What can you do about prostate cancer

Enlarged Prostate: When to Operate?

Status: 10/26/2020 11:50 a.m.

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

Benign prostatic hyperplasia (BPH) is the most common urological disease in men. The benign enlargement of the prostate usually begins 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 the seminal fluid and is normally about the size of a chestnut.

Diagnosis with ultrasound and urinary pressure measurement

The cause of the benign enlargement of the prostate has not yet been conclusively 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 the urodynamic examination (measurement of urinary pressure) and ultrasound examination of the bladder and prostate.

Minor complaints: Herbal remedies and bladder training

There are herbal products for mild complaints: preparations made from pumpkin seeds, nettle root or saw palmetto fruits are available without a prescription and can provide subjective relief. If there is an increased urge to urinate with smaller amounts of urine, bladder training is a sensible measure: The man tries to withstand the urge and only go to the toilet later. Pelvic floor training is useful to prevent incontinence.

Medication for prostate enlargement

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

PDE-5 inhibitors are mainly known from the treatment of erectile dysfunction. They, too, can relax the urinary tract and improve flow through the narrowed urethra when taken in small daily doses.

Help 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. They can be combined well with the means for relaxation.

Complications: inflammation and urinary obstruction

If some urine regularly remains in the bladder due to a slightly enlarged prostate, prostate and urinary tract infections can develop. In the worst case, this leads to urinary congestion. Prostate inflammation is fought with antibiotics.

Classic surgery for enlarged prostate

If the symptoms do not improve under drug therapy, surgical therapy may be necessary. The guidelines for choosing the most appropriate procedure for each patient are currently being revised.

The best known procedure is still the peeling of the prostate (bipolar transurethral resection of the prostate)/TURP): With an endoscope inserted through the urethra, tissue is removed with a high-frequency loop and the wound surface is scabbed at the same time.

Remove prostate tissue with 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 out. The procedure is carried out through the urethra. Thanks to the modern tools, experienced surgeons can control the procedure particularly well. On the one hand, enough tissue has to be removed in order to eliminate the symptoms and so that the success lasts as long as possible even if the prostate grows again. On the other hand, the outer capsule of the prostate should not be injured in order to avoid complications in the nerves and vessels.

Remove prostate tissue with a water jet

During the treatment with Aquabeam, the prostate is measured with ultrasound under computer control. The surgeon marks the areas that are to be removed. The removal takes place with a high pressure water jet, which is controlled by the computer and precisely removes only the excess tissue marked in the ultrasound.

The advantage of the gentle procedure, which only takes 20 to 30 minutes: After the procedure, the ability to ejaculate is often retained. Other procedures can result in ejaculation inwards into the bladder.

Precondition for the Aquabeam treatment: the blood coagulation must be intact because, unlike with laser therapy, the tissue is not charred. Aquabeam cannot be used during therapy with anticoagulant medication because the risk of bleeding is too great. The Aquabeam procedure is paid for by all health insurance companies.

Shrink prostate tissue through embolization

Embolization is performed by a radiologist. Under local anesthesia, he pushes a catheter over the inguinal artery to the arteries of the prostate. There numerous plastic spheres are inserted into the vessels under X-ray control (fluoroscopy). This reduces the blood supply to the glandular tissue - which in the long term should lead to the shrinking of the prostate. Whether and how much tissue goes back can only be observed in the course of the process. An incorrect injection can clog other blood vessels, e.g. B. lead to the intestine and cause serious complications. In addition, the radiation exposure through the X-ray control must be considered during the procedure.

Burn prostate tissue with steam

In water vapor ablation (rezum), a device is inserted through the urethra up to the prostate, which emits sterile water vapor at a temperature of 103 degrees Celsius. The thermal energy is supposed to burn prostate cells so that prostate tissue dies. The procedure under local anesthesia takes about ten minutes, but the heat usually only reaches a small amount of tissue.

Urolift implants for younger patients

The use of Urolift implants is another new procedure. Special anchors are inserted into the prostate through the urethra. They gather the prostate tissue and thereby expand the diameter of the urethra.

The procedure is offered to young men who want to temporarily retain their fertility. However, since this procedure does not remove 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

During an operation on the prostate, unwanted side effects can occur:
Bleeding may occur during and after the procedure. Incontinence and erectile dysfunction are also not uncommon, but often temporary.

After an operation, it can lead to a so-called Urge incontinence come. People lose urine at times. The sphincter apparatus first has to get used to the new situation. It can take months. During this time, so-called templates protect. Medication can also lower urinary pressure. Regular pelvic floor training strengthens the bladder sphincter.

Prostate: As a preventive measure from the age of 45

In order to be able to detect enlarged prostate and malignant changes at an early stage, men with prostate problems in the family should be examined at an early stage; At the latest, if men have to go to the toilet several times at night or if they can no longer completely empty their bladder, they should see a doctor.

Experts on the subject

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 (EAU) patient information

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