Transurethral resection of the prostate (TURP)

Surgical Treatment

Surgery involves removing the enlarged part of the prostate that constricts the urethra. It is recommended for patients who experience serious complications, such as the following:

Bleeding through the urethra as a result of BPH
Damage to the kidneys caused by urine backing up
Frequent urinary tract infections
Inability to urinate
Stones in the bladder

TURP

Transurethral resection of the prostate (TURP) is the gold standard to which other surgeries for BPH are compared. This procedure is performed under general or regional anesthesia and takes less than 90 minutes.

The surgeon inserts an instrument called a resectoscope into the penis through the urethra. The resectoscope is about 12 inches long and 3/8 of an inch in diameter. It contains a light, valves for controlling irrigating fluid, and an electrical loop to remove the obstructing tissue and seal blood vessels. The surgeon removes the obstructing tissue and the irrigating fluids carry the tissue to the bladder. This debris is removed by irrigation and any remaining debris is eliminated in the urine over time.

Patients usually stay in the hospital for about 3 days, during which time a catheter is used to drain urine. Most men are able to return to work within a month. During the recovery period, patients are advised to

avoid heavy lifting, driving, or operating machinery;
drink plenty of water to flush the bladder;
eat a balanced diet;
use a laxative if necessary to prevent constipation and straining during bowel movements.

Complications

Blood in the urine (hematuria) is common after TURP surgery and usually resolves by the time the patient is discharged. Bleeding also may result from straining or activity. Postsurgical bleeding should be reported to the urologist immediately.

Some patients have initial discomfort, a sense of urgency to urinate, or short-term difficulty controlling urination. These conditions slowly improve as recovery progresses, but it is important to remember that the longer the urinary problems existed before surgery, the longer it takes to regain full and normal bladder function after surgery.

Up to 30% of men who undergo TURP experience problems with sexual function. Complete recovery of sexual function may take up to 1 year. The most common, long-term side effect of prostate surgery is retrograde ejaculation (dry climax), which results when the muscle that closes the bladder neck during ejaculation is removed along with the obstructing prostate tissue. Semen enters the wider opening to the bladder instead of being expelled through the penis, causing sterility but not affecting the man's ability to experience sexual pleasure. This complication is not an issue for most men requiring prostate surgery.

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.http://www.urologychannel.com/prostate/bph/treatment_surg.shtml

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High Intensity Focused Ultrasound (HIFU)

High Intensity Focused Ultrasound (HIFU)

High intensity focused ultrasound (HIFU) is currently undergoing clinical trials in the United States. HIFU is a noninvasive treatment that uses precision-focused ultrasound waves to heat and destroy (ablate) targeted prostatic tissue without affecting healthy surrounding tissue. It has been shown to effectively treat BPH as well as localized prostate cancer. The Food and Drug Administration (FDA) has not yet approved this treatment in the United States.

In clinical trials, HIFU is performed on an outpatient basis, under anesthesia. HIFU can be repeated as necessary, and each treatment takes 1–3 hours. Following treatment, a catheter is necessary for about 1 week and most patients are able to resume regular activities within days. Impotence occurs in 1–7% of patients.
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Transurethral vaporization of the prostate (TUVP),

TUVP

Transurethral vaporization of the prostate (TUVP), also called vaportrode, involves direct application of heat (under 100° F) to the prostate tissue with a grooved roller-bar that vaporizes tissue. The immediate tissue loss leads to quick improvement of symptoms. The procedure takes from 20 to 65 minutes. The catheter is usually removed within 24 hours and most patients go home within 2 days.

http://www.urologychannel.com/prostate/bph/treatment_therm.shtml#laser
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Prostiva™ RF therapy

Prostiva™ RF therapy

Prostiva™ RF therapy, previously known as TUNA, may be used to treat symptoms of BPH in patients over the age of 50. RF therapy uses low-level radio frequency (RF) energy to destroy excess prostatic tissue, without damaging the urethra or surrounding healthy tissue. In this procedure, a small probe is inserted into the prostate through the urethra, and two electrodes are used to apply a low level of RF energy, which is directed to specific areas of the prostate to relieve obstruction.

