What are some tablets that I can take?

A. Alpha Blockers

Alpha blockers relax the muscles in your bladder and prostate, making it easier to pee. They help with urine flow and decrease the number of times you wake up to pee at night, without changing the size of your prostate. They usually work right away.

Aside from treating BPH, alpha blockers also treat high blood pressure. As such, side effects such as tiredness, dizziness, headaches and fainting may result.

Alpha blockers may also lead to retrograde ejaculation – when sperms go into your bladder instead of out through your penis. Retrograde ejaculation causes no harm, but it means that you may not have sperms when you ejaculate. Please keep this in mind if you intend to have children.

B. 5-Alpha Reductase Inhibitors (5-ARIs)

5-ARIs prevent prostate growth and in some cases, shrink it. This improves urine flow, and eases other symptoms of BPH as well. Some other benefits of 5-ARIs include:

• Lower chance of BPH causing other problems e.g. bladder damage
• Lower likelihood of surgery needed

However, it can take up to 6 months to see the full effects of 5-ARIs, and they must be taken continuously. Additionally, some side effects of 5-ARIs include:

• Erectile dysfunction
• Lowered sex drive
• Retrograde ejaculation
• Increased chance of aggressive prostate cancer.

C. Phosphodiesterase 5 inhibitors (PDE5i)

PDE5i is also used to treat erectile dysfunction, and they work by relaxing the muscles in your bladder and prostate, which help to ease the symptoms of BPH.

There are several types of PDE5i available, but the only PDE5i approved to treat BPH is Tadalafil (sold under the brand name Cialis). Some side effects include:

• Back and muscle pain
• Headaches
• Redness and warmth/ burning on the face, neck and upper body
• Stuffy nose
• Upset stomach after eating
• Vision problems

Which surgery is best for me?

Most surgical procedures will have the following risks:

• Urinary Tract Infection (UTI)
• Temporary difficulty with urinating

A. Transurethral Resection of the Prostate (TURP)

A resectoscope is inserted into the urethra until it reaches the prostate. The surgeon removes the section of the prostate that is causing harmful symptoms. A catheter (a thin tube) is then inserted to pump fluid into the urethra and flush away pieces of the removed prostate.

B. Transurethral Incision of the Prostate (TUIP)

A resectoscope is inserted into the urethra, and the surgeon makes a few small cuts in the prostate gland, widening the urinary channel and allowing the urine to pass through more easily.

C. Transurethral Microwave Thermotherapy (TUMT)

A small microwave antenna is inserted into the urethra, and the antenna emits microwave energy that heats and destroys the prostate tissue obstructing urine flow.

D. Transurethral Needle Ablation (TUNA)

Radiofrequency needles are placed through the urethra into the prostate tissue obstructing urine flow. Radio waves are sent through the needles to destroy the prostate tissue, causing the prostate to shrink.

E. Greenlight Laser Treatment

Therapy that evaporates prostatic tissue that is blocking the bladder. It is performed under anesthesia, where a telescope is placed into the urethra, up to the level of the prostate. A laser fiber is guided through the telescope, quickly and gently vaporizing the prostate tissue.

F. Open Prostatectomy

The surgical removal of the prostate gland, performed under anesthesia. An incision is made through the lower abdomen, after which a catheter may be placed in the bladder to help flush the bladder while another catheter comes out of the penis to drain the urine.

G. Prostatic Artery Embolisation

This minimally-invasive procedure is carried out by an interventional radiologist (IR) in order to shrink the prostate.

1. A Foley catheter is inserted into the urethra and positioned in the bladder. This provides a reference point for the surrounding anatomy

2. Another smaller catheter is inserted into the artery in the wrist/ groin

3. The catheter is guided into the blood vessels that lead to the prostate

4. An arteriogram (X-ray in which dye is injected into the blood vessels) is done to clearly see the blood vessels around the prostate

5. Tiny particles are injected through the catheter and into the blood vessels, reducing the blood supply

6. The catheter is then shifted to the other side of the prostate and the process is repeated

7. The prostate will gradually begin to shrink, relieving and improving symptoms within days of the procedure

H. UroLift

UroLift is a minimally-invasive surgical procedure that draws apart the enlarged prostate tissue that is obstructing the opening of the urethra. Unlike conventional surgical treatments for BPH, UroLift usually does not involve the insertion of a catheter into the urethra after the procedure.

I. Rezum

It is a minimally-invasive procedure that uses the stored thermal energy in water vapour to shrink the prostate and destroy the prostate tissue obstructing urine flow.

When water vapour comes into contact with the additional prostate tissue, it condenses and turns into water, releasing the stored energy in the vapour. This destroys extra prostate cells and reduces the size of the prostate.

Do consult your doctor if you have any more questions regarding these different types of surgeries to choose the one best suited for your needs!

For more information or if you require a medical consultation, please contact My Healthcare Collective here.