Can an enlarged prostate shrink again?
Treatment options for BPH
Benign Prostatic Hyperplasia (BPH) is a common health issue, especially in older men. This benign enlargement of the prostate, also known as benign prostatic syndrome, can lead to a variety of unpleasant lower urinary tract symptoms (LUTS). In this article, we explore the causes and symptoms of BPH, as well as various treatment options, including conservative approaches and surgical procedures.
The exact cause of BPH is not yet fully understood, but it is believed that hormonal changes associated with aging play a crucial role. The process of prostate enlargement is usually associated with an overproduction of dihydrotestosterone (DHT), a breakdown product of testosterone.
Lifestyle changes such as reduced consumption of caffeinated, carbonated, or alcoholic beverages and adequate fluid intake throughout the day can alleviate LUTS symptoms. Avoiding fluid intake approximately two hours before bedtime and reducing diuretics can also be helpful. Treating chronic constipation to alleviate symptoms and learning bladder training and specific techniques to empty residual urine are recommended.
Treatment options for BPH - Phytotherapeutics
Over-the-counter herbal medicines such as saw palmetto, pumpkin seeds, nettle root, phytosterols, and grass pollen can alleviate mild symptoms. Only saw palmetto extract (Serenoa repens) has been proven to improve urine flow and nighttime urination with prolonged use.
Treatment options for BPH - medical
The common prescribed medication therapy for mild prostate enlargement includes alpha-blockers such as tamsulosin, alfuzosin, or doxazosin, as well as the PDE-5 inhibitor tadalafil. These medications relax the muscles in the lower urinary tract, significantly improving urine flow.
Alpha-blockers can cause side effects like low blood pressure, dizziness, and retrograde ejaculation, where seminal fluid goes backward into the bladder. PDE-5 inhibitors can cause headaches, facial flushing, stuffy nose, and digestive issues. For significant prostate enlargement, 5-alpha-reductase inhibitors like finasteride and dutasteride are effective. They inhibit the conversion of testosterone to dihydrotestosterone (DHT), slowing down prostate growth. However, this can lead to reduced sexual desire and erectile dysfunction, which may persist in rare cases even after discontinuing the medication.
For irritative symptoms like frequent urination urgency, anticholinergics can be added to relax the bladder muscles. The side effects are diverse, including dry mouth, constipation, headaches, restlessness, and memory problems. The high rate of bothersome side effects often leads to therapy discontinuation, making a change of medication sensible. Beta-3-adrenergic receptor agonists like mirabegron also relax the bladder and increase functional bladder capacity.
Surgical Treatment Options for Benign Prostatic Hyperplasia
If BPH symptoms are no longer controlled by medications or conservative measures, or if complications like urinary retention occur, surgical reduction of the prostate is necessary. Often, this can be done minimally invasively through the urethra.
A common surgical method is transurethral resection of the prostate, abbreviated as TUR-P. In this procedure, prostate tissue is endoscopically removed using an electrical loop. As with any surgery, there are risks of complications such as infections or bleeding. In rare cases, injury to the urethral sphincter can lead to incontinence. Nowadays, TUR-P is often successfully replaced by enucleation of the prostate. Various methods using lasers (holmium laser, thulium laser, or greenlight laser) or bipolar power source are used in this procedure. Other alternatives include prostate embolization, transurethral microwave therapy, water vapor or needle ablation. For mild symptoms, the insertion of tissue retractors (Urolift) without removing prostate tissue can also help.
In the treatment of an overactive bladder, injection of the neurotoxin Botox into the bladder muscle may also be considered.