In the past, the primary focus of BPH treatment was to alleviate the bothersome lower urinary tract symptoms that result from prostatic enlargement. However, more recently, urologists have expanded their treatment goals to not just alleviate the symptoms of the disease, but also to slow the progression of the gland enlargement to prevent complications and further disease progression.
A variety of BPH treatment options are available ranging from pharmacologic treatments to surgery. It is important to provide multiple treatment options for your patients and to fully educate them on all available options, including the benefits and risks of each. This approach allows the physician and patient to determine together the safest and most effective treatment based on your patient’s individual medical condition and preferences.
For a comprehensive review of the AUA Guidelines for Management of BPH, please refer to the AUA Website.
Medical management may be effective for patients with mild to moderate symptoms of BPH. Several different types of medications are available to treat the symptoms of enlarged prostate and generally fall into these categories:
In many practices medication is still the primary treatment option offered to patients due to its simplicity but, unfortunately, medication is not effective for all men with a reported 48% of patients not showing clinically significant symptom improvement.1
Non-surgical therapies provide a safe, effective and durable treatment option for patients with moderate-to-severe symptoms of BPH. In-office BPH treatment options involve performing a single, non-surgical procedure in less than one hour comfortably managed without the need for general anesthesia. In-office BPH treatment options are ideal for patients who do not want to take daily medications for the rest of their lives, dislike the side effects and ongoing costs of medication or do not want the risks, side effects or high costs of invasive surgery.
As with any medical procedure, there are potential risks and side effects that can occur with in-office medical procedures. We’re committed to providing the information you and your patients need to make a well-informed BPH treatment decisions. Although these problems rarely occur, we want you to know the facts. Please refer to the Cooled ThermoTherapy™ and Prostiva® RF Therapy manuals to learn about the benefits and risks specifically associated with procedures.
Urologix offers two versatile minimally invasive treatment options:
Cooled ThermoTherapy™ (CTT), also known as transurethral microwave thermotherapy (TUMT), is optimal for controlled treatment in a broad patient population. CTT is a targeted therapy that achieves deep tissue necrosis in a single 28.5 minute treatment.1 It includes an advanced cooling design providing enhanced protection for the healthy urethra as well as increased patient comfort. CTT provides durable results with no reintervention required in over 90% of patients at five years.2
Prostiva® RF Therapy, also known as transurethral needle ablation (TUNA), is great for direct visualization and treatment of complex anatomy and smaller glands. Prostiva uses radio frequency needles placed directly into the prostate to generate heat and cause coagulation. Prostiva provides durable results with no reintervention required in over 86% of patients at five years.3
“TURP may be considered the “Gold standard” for treatment of BPH, but with the aging male population, the risks and expense of a hospital procedure, an office CTT or Prostiva can be served on a “Silver Platter” with far less risk and comorbidity for the patient.” – J. Randall Beahrs, MD
Below is a treatment comparison of several in-office therapies that are currently offered and some of the overall highlights of each treatment.
Surgical intervention may be an appropriate treatment option for patients with moderate to severe symptoms of BPH or patients that have developed acute urinary retention or other BPH-related complications. There are two primary surgical options currently available:
Transurethral resection of the prostate is the surgical removal of part of an enlarged prostate gland utilizing an endoscopic approach through the urethra. This procedure is currently the most common surgical treatment for symptomatic BPH. This procedure requires a hospital stay and is performed under general or spinal anesthesia. As with any surgical procedure, there are possible complications including TURP syndrome (a dilutional hyponatremia that occurs when irrigant solution is absorbed into the bloodstream), sexual dysfunction, irritative voiding symptoms, bladder neck contracture, the need for blood transfusion, UTI, and hematuria.
1Wel, et al, High Rates for Continued BPH Medical Therapy Among Non-Responders, Abstract 498, AUA Annual Meeting, 2009. 2Mynderse, L., et al, 5 year Results of a Multi-Center Trial of a New Generation Cooled TUMT for BPH, Journal of Urology, May 2001. 3Hill, B., et al Transurethreal Needle Ablation vs TURP for the Treatment of Symptomatic BPH: 5 Year Results of a Prospective, Randomized, Multicenter Clinical Trial, Journal of Urology Vol 171, 2336-2340, June 2004. 5Data from online survey conducted by Harris Interactive, August 2007 sponsored by Medtronic, Inc. Survey included 206 qualified respondents.