• BPH : treatment needs a holistic treatment plan and includes lifestyle modification, medications and surgical procedures.
• Lifestyle Modification : certain steps like reduced water intake during nighttime, reduction of alcohol and caffeine intake and minimizing the dosage of certain drugs which increase the symptoms like decongestants, opiates, antihistamines, diuretics and antidepressants after due consultation with a medical professional.
• Surgical Management : A variety of treatment options are available in prostatic surgery nowadays like Minimally invasive therapies, Transurethral prostatectomy, Laser prostatectomy, HIFU and Robotic prostatectomy
1 ) Minimally Invasive Techniques :
- SPAD – Super Selective Intra- Prostatic Androgen Deprivation : In this procedure, a radiopaque dye is injected into the vein of the leg after which an X-ray of the venous network is carried out (venography). Then a medicine that shrinks the blood vessels is injected into the vein (sclerotherapy) resulting in reduction of prostate volume. This provides relief in cases of nocturia, improves bladder emptying and increases urine outflow. There are minimum sideeffects as compared to traditional surgery.
- Transurethral Microwave Thermotherapy (TUMT) :
• It is a very effective treatment in case of BPH and provides relief from lower urinary tract symptoms after a single procedure.
• It is a minimally invasive technique performed under local anesthesia.
• A special microwave urinary catheter is inserted through the urethra into the enlarged prostate. The microwave antennae are then heated up to at least 111 degree Fahrenheit which destroys the surrounding tissues.
• The procedure takes around 30 minutes to 1 hour after which there is slight swelling and irritation in the prostate. A Foley’s catheter is placed in the bladder to allow bladder emptying without increasing the prostatic irritation and is removed within 3-5 days.
• There may be a few risks like pain after the procedure, urinary retention and infection but the incidence is very less.
• The problem of urinary retention resolves within a week’s time, but some patients replace the Foley’s catheter with a temporary prostatic stent to allow volitional emptying of bladder. This improves their quality of life.
- Transurethral Needle Ablation (TUNA) :
• In this procedure low energy frequency radio energy is delivered through two needles placed inside the prostate by passing through the urethra, creating a high temperature in a small zone, which destroys the excessive prostatic tissue without damaging the urethra.
• The procedure is performed under local anesthesia on an outpatient basis. It is a single session treatment procedure with the number of needles varying with size of the prostate.
• It is fairly safe and effective and has minimal side-effects.