Treatment

Benign Prostate Hyperplasia

Benign Prostatic Hyperplasia Treatment and Technology

Treatments for benign prostatic hyperplasia (BPH) vary according to the severity and intensity of the symptoms. We can distinguish between medical and surgical treatment:

Medical treatment

It is the treatment for most men with mild to moderate urinary symptoms. The risk of progression of prostate problems, which can reach up to 30% in large prostates, must be taken into account, as well as the efficacy and safety profile. Some prostate drug treatments cause sexual problems such as impotence, anejaculation or decreased sexual desire.

• Phytotherapy. It consists of plant extracts that improve urinary symptoms. It is indicated in mild and moderate symptoms without complications. It does not produce side effects in the sexual sphere.

• Alpha blockers. These are drugs that "open" the bladder neck and reduce symptoms, facilitating urination. They do not alter the natural history of the disease, so they could be considered "prostate analgesics". They have two side effects to be taken into account: arterial hypotension and the decrease, even elimination, of sperm with orgasm.
• 5-alpha-reductase inhibitors. These are drugs indicated in prostates larger than 40cc to reduce their size and improve urine flow by blocking an enzyme that the body needs to make dihydrotestosterone.

Its effects take some time to react, but this treatment reduces the risk of complications and the need for surgery in the long term. The main drawbacks are decreased sexual desire and possible erection problems.

Surgical treatment

When there are important symptoms or complications, the best alternative is surgery. Among the surgical options, there are minimally invasive ones that allow very short admissions and minimize the risk of complications.

Classic techniques

• Transurethral resection of the prostate (TURP). Classically, benign prostatic hyperplasia of less than 60cc has been treated by transurethral resection of the prostate (TURP). It consists of removing the prostatic adenoma little by little with a classic scalpel through the urethra, without incisions. This technique can lead to a series of complications such as bleeding, fluid absorption or the need for reoperation in the medium to long term.
• Open surgery. When the adenoma is larger than 60cc, classically open surgery was required, since it was not possible to remove all the tissue through the urethra. This technique is much more aggressive, but it manages to remove the entire prostatic adenoma, preventing the recurrence of the disease, there are no recurrences. Although it is effective and definitive, it has a lot of associated morbidity and mortality: bleeding, high percentage of blood transfusion, surgical wound, requires hospital admission and prolonged bladder catheterization, recovery and reintegration to our daily life is slower.

Modern techniques

• Holmium Laser (HoLEP). The most powerful deobstructive treatment with the best safety profile is prostatic enucleation with Holmium Laser. It is indicated for all prostate sizes and has the same efficacy as open surgery but with much less aggression and many fewer complications. In ROC Clinic we have more than 15 years of experience in this technique and we have performed more than 3,500 interventions with holmium laser.

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• Tulium laser (ThuLEP). The Tulium laser prostatic vapoenucleation technique allows the vaporization of prostate tissue through energy emitted continuously, unlike the Holmium laser, which does it in the form of pulses.

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• AquaBeam. This is a robotic treatment that vaporizes the prostate tissue using water. It is a very safe procedure with virtually no incontinence, erection problems or ejaculation disturbances. It is effective in medium to large prostates.

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• Rezum. It consists of the injection of water vapor into the prostate producing the unblocking of the lower urinary tract and improvement of symptoms. It does not cause side effects such as incontinence, erectile dysfunction or anejaculation. It is effective in small or medium sized prostates. It is a treatment valid only for patients strictly selected on the basis of a series of personal, clinical and anatomical parameters, with a mild condition and for prostates no larger than 80cc in size. It is usually presented as an alternative to medication.

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• Green laser. This treatment is indicated for prostates smaller than 60-80gr. It consists of vaporizing the prostate tissue through the urethra, making it disappear and thus eliminating the bladder obstruction. The functional results are similar to those obtained with classic transurethral resection of the prostate, but inferior to open surgery or prostatic enucleation.

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