RF therapy is performed in an office or hospital outpatient center and typically does not require general anesthesia. The procedure usually takes less than 1 hour to perform and often relieves BPH symptoms within 2 to 6 weeks.

Most patients are able to resume regular activity in 24–48 hours. Catheterization (usually not longer than 3 days) may be necessary following treatment. Side effects, which are usually minor and resolve without intervention during the healing period, include blood in the urine (hematuria), obstruction, discomfort or pain (may be relieved using over-the-counter pain relievers), and urinary tract infection (UTI; may require long-term medication).

Long-term complications (e.g., urinary retention, sexual dysfunction) are unusual and occur less often than following conventional procedures such as TURP.

http://www.urologychannel.com/prostate/bph/treatment_therm.shtml#laser
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AquaTherm™

The AquaTherm™ System uses water-induced thermotherapy (WIT) to destroy obstructive prostatic tissue and reopen the urethra. WIT can be performed in ambulatory surgery, outpatient surgery, or a physician's office. It takes only 45 minutes and does not require general anesthesia.

A catheter made up of four contiguous sections - the urinary drainage lumen, the positioning balloon, the treatment balloon, and the insulated shaft - is attached to a computer console that heats water to 60° C (140° F). Throughout the procedure, the computer console precisely maintains the water temperature at 60° C, and urine is allowed to pass by means of the urinary drainage lumen.

The urologist inserts the catheter through the urethra and into the bladder. Once the urinary drainage lumen and the positioning balloon reach the bladder, the positioning balloon inflates and secures the catheter. The treatment balloon, resting in the prostatic urethra (located directly below the bladder), inflates and fills with water. Temperature-controlled water circulates through the insulated shaft into the treatment balloon. The catheter conducts heat through the insulated shaft to the prostate gland, raises the temperature of the gland, and destroys the obstructive tissue. Destroyed tissue is either sloughed off or absorbed by the body over time. After 45 minutes of treatment, the catheter is removed.

Following the procedure, a urethral catheter remains in place for approximately 4 to 17 days, or until normal urinary flow is restored. Temporary hematuria, or blood in the urine, is usually present after the procedure, and treatable urinary tract infection or urinary urgency also may occur.
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Prolieve™

Prolieve™ Thermodilatation System is a transurethral microwave thermotherapy (TUMT) device that also uses a special balloon catheter to open up (dilate) the urethra, as well as microwave energy to heat and destroy enlarged prostatic tissue. In this procedure, the balloon catheter is filled with warm water. After the temperature of the tissue returns to normal, the urethra remains open. Prolieve™, which takes about 45 minutes, is performed in a physician's office under local anesthesia. In a recent study, about 5% of patients required catheterization following the procedure.
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CoreTherm®

An outpatient, microwave-generated heat treatment that destroys excess prostate tissue. CoreTherm uses a transurethral catheter containing a microwave antenna and an intraprostatic probe with three temperature sensors. This system takes into account the fact that different patients have differently sized prostates and different intraprostatic blood flows.

Continuous monitoring of intraprostatic temperatures, intraprostatic blood flow rate, progressive destruction of targeted tissue, and adjustable microwave power enable the physician to tailor treatment to the individual. These data are calculated and displayed in real time on a computer screen throughout the session, which helps the physician determine when to stop treatment.

Before the procedure, the bladder and bowel are emptied, and the patient is given a sedative, local anesthesia, and antibiotics. Urinary retention is a common temporary side effect. A urinary catheter is placed after treatment and removed within a couple of weeks.

