Edward J. Mueller: Early on when the BPH just starts there are some good medications that can help. The common ones we use are the alpha blockers which will relax the muscles in the process, the prostate has muscle and the capsule will be prostated in the tissue of the prostate as well as at the bladder neck, where the bladder and prostate come together. There is an internal swing too there and the alpha blockers relax the alpha nerve fibers, the alpha nerve fibers constrict muscles.
So they will constrict the muscle in the prostate and tighten it up, taking the alpha blocker medications will relax those muscles and open up the prostate a little bit and then we have the 5alpha-reductase medications and 5alpha-reductase is an enzyme that converts testosterone to dihydrotestosterone. Dihydrotestostrone is the main testosterone that function in the prostate to cause the enlargement, by blocking that you will have testosterone which is a much weaker stimulant of prostate growth and you can decrease the growth of the prostate that way.
So sometimes combining those two medications, can be fairly effective when the patient symptoms aren’t too bad, but when the patient gets large prostate and there is a large obstruction, those medications aren’t going to help too much.
Edward J. Mueller: Heat therapies are new minimally invasive therapies where you don’t actually remove tissue what you do is you heat up the tissue to appoint where it won't vaporize but the cells will die.
Barry Stein: In some way, the temperature change can cause the tissue to die to coagulate, to vaporize, sometimes we think we cause the nerves to be damaged. So the heat depending on how it’s delivered, what source it’s delivered, what temperature it’s delivered too, the heat is very different in everyone of these.
Edward J. Mueller: The theory is they will sluff and the die and the prostate will open up and usually right after this has done, you are going to get a lot of swelling, so the symptoms will get worst. Frequently patients will have a catheter in for three four weeks afterwards and then lot of times they don’t get a lot better because you don’t get the necrosis and the shrinking that you hope for. Sometimes you get moderately good results and if the patient’s symptoms aren’t that bad, they can work fairly well, but there is a lot of risk involved in that.
Barry Stein: And the most important ones would be a microwaves therapy and Transurethral Needle Ablation Therapy, both of those are out ablation therapies and they are both very different. One is done with catheters in probes of that level and the other is done through a scalp with needles. Both of them use heat to warm the prostate and both of them have the same disadvantage that they do not remove tissue. In fact although there are several working theories, nobody is really totally sure how either one actually works.
Edward J. Mueller: Prostate swells and a lot of patients have to have a catheter afterwards for quite a while, sometimes they get a lot of irritating symptoms because of the cells that are dying and their causing irritation, giving you urgency and frequency as it heels, but the major side effect is the swelling that occurs and they need to have a catheter for quite a length of time after the procedure.
Barry Stein: Both of them have high recurrence rates and a lot of the patients end up back on their medical therapy or eventually another type of surgical therapy.
Edward J. Mueller: Basically a TURP is a procedure where you go in and you use a hot loop to cut out these overgrowth of tissue that constricts down your urethra. They open up the channel and the patient will urinate much, much better.
Barry Stein: It’s been around for 75 years, so we all have a lot of experience in using it, everyone was trained in using it. So one of the major pros is the familiarity and the experience with it, the cons is that requires hospitalization and that there are more complications than other transurethral methods.
Edward J. Mueller: During the procedure, it uses the hot loop to cut the tissue out, the tissue is going to bleed, and it frequently bleeds pretty profusely, you can loose a lot of blood during the procedure and afterwards you need to leave the catheter in to let this sort of heel over and the bleeding will stop. Most of the time you have the catheter in from anywhere one to three days and the patient is usually in the hospital during that time and then afterwards you have to take it easy for about a month, because you can get too active, you can do too much, your abdominal pressure pushing down will cause those little vessels to open up and bleed and you can develop bleeding. So most people have to take it easy for four to six weeks after a TURP.
So it will do a great job, don’t open up the prostate, I mean you will avoid very, very well, the main side effect, the pros of it you are going to avoid very, very well, the cons of it are, you are in the hospital longer there is a lot more bleeding involved the catheter is in for one to three days and then usually you have to take it easy for four to six weeks afterwards.
Barry Stein: Bleeding, delayed return to work, and then other risks which becomes smaller but real impotents for example urinary incontinence and as I say each one, we go down—further down the likelihood that these could happen to anyone, but they can happen if it’s you, it’s important.
Edward J. Mueller: The nerves to the penis run right along to the capsulate the prostate and when you are doing to a TURP, you are using electrocautery, there is an electrical current going through there. When you near those—the capsule and those nerves that electrical current can be transmitted through the capsule to the nerves and you can injure those nerves. So the possibility is there.
The green light photoselective vaporization of the prostate is the newest laser treatment out there that can provide relief of symptoms very compatible to a TURP with minimal side effects and minimum hospitalization.
Barry Stein: Why don’t we say, it’s like taking a hot knife through butter and the prostate just really literally melts in front of you, because it’s done under fluid medium, we don’t really see smoke per say, but it looks like these tissues just melting in front you and that’s used to—if you will melt the tissue away without bleeding and some of the other issues that we see when you do at TURP procedure.
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