Enlargement of the prostate: Gentle procedures help

Interview with Dr. Stephan Neubauer and Dr. Pedram Derakhshani from the West German Prostate Center in Cologne

Constant urination, a weak stream of urine and unpleasant dripping - which for many men becomes a nightmare, is usually due to a benign enlargement of the prostate gland. She meets almost every second man over 50 and even every 80-year-old. In benign prostatic syndrome (BPS), the glandular tissue of the prostate grows in the area of the urethra. The emptying of the bladder is thereby hindered and the urethra is increasingly narrowed, which in turn leads to problems when urinating. Fortunately, there are now effective therapies. We spoke with the urologists Dr. Stephan Neubauer and Dr. Pedram Derakhshani from the West German Prostate Center in Cologne. 

Does enlargement of the prostate always have to be treated?

Dr. Neubauer: No, not every enlarged prostate causes symptoms automatically. If the patient feels that the symptoms are not stressful, he can wait and see. However, regular check-ups should then be carried out in order to detect changes in need of treatment in good time. However, many patients struggle unnecessarily long before they see a doctor and start therapy.

What complications can occur if men shy away from visiting a doctor despite considerable problems with urination?

Dr. Derakhshani: Complications arise mainly due to the mechanical obstruction of urine drainage. If the bladder is only partially emptied, germs form in the residual urine, which in turn cause painful inflammations in the urinary tract and bladder. In the worst case, a complete closure of the urethra can occur at an advanced stage. The so-called urinary retention is always an emergency which must be treated immediately, as otherwise a urinary retention in the kidneys with subsequent renal failure can occur.

How can the doctor detect a benign prostate enlargement?

Dr. Neubauer: In order to clarify a possible prostate disease, the urologist conducts some examinations as part of cancer screening or in the case of complaints. This includes detailed questioning, scanning the prostate and determining the PSA value. If a benign enlargement of the prostate is present, an additional measurement of the urine stream to determine the flow obstruction of the urine and a subsequent ultrasound examination of the bladder to determine the residual urine are carried out. A urine sample provides information on concomitant diseases such as inflammation or bleeding of the urinary tract.

How does the patient know which treatment is right for him?

Dr. Derakhshani: Which therapy is suitable for the patient depends primarily on the type and severity of his or her complaints. If the symptoms are weak, herbal medicines such as saw palmetto, pumpkin seed or nettle root can effectively relieve the symptoms. In addition, general measures such as the avoidance of cold and strong alcoholic beverages as well as a lot of exercise make sense at this early stage. If this is not enough, alpha blockers are the means of choice. These drugs lead to relaxation of the smooth muscle cells in the prostate and bladder neck, thus improving the emptying of the bladder. Additional volume reduction can be achieved by the administration of 5-alpha-reductase inhibitors.

What can be done if the symptoms do not improve despite the medication?

Dr. Derakhshani: If the drugs do not lead to the desired success, or if repeated urinary tract infections or blood infections occur in the urine, surgery is usually required to eliminate the urinary flow disorder. Even if a normal emptying of the bladder is no longer possible, i. e. with a single or repeated urinary retention, the specialist will advise you to have an operation. In addition, the considerations of age, general condition and existing illnesses should also be taken into account.

Which surgical techniques are available?

Dr. Neubauer: In addition to open surgery, which is rarely used today, the removal of the prostate gland (transurethral resection / TURP) is still regarded as a standard procedure. A special endoscope is inserted into the urethra and the glandular part of the prostate is hollowed out with an electric loop around the urethra. Although this method has been significantly improved in recent years thanks to medical progress, complications can occur. Immediately after the operation, for example, bleeding may occur, but only in rare cases does hemostasis require a second short intervention. Long-term possible complications include a narrow urethra, inability to conceive because of back ejaculation in the bladder, and rarely impotence or persistent urinary incontinence.

Are there alternative possibilities to the classical peeling?

Dr. Derakhshani: Modern laser procedures such as greenlight laser therapy or the diode laser method are far more gentle than conventional peeling. During laser resection, the prostate tissue is also ablated through the urethra. Instead of the electrical current, excess tissue is evaporated by means of laser energy. This has the advantage that postoperative bleeding is almost completely avoided. Side effects such as impotence and incontinence can also be virtually ruled out with laser procedures. Patients can usually leave the clinic after 2 days or be treated on an outpatient basis.

Who do you recommend laser therapy to?

Dr. Neubauer: Basically, every man with an enlarged prostate benefits from laser therapy. However, especially in patients who take blood thinning drugs, laser treatment should be considered. Even patients with a large prostate can be treated with the high-performance Evolve 150 diode laser without any problems. In addition, the shorter duration of treatment enables a gentler anaesthesia procedure, which places less strain on the cardiovascular system of the patient.

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