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Cooled ThermoTherapy™TUMT™

Cooled ThermoTherapy/TUMT reduces BPH symptoms, preserves sexual function, and provides durable results using the Targis® system or the Prostatron® system. Treatment can be completed within 30 minutes, usually does not require anesthesia, and is performed in a physician's office or an outpatient setting.
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In this treatment, a specially designed antenna inside a catheter is inserted into the prostate through the urethra. This antenna is used to direct microwave energy into the prostate to heat and destroy enlarged tissue. During the procedure, cool water is circulated through the catheter to minimize patient discomfort, protect adjacent urethral tissues from excessive temperatures, and reduce the risk for serious side effects.
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Medication is often administered to reduce discomfort and help patients relax during the procedure. Many patients are able to read, watch television, or listen to music during treatment and some may experience the following:
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Bladder spasms
Pressure in the rectum
Sensation of needing to empty the bladder or have a bowel movement
Warm or burning sensation in the abdomen or penis
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Following treatment, anti-inflammatory medication and antibiotics may be prescribed. Most patients can resume normal activity immediately after treatment. Destroyed prostatic tissue is reabsorbed by the body or discharged in the urine over the course of 6 to 12 weeks and BPH symptoms gradually improve during this time.
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Side effects usually resolve without intervention within a few weeks of treatment and include the following:
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Frequent urination
Pink discharge in the urine or around the catheter
Soreness in the lower abdomen
Urethral inflammation and swelling (most patients require catheterization for 2–5 days)
Urgency (even after removal of the catheter)
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HoLAP (holmium laser ablation of the prostate)

HoLAP (holmium laser ablation of the prostate) involves using a laser to vaporize obstructive prostatic tissue. The decision whether to use HoLAP or HoLEP (holmium enucleation of the prostate) is based primarily on the size of the prostate. Ablation usually is performed when the prostate is smaller than 60 cc (cubic centimeters).
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HoLAP offers many of the same advantages as HoLEP when compared to traditional surgery (e.g., TURP). These potential benefits include a shorter hospital stay, less bleeding and shorter catheterization and recovery times.
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Patients who undergo HoLAP usually do not require overnight hospitalization and in most cases, the catheter is removed the same day or the morning following the procedure.
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Photoselective vaporization of the prostate (PVP)

Photoselective vaporization of the prostate (PVP) is a minimally invasive procedure that uses a special high-energy laser (e.g., GreenLight PVP™ Laser) to vaporize excess prostate tissue and seal the treated area.
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The procedure is performed on an outpatient basis in a hospital or surgical center and may be performed under local, spinal, or general anesthesia.
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PVP takes between 10 and 30 minutes to perform, depending on the size of the prostate and patients are usually discharged within a few hours.
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The type of laser used in PVP is delivered to the prostate through an endoscope (device that consists of a tube and an optical system) that is inserted into the urethra. The procedure prevents damage to surrounding tissue and minimizes side effects such as pain, blood in the urine (hematuria), and swelling.
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Many patients do not require a catheter after PVP, and those who do typically are catheterized for less than 24 hours. Patients are advised to avoid strenuous exercise for 2 weeks following the procedure and can usually resume regular activities the next day. PVP provides immediate and long-lasting results comparable with other minimally invasive procedures.
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Interstitial Laser Coagulation

Interstitial laser coagulation is often performed under local anesthesia on an outpatient basis. The Indigo LaserOptic Treatment® System uses a cystoscope through which a fiberoptic probe is directly introduced into the prostate. Heat energy is conducted through the probe for 3 minutes and quickly coagulates the obstructing prostate tissue. The process can be repeated to treat another area in the prostate, as determined by the physician. The procedure lasts approximately 30 to 60 minutes.
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Symptoms resolve over 6 to 12 weeks, as tissue is absorbed.
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After the device is removed, a Foley catheter is inserted to drain urine for several days, until bladder function returns.
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Blood in the urine is a common side effect of the procedure and resolves within a week or so. Erectile dysfunction (impotence), retrograde ejaculation, and incontinence are rare complications.
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BPH: Minimally Invasive Therapy

Minimally Invasive Treatment

Minimally invasive BPH treatments use state-of-the-art tools and techniques to reduce or eliminate symptoms. Men are treated on an outpatient basis in a urologist's office or the hospital.
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Other advantages of minimally invasive treatments are
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less pain,
faster recovery,
lower costs, and
local anesthesia and mild sedative.
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Usually, heat is used to destroy excess prostate tissue.
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Techniques differ in heat source, heat delivery method, side effects, and number of treatments.

