Minimally Invasive Therapy for Prostate Enlargement
Many men in their late 50s begin to have difficulties related to the urge to urinate frequently, having the need to urinate many times overnight, and possibly not getting to the bathroom in time and experiencing incontinence. Benign prostatic hyperplasia (BPH) is what these patients most likely suffer from.
Beginning in the early 1990’s a shift in treatment occurred from this being a disease that was treated exclusively by surgical intervention, to a disease that was predominantly treated with medical therapy. The surgical therapy that was used was a transurethral resection of the prostate (TURP) which is the removal of the prostate gland that occurs with the use of an instrument that is placed through the urethra (cystoscope) and the prostate gland is removed. The easiest way to think of the procedure is to visualize an orange. When you peel an orange, the rind is left behind, and the inside is eaten. If the prostate were an orange, when doing a TURP, the rind (the prostate capsule) is left behind, and the inside (the enlarged portion of the gland) is removed. It is this inner portion that is responsible for the symptoms that are associated with an enlarged prostate such as frequency, a poor flow, incomplete bladder emptying, voiding frequently overnight, and possible urinary incontinence.
Medication vs. surgery options
Several medications were developed that resulted in fewer prostatectomies being performed now. These medications fall into two categories. The alpha-blockers (medications such as Rapaflo and Flomax) work by relaxing a portion of the prostate so that the urethra, which runs through the central portion of the prostate, is not squeezed and the symptoms dissipate. The two alpha-reductase inhibiting drugs (Avodart and Proscar) work by shrinking the overall size of the prostate, however their results are not seen for approximately 6 months. Although these medications are very effective, they do not work in all patients, and others may not tolerate these drugs. It is this group of patients that seek out other alternatives for treatment.
Although TURP was at one time the most commonly performed surgeries in the US, today changes have occurred that do not reflect this. In a recent study in the Journal of Endourology (2014), it has been reported that over the last 10 years, the number of TURPs has fallen to 48% of all surgeries performed for BPH, while the number of laser prostatectomies has risen to 44%.
Laser prostatectomy falls into a category of Minimally Invasive Surgical Therapies (MISTs). These procedures, are in most cases as effective as the prior gold standard. The TURP - able to be performed as an outpatient - are associated with less blood loss, often can be performed on elder patients who may be sicker yet need the procedure, are associated with a decreased incidence of one of the more serious complications associated with TURP and are as effective. Patients like the concept of being treated with a laser, as it implies a newer technology that is less invasive.
Laser surgery for the prostate is clearly one of the best alternatives for the surgical treatment of BPH. If taking medical therapy and unhappy about how the results with the medication, you should discuss with your Urologist the possibility of undergoing a laser prostatectomy.
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Jay Motola, MD, is a board-certified urologist and attending physician, Department of Urology, Mount Sinai West, and Assistant Professor of Urology, Icahn School of Medicine at Mount Sinai. Dr. Motola is a summa cum laude, Phi Beta Kappa graduate of Boston University, and earned his medical degree at the State University of New York at Stony Brook.