Management and Treatment of Prostatic Adenoma

25% of men with prostatic adenoma will require treatment. Treatment can help relieve the urinary symptoms associated with prostatic adenoma. According to the severity of symptoms and prostate size, prostatic adenoma can either be treated surgically, or without surgery with medication or alternative techniques.
 

Surgical Management

Severe lower urinary tract symptoms will require surgical removal of the prostate or of some of the tissues causing obstruction. Each type of surgery has its advantages and disadvantages. It is best for the patient to discuss which procedure will be performed with his doctor.

  1. Transurethral resection of the prostate (TURP)
  2. Resectoscope

    Resectoscope

    TURP is the gold standard when it comes to surgical treatment. It is the most common surgical procedure performed for prostatic adenoma. The patient is given general or spinal anaesthesia for this procedure. A tube-like device with a hoop at the end is inserted through the urethra. An electric current is used to heat this loop which enables the surgeon to cut strips off an enlarged prostate. This procedure usually takes between 60 and 90 minutes. Most patients are recommended to sleep in hospital the night of the surgery for observation. A catheter is inserted for a few days after surgery.

  3. Enucleation by Holmium laser
  4. This is a procedure which, with the help of a laser, removes the parts of the prostate which are causing obstruction. General or spinal anaesthesia is used. A device is inserted via the urethra to reach the prostate. A catheter is also required for a few days after surgery.

  5. Open Prostatectomy
  6. Open surgery is only rarely required. It is done in very large prostates or if there are other associated problems like bladder stones. If the prostate is more than 100cm3 open surgery will have to be performed. Open surgery is either performed suprapubically or retropubically (above or below the bladder). The suprapubic option is used when bladder stones are present.

  7. Transurethral needle ablation
  8. Needle ablation therapy computer and device

    Needle ablation therapy computer and device

    This procedure is usually done with local anaesthesia which is less dangerous than general or spinal anaesthesia. With transurethral needle ablation certain areas of the prostate are burnt away. Although this is not as effective as other surgeries and may require repeat ablation, the side effects are less than the other techniques. This is also a better option in men using medication, like warfarin, to thin their blood and those unfit to receive anaesthesia.
     
     
     
     

  9. Other minimally invasive procedures
  10. Although not very common, these procedures are also options for patients with prostatic adenoma. The urologist and patient should decide together what management would be best.

    • Microwave Thermotherapy
    • In Thermotherapy the prostate is heated by microwaves. These waves have a radio frequency and reach the prostate through a catheter. This is a little better than medication and may be used in a patient who is unfit for surgery. It can be an effective alternative to surgery.

    • Stent insertion
    • A permanent or temporarily stent can be inserted into the urethra to help prevent obstruction. Prostate tissue is not removed during this procedure. It can help relieve recurrent urinary obstruction in patients with a small prostate or in patients who are unfit for surgery.

    • Cryotherapy
    • This technique uses extremely low temperatures to burn prostatic tissue to improve symptoms. Cryotherapy is not used very often.

    • High intensity focused ultrasound
    • This technique uses ultrasound energy converted to heat which destroys the abnormal prostatic tissue. A transrectal probe is inserted into the rectum. This probe gives off waves which focuses on a specific area of the prostate. High intensity focused ultrasound has been shown to be an effective alternative to surgery.

The following patients usually need to undergo surgery:

  • Refractory urinary retention
  • If the patient’s prostatic adenoma is making him unable to effectively void his bladder surgery is recommended.

  • Recurent UTIs
  • A patient who needs recurrent antibiotics for treatment of a Urinary Tract Infection should consider surgical removal of the prostate.

  • Recurrent gross hematuria
  • If the patient has visible blood in his urine on more than one occasion he should consider surgical intervention.

  • Bladder stones
  • If the patient with prostatic adenoma also has bladder stones, surgery is recommended.

  • Renal insufficiency
  • Prostatic Adenoma that is causing kidney pathology should undergo surgery before renal failure occurs.

 

Non-Surgical Management and Treatment of Prostatic Adenoma

 

    medical treatment

    Medical treatment

  1. Medication for Prostatic Adenoma
  2. Many men with mild to moderate symptoms do not have to be treated with surgery and can find relief of their symptoms with medication. This medication usually needs to be taken life-long. There are two groups of medication which are used: Alpha Blockers and Alpha Reductase Inhibitors.
     
     
     
     

    • Alpha Blockers
    • If the prostate is under 40cm3 an Alpha Blocker like Tamsulosin (Flomax) is used. These diminish the tone in the prostate by blocking the Alpha receptors, causing the muscle tissue of the prostate to relax. By relaxation of the muscles the obstruction is reduced or relieved. Rapid improvement in urinary symptoms is seen in 60-70% of patients who are started on an Alpha Blocker. The patient should tell his doctor if he is using Viagra or any other medication for erectile dysfunction as some Alpha Blockers do not work if medication for erectile dysfunction is used.

    • Alpha Reductase Inhibitor
    • An Alpha Reductase inhibitor like Finasteride (Proscar) is used if the prostate is larger than 40cm3. Finasteride inhibits the conversion of testosterone to dihydrotestosterone in the prostate and so causes the prostate to shrink. Although the shrinkage is slow, symptoms have been shown to improve over time. Most men see an improvement in their symptoms after 6 months of taking this treatment. An Alpha Reductase Inhibitor may be combined with an Alpha Blocker in some men for a more beneficial effect.

  3. Lifestyle changes
  4. Lifestyle changes are also recommended to improve symptoms.

    • Avoid drinking excessive fluids and fluids which have a diuretic effect
    • (causing one to need to urinate more regularly.) Common examples of fluids with a diuretic effect are caffeine and alcohol.

    • Do not drink much fluid at night.
    • This will decrease the amount of times that the patient will have to wake up to urinate during the night.

    • Using a technique called Double void.
    • When the patient is finished urinating, he waits for a moment and then tries to urinate again. Try not to force urine out by straining.

    • Avoid certain medications.
    • Some antihistamines and decongestants (like pseudoephedrine) can worsen lower urinary tract symptoms.

Prostatic Adenoma is a common condition among men and the symptoms can be annoying and embarrassing. Not treating Prostatic Adenoma not only causes symptoms to worsen, it can also be fatal because it causes renal failure. The symptoms are treatable and great relief can be obtained with the correct management. Men are encouraged to seek medical intervention early.