Laser Treatments
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Interstitial Laser Coagulation
Photoselective vaporization of the prostate (PVP)
HoLAP (holmium laser ablation of the prostate)
Cooled ThermoTherapy™TUMT™
CoreTherm®
TherMatrx®
Prolieve™ Thermodilatation System
The AquaTherm™ System
Prostiva™ RF therapy ( previously known as TUNA)
Transurethral vaporization of the prostate (TUVP)
High Intensity Focused Ultrasound (HIFU)
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http://www.urologychannel.com/prostate/bph/treatment_therm.shtml#laser
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BPH: Symptoms

Important Facts

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Benign prostatic hyperplasia often causes urinary symptoms
Frequent urination, especially at night, is a sign of BPH
An enlarged prostate can cause difficulty urinating
Severe cases of BPH can cause an inability to urinate (urinary retention)
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Signs and Symptoms
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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)
Hesitant, interrupted, or weak urine stream caused by decreased force
Leakage of urine (i.e., overflow incontinence)
Pushing or straining to begin urination
Recurrent, sudden, urgent need to urinate
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In severe cases of BPH, another symptom, acute urinary retention (the inability to urinate), can result from holding urine for a long time, alcohol consumption, long period of inactivity, cold temperatures, allergy or cold medications containing decongestants or antihistamines, and some prescription drugs (e.g., ipratropium bromide, albuterol, epinephrine). Any of these factors can prevent the urinary sphincter from relaxing and allowing urine to flow out of the bladder. Acute urinary retention causes severe pain and discomfort. Catheterization may be necessary to drain urine from the bladder and obtain relief.

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http://www.urologychannel.com/prostate/bph/symptoms.shtml

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Source of Image:

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http://www.abbott.co.in/patientinfo.htm

Overview: The Urology Channel

a. & b. prostate interior
c. external sphincter

d. bladder trabeculation

Important Facts

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Benign prostatic hyperplasia, BPH, also is called an enlarged prostate gland
Tissue growth in the prostate gland is controlled by hormones
An enlarged prostate can cause urinary symptoms
BPH is a common condition in men over the age of 50
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Benign prostatic hyperplasia (BPH) is not simply a case of too many prostate cells. Prostate growth involves hormones, occurs in different types of tissue (e.g., muscular, glandular), and affects men differently. As a result of these differences, treatment varies in each case. There is no cure for BPH and once prostate growth starts, it often continues, unless medical therapy is started.

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The prostate grows in two different ways. In one type of growth, cells multiply around the urethra and squeeze it, much like you can squeeze a straw. The second type of growth is middle-lobe prostate growth in which cells grow into the urethra and the bladder outlet area. This type of growth typically requires surgery.
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Anatomy

The prostate is a walnut-sized gland located beneath the bladder and in front of the rectum. It is surrounded by a capsule of fibrous tissue called the prostate capsule. The urethra (tube that transports urine and sperm out of the body) passes through the prostate to the bladder neck. Prostate tissue produces prostate specific antigen and prostatic acid phosphatase, an enzyme found in seminal fluid (the milky substance that combines with sperm to form semen).
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Incidence and Prevalence
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It is difficult to establish incidence and prevalence of BPH because research groups often use different criteria to define the condition. According to the National Institutes of Health (NIH), BPH affects more than 50% of men over age 60 and as many as 90% of men over the age of 70.

