Treat and operate a benign enlarged prostate | – guide


Status: 26/10/2020 11:50

A benign enlarged prostate leads to frequent urination and pain when urinating. Bladder training, medication, or an operation can help with symptoms.

Benign prostatic hyperplasia (BPH) is the most common urological disease in men. Benign prostate enlargement usually starts from the age of 50. The gland encloses the urethra between the bladder and the sphincter muscle. Together with the testicles and seminal vesicles, it forms seminal fluid and is normally the size of a chestnut.

In conversation

Image of a prostate in the abdomen © Photo Fotolia: magicmine

The prostate enlargement chat starts on October 27 at around 8.45pm and lasts from 30 to 45 minutes. More

Diagnosis with ultrasound and measurement of urinary pressure

The cause of benign prostate enlargement has not yet been definitively clarified. What is certain is that hormonal changes and genetic factors play a role. Important to know: Benign enlargement has nothing to do with prostate cancer. Diagnostics include urodynamic examination (measurement of urinary pressure) and ultrasound examination of the bladder and prostate.

Minor ailments: herbal remedies and bladder training

Herbal products help with mild ailments: preparations made from pumpkin seeds, nettle root or saw palmetto fruits are available without a prescription. Bladder training is also a useful measure when there is an increased urge to urinate with smaller amounts of urine – the man tries to resist the urge and only goes to the toilet later. Pelvic floor training is helpful in preventing incontinence.

Drug for enlarged prostate

So called Alpha-Blocker it can help relax the tissues of the prostate and the slightly enlarged urethra. However, they have no effect on the growth of the prostate size.

Helps against excessive prostate enlargement 5-alpha reductase inhibitorswhich can reduce the volume of the prostate. Their effect is based on a reduction in the effect of hormones on the prostate.

Complications: inflammation and urinary obstruction

If some urine regularly remains in the bladder due to a slight enlargement of the prostate, prostate and urinary tract infections can develop. In the worst case, this leads to urine congestion. Inflammation of the prostate is fought with antibiotics.

Classical surgery for enlarged prostate

If symptoms do not improve with drug therapy, surgical therapy may be required. The choice of surgery also depends on how much the prostate has already grown.

The standard procedure is still removal of the prostate (bipolar transurethral resection of the prostate)/TURP): With an endoscope inserted through the urethra, the tissue is removed with a high-frequency ring and the wound surface is covered with scabs at the same time. There is no other surgical procedure whose long-term success has been so well documented. The chances of success are over 90 percent. The procedure is suitable for an enlarged prostate weighing up to 70 grams.

Remove the prostate tissue with the laser

Alternatively, prostate tissue can also be removed with the help of laser beams: conventional lasers vaporize the excess tissue and light scalpels cut it. The procedure is performed through the urethra. Laser procedures are suitable for an enlarged prostate weighing up to 150 grams.

Remove the prostate tissue with a jet of water

During treatment with Aquabeam, the prostate is measured by ultrasound under computer control. The surgeon marks the areas that need to be removed. Removal is done with a high-pressure, computer-controlled jet of water and precisely removes only the excess tissue marked in the ultrasound.

The advantage of the gentle procedure, which takes only 20-30 minutes: after the procedure, the ability to ejaculate is usually maintained. Other procedures can result in ejaculation inward into the bladder.

Prerequisite for the Aquabeam treatment: Blood coagulation must be intact, because unlike laser therapy, the tissue is not charred. Aquabeam cannot be used during therapy with anticoagulant drugs, as the risk of bleeding is too high. The Aquabeam procedure is the responsibility of all health insurance companies.

Remove prostate tissue by embolization

Embolization is performed by a radiologist. Under local anesthesia, it pushes a catheter over the inguinal artery to the prostate arteries. Numerous plastic beads are inserted into the vessels under X-ray control. This reduces the blood supply to the glandular tissue: the prostate gradually narrows, the urethra is relieved. Those affected usually feel improvement after a few weeks. The first experiences show: after about six months the prostate has shrunk to normal size. There is still a lack of long-term experience for the process, such as how long the effect lasts. As a rule, legal health insurance companies cover the costs of embolization.

Remove prostate tissue with steam

Water vapor ablation (rezum) works in a similar way to laser methods. A device is inserted through the urethra to the prostate. In this process, it emits sterile water vapor at a temperature of 103 degrees Celsius. Thermal energy burns cells, prostate tissue dies. The procedure under local anesthesia takes about ten minutes. Improvement occurs after up to four months. Long-term experience in the United States shows good treatment results. Legal health insurance companies usually cover the costs for water vapor ablation.

Urolift implants for younger patients

Using Urolift implants is another delicate procedure. Special anchors are inserted into the prostate through the urethra. They collect the prostate tissue and thus expand the diameter of the urethra. The urine flow therefore increases by an average of one third.

The procedure is particularly suitable for affected young people who want to maintain their fertility. The prostate should not weigh more than 40 grams. Since this procedure does not eliminate the cause of the discomfort, the prostate continues to grow. The anchors could potentially tear and require further therapy.

Surgical side effects: erection problems and incontinence

Prostate surgery can cause unwanted side effects:
Bleeding can occur during and after the procedure. Incontinence and erectile dysfunction are not uncommon, but often temporary.

After an operation it can lead to a so-called Urge incontinence to come. People sometimes lose urine. The sphincter apparatus must get used to the new situation. It can take months. So-called models protect during this period. Medicines can also lower urinary pressure. Regular pelvic floor training strengthens the bladder sphincter.

Prostate: as a preventive measure from the age of 45

To be able to detect enlarged prostate and malignant changes early, men with prostate problems in the family should be examined at an early stage, otherwise once a year from the age of 45. At the latest, if men have to go to the bathroom several times during the night or if they can no longer empty their bladder completely, they should see a doctor.

Additional information

3D abstract illustration of the prostate.  © fotolia Photo: magicmine

After radical removal of the prostate, one in two men can no longer hold urine. In many cases, the loss of urine can be alleviated or even stopped. More

Blood sample in the test tube.  © Photo: jarun011

An increase in the PSA level can indicate prostate cancer. Men should be tested from the age of 45 to detect malignant prostate tumors at an early stage. More

Subject matter experts

Prof. Dr. Andreas Gross, Head of Urology
Asklepios Clinic Barmbek
Rübendamm 220
22291 Hamburg
(040) 18 18 82-98 21

Dr. Mahmoud Salman, specialist in urology and andrology
Rathausallee 94 a
22846 Norderstedt

Additional information
European Association of Urology (UAE) Patient Information

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