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Prostate Problem Guide
An Introduction To Minimally Invasive BPH Treatment
For many men suffering from BPH (a swollen or enlarged prostate) drug treatment is the answer and can reduce BPH symptoms to an acceptable level. For others however medication does not prove effective or is not a viable option and the doctor may recommend one of a number of minimally invasive surgical procedures.
The first procedure to consider is catheterization. Catheterization involves the insertion of a catheter into the penis and bladder to act as a drain and is normally considered only as a temporary solution. It is used mainly for patients who are waiting for the effects of drug treatment to kick in (some drugs used in BPH treatment can take 6 to 12 months before they start to show results) or for other surgical treatments. It can also be used to assist in treating infections.
The next procedure to consider is Holmium laser enucleation prostate (HoLEP). This procedure, which is carried out under anesthesia and requires a short 1 or 2 day stay in hospital, involves the insertion of a resectoscope through the penis and into the urethra. A laser is then passed through the resectoscope and is used to vaporize prostate tissue.
A similar procedure to HoLEP is that of interstitial laser coagulation. This procedure is again carried out under anesthetic, although patients are not normally required to remain in hospital overnight. In this case a cystoscope, which is a metal tube through which a visual lens and laser can be passed, is used and tissue is burnt away from the prostate using laser energy.
In cases where a patient cannot tolerate anesthesia a prostatic stent may be used. Stenting involves the placement of a spring-like device into the urethra at the point at which it passes through the prostate in order to hold the urethra open. Unfortunately there are a number of problems associated with this form of BPH treatment and it is normally only used for patients who suffer from additional medical problems and for whom surgery would present unacceptable risks.
AAWR: anti-androgen withdrawal response; a decrease in PSA seen upon stopping treatment with an anti-androgen such as Flutamide or Casodex®; this occurs because the anti-androgen has induced a mutation in the androgen receptor (AR) which is allowing the anti-androgen to stimulate rather than inhibit prostate cancer growth.
EXPERIMENTAL: an unproven (or even untested) technique or procedure; note that certain experimental treatments are commonly used in the management of prostate cancer.
PCNA (PROLIFERATING CELL NUCLEAR ANTIGEN): an index of cell division or proliferation prostate cancer.
RADIATION CYSTITIS: inflammation of the bladder lining due to the ionizing effects of radiation therapy.
Transurethral microwave thermotherapy of the prostate (TUMT) is a form of minimally invasive surgery that does not require hospitalization or anesthesia and is carried out using a local anesthetic and oral pain medication. In this procedure a catheter is inserted through the penis and computer controlled microwaves are used to heat, and thus shrink, sections of the prostate.
Another office-based procedure is the transurethral radio frequency needle ablation of the prostate (TUNA). Here light anesthesia and medication is used to make the patient sleepy and prostate tissue is heated using radio frequency energy transmitted through a series of needles placed directly into the prostate. This procedure initially causes a swelling of the prostate, followed by shrinkage, and patients will usually be required to use a catheter for a short period after the procedure.
There are clearly a number of different forms of minimally invasive surgery available for BPH treatment and patients will need to discuss each of these with their doctor to determine which will best suit their particular circumstances.
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