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http://www.urologychannel.com/prostate/bph/index.shtml

BPH: Hydrotherapy

Hydrotherapy, or water therapy, is the application of water to initiate cure. All three forms of water (liquid, steam, ice) can be used therapeutically.
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Advantages to hydrotherapy are:
It is almost always available.
It is easy to learn and perform.
It is painless and has no ill side effects.
It is inexpensive and can be done at home.
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The goal of hydrotherapy is to improve the circulation and quality of blood. This is important because blood delivers nutrients to and removes wastes from tissues and organs. If circulation is poor or slow, healing nutrients cannot be delivered and toxins cannot be removed, which causes degeneration of the tissues and organs. By improving the quality of blood, more nutrients are available for cells to use and toxins are managed more efficiently.
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General therapeutic uses of hydrotherapy include:
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Pain and swelling of injuries
Fever
Elimination of toxins
Antispasmodic
Constipation
Improve immune function
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Alternating hot and cold (contrast hydrotherapy) is a common hydrotherapy treatment. The hot application expands blood vessels, filling them with blood, and the cold application constricts the blood vessels, forcing the blood to move on to other parts of the body. Hot and cold can be applied to any part of the body that is inflamed, congested, or injured. Treatment normally consists of applying a hot cloth for 3 minutes then a cold cloth for 30 seconds, alternating 3 times in a row.
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The treatment can be done several times a day. The amount of time the hot and cold is applied may vary (e.g., 5 minutes hot, 1 minute cold) as long as the cold application is of shorter duration than the hot. It is also important to end the treatment with the cold application. The hot application should be pleasantly hot
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Caution: Do not apply water that is hot enough to burn. People have different tolerance levels for hot water on different parts of their body.
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Tolerance levels can change from treatment to treatment, depending on emotional state, degree of injury or illness, and body temperature.
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Water works on the body reflexively. This means that when water is applied to one part of the body, other parts of the body are also stimulated by an arterial (blood vessel) reflex or spinal cord reflex. Hydrotherapy takes advantage of this reflexive action. For example, if the left foot is fractured and in a cast, an alternating hot and cold treatment can be performed on the right foot. Because of the reflexive action, the left foot obtains the benefits of the hydrotherapy treatment even though it was done on the right foot. This principle is also used when a hot and cold treatment is applied to the feet to treat the throat or sinuses.
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Hydrotherapy treatments include the following:
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Baths and showers Baths and showers can be healthy and healing. A hot bath or shower can encourage relaxation, reduce stress, and flush out toxins. Adding essential oils or herbs to the bath can enhance the therapeutic benefits. Cold baths and showers can be energizing and stimulating. A rinse of cold water after a hot shower can invigorate, boost the immune system, and improve blood flow.
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Hot foot bath
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A hot foot bath is the immersion of both feet and ankles in hot water for 10–30 minutes. It is an excellent way to draw blood from inflamed or congested areas of the body. Indications for use are foot and leg cramps, sore throat, cold, flu, nausea, insomnia, and chest or pelvic congestion.
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Heating compress
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The heating compress is an application of a cold compress to an area that is initially cooled by the water and then warmed by the influx of blood to the area. It is an effective therapy for sore throat, cold, flu, and sinus congestion when it is administered to the throat or feet. When the feet are treated, it is also known as warming socks or wet socks treatment.
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Contraindications
Skin conditions irritated by moisture
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Weak persons with low vital force
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Sitz bath
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A sitz bath is taken in just enough water to cover the buttocks, upper thighs, and lower abdomen. It is more labor intensive than other hydrotherapy treatments but it powerfully affects the pelvic and abdominal organs.
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Contraindications
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Peripheral vascular disease (arteriosclerosis, deep vein thrombosis, Buerger's disease)
Diabetes
Loss of peripheral sensation
Unconsciousness
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Castor oil pack
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Castor oil has been used therapeutically for hundreds of years, both internally and externally. Castor oil applied topically has many beneficial effects and can be used for almost any malady. The castor oil pack is a simple procedure, yet it can produce wonderful results. Physiological effects of the castor oil pack include, but are not limited to: stimulating the liver, increasing eliminations, relieving pain, increasing lymphatic circulation, improving gastrointestinal function, increasing relaxation, and reducing inflammation.
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Constitutional hydrotherapy
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The constitutional hydro is a series of hot and cold towels applied to the chest and back. This treatment is more involved than other hydrotherapy treatments but is very effective for almost every condition. Naturopathic physicians use this method for promoting overall health and immune system function.
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Indications
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Immune enhancement
Digestive problems
Bronchitis
Cold and flu
Premenstrual syndrome
Menstrual cramps
Cancer
Varicose veins
Hypertension
Arthritis
Diabetes
Depression
Psoriasis
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Contraindications
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Acute bladder infection
Acute asthma
Oral temperature less than 97° F
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http://www.alternativemedicinechannel.com/naturopathic/hydrotherapy.shtml

