptying of the bladder. 

Medical Science has seen revolutionary headway in the past few decades and this has made the treatment of many diseases easier and more successful. The same is the case with benign prostatic hyperplasia. The most commonly used surgical treatment of BPH, known as an open prostatectomy, can successfully reduce most of the enlarged prostate to relieve the compression of the urinary tract. 

Open prostatectomy is an invasive procedure and can lead to morbidity and despondency. It would require a significant abdominal incision and consequently longer hospitalization and slower recovery. Despite being a successful treatment for BPH,  around 20% of patients have a recurrence of BPH within 10 years after an open prostatectomy, and around 15% of the patients suffer from serious complications.

To overcome such issues, urologists now use advanced and less invasive techniques for enlarged prostate treatment. The technologically advanced minimally invasive procedures that make use of laser for depleting hyperplasia have had impressively successful outcomes to date, and have been able to avoid the complications of traditional open prostatectomies. 

Advanced Laser Treatments for Benign Prostatic Hyperplasia

HoLEP: Holmium Laser Enucleation of the Prostate, more commonly known as the HoLEP procedure involves the use of a holmium laser beam by a urologist to treat benign prostatic hyperplasia. In simpler words, the excess hyperplasia tissue is removed from the prostate without cutting into it. Depending on the size of the prostate, the procedure could take 1 to 2 hours. 

Before the procedure begins, the patient is given general or spinal anesthesia to numb all sensations waist-down. Once the anesthetic has kicked in, a telescopic camera is inserted through the penis and a holmium laser is used to enucleate the excess tissue. Finally, the separate tissue is moved into the bladder, grounded up, and sucked out with special equipment. The tissue sample is later sent to a laboratory to rule out cancer. 

Rezum Water Vapor Therapy: This is an invasive treatment that controls the lower urinary tract issues caused by BPH without the side effects that medicines may cause. Rezum relies on the body’s natural systems to minimize the prostate tissue and relies on the body’s natural systems to minimize the prostate tissue uses thermal thermal energy to treat the hyperplasia tissue in the prostate without its removal. Numerous prostates can be treated with this technique, and most patients are able to get on with their routine lives a few days after the procedure. 

Greenlight Laser Therapy:  This technique involves the use of high-powered laser energy to heat the prostate until it vaporizes. The process is repeated and continued until all the enlarged hyperplasia tissue has been completely removed from the prostate, and lower urinary tract symptoms are completely relieved. The procedure can require an overnight stay in some cases, depending on the patient’s medical condition, age, and general health. 

Urolift: Urolift is not the same as Rezum or Greenlight therapy as it does not depend on the shrinkage of the prostate tissue. It involves the use of some anchors or retractors into the sides of the prostate to widen the urethral opening. By pulling the prostate lobes away from each other, this technique relieves the pressure on the urethra and alleviates the symptoms of BPH. 

Minimally invasive  treatment options for Benign Prostatic Hyperplasia

Transurethral Needle Ablation:  This is a minimally invasive technique that uses radiofrequency waves to treat benign prostatic hyperplasia. It is done under the influence of a local anesthetic and makes use of radio frequencies to heat up and destroy enlarged prostate issues. First, a cystoscope is inserted through the urethra to reach the prostate, and then small needles are inserted through the scope to emit high-frequency radio waves that would destroy the hyperplasia tissue. The procedure is quite suitable for men that have other medical conditions and are required to avoid anesthetics. 

 Transurethral Electrovaporization: TUVP treats benign prostatic hyperplasia by using an electric current to destroy the prostatic tissue. It is a minimally invasive procedure in which a scope is inserted through the penis and a controlled electric current destroys the enlarged tissue. Blood vessels are sealed properly to avoid the risk of bleeding. The patient may be required to stay in the hospital for a couple of days after the treatment. 

Prostatic Stent Insertion: Stents placed in the prostatic urethra and the bladder neck to treat benign prostatic hyperplasia. This procedure is minimally invasive and prevents the prostatic urethra from collapsing and allowing urine true drain from the bladder. The stents expand like a spring and keep the urethra open for the urine flow. However, stents may cause increased urination and mild discomfort to the patient. 

Transurethral Microwave Thermotherapy: TUMT  involves the use of microwaves to treat benign prostatic hyperplasia. An antenna is used to send microwaves through a catheter to the prostate to destroy the enlarged hyperplasia tissue with heat from the microwaves. Being a minimally invasive procedure,  transurethral microwave thermotherapy is done on an outpatient basis and is completed within an hour without any anesthesia. It should be noted that microwave therapy does not eliminate BPH but reduces symptoms like frequent urination, urgency, and straining to a significant level. 

The goal of benign prostatic hyperplasia (or enlarged prostate) surgery

Treatment for benign prostatic hyperplasia aims to make the prostate gland smaller so that it does not compress the urethra and the bladder. In most surgical procedures, small instruments are inserted through the urethra to access the prostate and to remove the enlarged prostate tissue. Consequently, the pressure on the bladder is relieved and the urethra widens in size. If the prostate has enlarged very much,  it may need to be operated upon from the outside through an incision. However, this is rarely necessary as most prostates can be treated with minimally invasive surgical techniques. 

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