Treatment Options for Overactive Prostate: Classifications
Benign Prostatic Hyperplasia (BPH), an enlarged prostate, is a noncancerous abnormal cell growth that affects many men as they age. While antimuscarinic drugs and alpha blockers are commonly prescribed to manage BPH symptoms, alternative treatment options are available.
Common alternative treatment options for BPH beyond medication include minimally invasive therapies, various surgical procedures, prostate artery embolization (PAE), focused ultrasound therapy, and lifestyle modifications such as exercise.
Minimally Invasive Therapies (MIST) are procedures that can be done in a physician’s office with local anesthesia. Examples include prostatic urethral lift, water vapor thermal therapy, implantable temporary nitinol device, and anterior commissurotomy. These treatments generally do not worsen sexual function and are suitable for patients who prefer to avoid daily medication.
Surgery is typically performed under anesthesia in a hospital. Surgical options include laser prostate surgeries (e.g., green light vaporization), transurethral aquablation, and robotic simple prostatectomy. Surgery offers the most durable relief without ongoing medication but is more invasive than MIST.
Prostate Artery Embolization (PAE) is a non-surgical outpatient procedure done by an interventional radiologist. It uses tiny beads to block blood flow to prostate tissue, causing it to shrink and easing symptoms. PAE avoids surgery’s risks and recovery time.
Aquablation Therapy is an AI-powered robotic waterjet procedure that removes excess prostate tissue while preserving sexual function and continence. It is minimally invasive and image-guided, offering precise removal of tissue without the side effects common in traditional surgeries like TURP.
Focused Ultrasound Therapy is a noninvasive technique where focused ultrasound waves thermally ablate prostate tissue without surgery. This approach reduces risks related to surgery and can be repeated if necessary, but insurance coverage varies.
Lifestyle Changes and Exercise can also help manage BPH symptoms. Effective exercise regimens including pelvic floor exercises (Kegels), aerobic activities, strength training, and yoga can improve urinary symptoms, blood circulation, reduce inflammation, and enhance overall prostate health.
These alternatives provide a range of options tailored to patient preferences, prostate size, symptom severity, and the desire to preserve sexual function or avoid daily medication.
Combining two types of medication may be more effective for treating symptoms of BPH than using one medication alone. Effective combinations include alpha blockers and antimuscarinics, dutasteride and tamsulosin, and finasteride and doxazosin. PDE5 inhibitors, prescribed to treat erectile dysfunction, also help relieve symptoms of BPH by relaxing the smooth muscles in the lower urinary tract.
In conclusion, while antimuscarinic drugs and alpha blockers remain common treatments for BPH, alternative treatments such as minimally invasive therapies, various surgical procedures, prostate artery embolization (PAE), focused ultrasound therapy, and lifestyle modifications offer a range of options for managing BPH symptoms. The decision on the most appropriate treatment for BPH depends on the severity of the condition, a person's overall health, and their preferences.
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