Sunday, February, 12, 2012

Enlarged Prostate

Table of Contents

Many herbs have been tried for treating an enlarged prostate. Saw palmetto has been used by millions of men to ease BPH symptoms and is often recommended as an alternative to medication. Some studies have shown that it helps with symptoms, but there is evidence that this popular herb is no better than a dummy pill in relieving the signs and symptoms of BPH. Further studies are needed. If you use saw palmetto and think it works, ask your doctor if you should still take it.

SURGERY

Prostate surgery may be recommended if you have:

  • Incontinence
  • Recurrent blood in the urine
  • Inability to fully empty the bladder (urinary retention)
  • Recurrent urinary tract infections
  • Kidney failure
  • Bladder stones

The choice of a specific surgical procedure is usually based on the severity of your symptoms and the size and shape of your prostate gland.

  • Transurethral resection of the prostate (TURP): This is the most common and most proven surgical treatment for BPH. TURP is performed by inserting a scope through the penis and removing the prostate piece by piece.
  • Transurethral incision of the prostate (TUIP): This procedure is similar to TURP, but is usually performed in men who have a smaller prostate. It is usually performed without the need for a hospital stay. Like TURP, a scope is inserted through the penis until the prostate is reached. Then, rather than removing the prostate, a small incision is made in the prostate tissue to enlarge the opening of the urethra and bladder outlet.
  • Simple prostatectomy : An open prostatectomy is usually performed using general or spinal anesthesia. An incision is made through the abdomen or perineum (the area behind the scrotum). Only the inner part of the prostate gland is removed. The outer portion is left behind. This is a lengthy procedure, and it usually requires a hospital stay of 5 to 10 days.

Most men who have prostate surgery have improvement in urine flow rates and symptoms. See prostate removal for a description of complications.

Other, less-invasive procedures are available. These use different forms of heat to destroy prostate tissue, including:

  • Radiofrequency energy -- transurethral needle ablation (TUNA)
  • Microwave energy -- transurethral microwave thermotherapy (TUMT)
  • Electrical current -- transurethral electrovaporization (TUVP)
  • Hot water -- water-induced thermotherapy (WIT)
  • Laser -- interstitial laser coagulation (ILC) and holmium laser enucleation of the prostate (HoLEP)

None of these techniques have been proven to be better than TURP. Patients who receive these less-invasive procedures are more likely to need surgery again after 5 or 10 years. However, these procedures may be a choice for:

  • Younger men (many of the less-invasive procedures carry a lower risk for impotence and incontinence than TURP, although the risk with TURP is not very high)
  • Elderly patients
  • Patients with severe medical conditions, including uncontrolled diabetes, cirrhosis, alcoholism, psychosis, and serious lung, kidney, or heart disease
  • Men who are taking blood-thinning drugs

Robot-guided prostatectomy is another newer technique. However, the technology is not widely available, and surgeon experience should be taken into consideration. In addition, there are no long-term studies of this surgery.

Another form of treatment is prostatic stents.

For more information, see prostate surgery.


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Review Date: 08/10/2009
Reviewed By: Reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc. Also reviewed by Scott Miller, MD, Urologist, private practice, Atlanta, Georgia.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)