Enlarged prostate or Benign Prostatic Hyperplasia (BPH) is a condition that affects more than half of men over 60 and even 90% of men over 85, according to the American Urological Association (AUA). 

You have been diagnosed with the BPH? Don’t panic, put simply, it is a non-cancerous enlargement of a prostate gland. Usually, it develops naturally with age and causes several problematic symptoms like frequent and urgent urination need, thus significantly influences the quality of life, yet it is not life-threatening. In many cases the symptoms are severe, and patients need to use a catheter, because it got impossible to pass water, and the urine which stayed in the bladder could cause infections.

Despite the fact that the BPH is such a common issue, until recently medicine has not come up with a really effective solution that would provide significant improvements with minimal invasiveness and low risk. Usually, the first step is herbal teas and medications, later prescribed drugs, but those are often not efficient enough. When the problem starts being unbearable, men start searching for surgical methods.

The greatest fear is side-effects – urinary and sexual dysfunctions, impotence, surgery complications. Luckily, medical science is working on new treatment strategies that show promising results and offer opportunities for Patients to come back to their normal life without significant potential complications.

Available Treatments for Enlarged Prostate

At the moment patients that look for enlarged prostate treatment may choose from several different procedures. Most of them require less or more invasive surgeries and are recommended depending on the severity of symptoms. In the table below you can find a quick summary of the most common methods including: TURP, Open Prostate Surgery, HoLEP, UroLIFT and Prostate Artery Embolization (PAE).

PAE (Prostate Artery Embolization, sometimes called Prostatic Artery Embolisation) – 

During PAE procedure, like in none of listed above, the prostate tissues are not damaged, also no resectoscope or laser tool is inserted through the urethra. The idea is to let the prostate shrink itself, by blocking the arteries and blood vessels, that surround the gland. Lower blood supply (which “feeds” the prostate) causes it to shrink with time. Usually, it takes about 2-3 weeks to notice the results, some patients may wait a few weeks longer for the significant change. 

Prostatic Artery Embolisation

The surgery itself lasts about 1,5 hour and is performed under a local anesthetization. The patient stays in the clinic overnight. After the detailed qualification (pelvis MRI, CT of the pelvis and femoral arteries CT with contrast agent as well as a urologist and vascular consultation) the operating doctor (experienced vascular surgeon or interventional radiologist) fulfils the surrounding blood vessels (that nourish the prostate gland) with special molecules (round microspheres, embolization molecules), to reduce the blood supply, and in effect, reduce the prostate. The surgeon will enter the blood vessels that supply blood to the prostate via your groin. A tiny incision will be performed (no stitches needed). Little particles (embolization molecules) are injected through the catheter. Following this procedure, the prostate gland will begin to shrink, relieving symptoms.  

The National Institute for Health and Care Excellence (NICE), which provides national guidance and advice to improve health and social care, has decided that the current evidence on the safety and efficacy of prostate artery embolization for benign prostatic hyperplasia is adequate to support the use in male patients suffering from BHP.

In some European countries, the procedure became popular, thanks to the low invasiveness. In the UK this kind of treatment is still not widely available (only in major cities) and expensive, but in our southern neighbour countries, there are some high-specialized private facilities, where prostate artery embolization can be achieved at the favourable price.

Transurethral resection of the prostate (TURP)

Transurethral resection of the prostate (TURP) has been long considered a golden standard in enlarged prostate treatment providing good effects and at the same time being less invasive than the open surgery. In this procedure, the excess prostate tissue is removed with use of the resectoscope which is inserted through the urethra. After the procedure the patient needs to wear a catheter because of the swelling that may influence urination and is likely to stay in the hospital for at least 24 to 48 hours. TURP is usually recommended for patients that experience moderate BPH symptoms. Despite being very effective treatment it also carries several risks which may include temporary difficulty urinating, urinary tract infection, retrograde ejaculation (common and long-term effect), erectile dysfunction (rare), etc. Furthermore, recently number of new less invasive procedures have been developed, that are claimed to be more successful, to cause fewer complications and shorter recovery period.

Open Prostate Surgery (Prostatectomy)

Prostatectomy procedure is recommended in cases of greatly enlarged prostate where the other treatments have not provided significant improvements. It is also useful when having bladder damage, bladder stones or if the urethra is narrowed.This is the most invasive surgery, which takes an incision in the abdomen to get to the prostate gland in order to remove an excessive tissue. The common side-effects are similar to TURP and there is a long recovery period involved (few weeks to several months).

Laser surgeries (HoLEP)

Laser Prostate Treatment

This is the group of minimally invasive surgeries where the principle is similar to TURP, but the difference is that it uses holmium laser as a tool for tissue removal. The most popular surgery of this type is called Holmium Laser Enucleation of the Prostate (HoLEP). Being less invasive than TURP laser surgeries offer quicker recovery and symptoms relief, nevertheless may cause painful urination for a few weeks and side effects such as retrograde ejaculation are involved. This method can be also used for severely enlarged prostate.

UroLift

The UroLift System treatment uses tiny implants to hold open the obstructed pathway that is blocking urine flow.

UroLift Procedure

The specially designed UroLift Delivery Device is inserted transurethrally (through the penis) to access the enlarged prostate. Implants are permanently placed to lift and hold the enlarged prostate tissue out of the way and increase the opening of the urethra. This treatment gives immediate results, and the prostate tissues are not removed, also erectile functions are preserved. However, there are some issues that may arise after your procedure. Pain and sensitive while urinating during the recovery period is normal along with several other urinary issues that may arise. For the first week of recovery, penis pain will be prevalent but will subside by the second or third week of recovery. One of the chief issues to guard against is an infection. One out of seven patients report that treatment may not relieve all the symptoms so that they require further treatment within 5 years. Also, some of the patients do not feel comfortable with the awareness of having a foreign body on the prostate gland.

Conclusions:

Luckily, nowadays there are many different surgical methods of benign prostate hyperplasia treatment. Each patient should consider the possible benefits and risks, before deciding on the particular technique. What should be taken into consideration is not only the effects regarding BPH symptoms but also side-effects regarding other functions like maintaining the sexual functions, removal or preserving the prostate tissues, way of getting to the prostate gland – through the urethra (penis), through the groin or abdominal. 

Remember, that whenever you start feeling the problems with urination, you shouldn’t wait to see a doctor. Sometimes the frequent urination might be a sign of prostate cancer, and the early detection may give the chance for a full recovery. Also, if the diagnose is BPH, waiting too long may lead to the need of using a catheter daily, bladder infections etc.