BPH: Alternative Treatments

Naturopathic Treatment
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The goal of benign prostatic hyperplasia (BPH) treatment is to reduce excessive cell growth by inhibiting the conversion of testosterone into the more potent hormone dihydrotestosterone (DHT) and by preventing estrogen from attaching to receptors in prostate tissue. From a naturopathic viewpoint, this is accomplished through nutrition and the use of supplements and herbs.
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Nutrition
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Eat whole, fresh, unrefined, and unprocessed foods. Include fruits, vegetables, whole grains, soy, beans, seeds, nuts, olive oil, and cold-water fish (salmon, tuna, sardines, halibut, and mackerel). Eating organic food helps reduce exposure to hormones, pesticides, and herbicides.
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Avoid refined sugar and flour, dairy products, refined foods, fried foods, junk foods, hydrogenated oils, alcohol (particularly beer), and caffeine.
Eliminate food sensitivities.
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Supplements
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Supplements are intended to provide nutritional support. Because a supplement or a recommended dose may not be appropriate for all persons, a physician (i.e., a licensed naturopathic physician or holistic MD or DO) should be consulted before using any product. Recommended doses follow:
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Amino acids – The combination of glycine, alinine, and glutamic acid (200 mg of each daily) reduces urinary urgency, urinary frequency, and delayed micturition (initiation of flow).
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Beta-sitosterol – 120 mg daily in 3 divided doses may help reduce symptoms. Beta-sitosterol also lowers cholesterol (a higher dose of 500 mg 3 times daily is required), which is important since high cholesterol levels can cause prostatic hyperplasia.
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Flaxseed meal – Grind and eat 2-4 tbsp daily. An alternative is to take 1 tbsp of flaxseed oil daily. Flaxseed oil is a good source of the essential fatty acid (EFA) alpha-linolenic acid (an omega-3 fatty acid).
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Flower pollen – Follow product directions. It has been used in Europe for over 25 years to treat BPH. Flower pollen is not the same as bee pollen.
Zinc picolinate – 30–50 mg daily. Zinc competes with copper for absorption; therefore, when supplementing long term with zinc, copper should also be supplemented. There are supplements available that contain both zinc and copper.
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Herbal medicines usually do not have side effects when used appropriately and at suggested doses. Occasionally, an herb at the prescribed dose causes stomach upset or headache. This may reflect the purity of the preparation or added ingredients, such as synthetic binders or fillers. For this reason, it is recommended that only high-quality products be used. As with all medications, more is not better and overdosing can lead to serious illness and death.
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These herbs may be used to treat BPH:
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Saw palmetto (Serenoa repens) – Inhibits the conversion of testosterone to DHT in the prostate, has an antiestrogenic effect, and helps improve all symptoms of BPH. Recommended dosage is 320 mg of extract (standardized to contain approximately 85% fatty acids and sterols) daily.
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Pygeum (Pygeum africanum) – Reduces BPH symptoms. Recommended dosage is 100-200 mg of extract (standardized to 14% triterpenes) 2 times daily.
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Stinging nettles (Urtica dioica) – The concentrated extract reduces symptoms. Recommended dosage is 120 mg daily.
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http://www.urologychannel.com/prostate/bph/treatment_alt.shtml