What is Prostate Adenoma (BPH)?
Benign prostatic hyperplasia (BPH), commonly referred to as prostate adenoma, is a prevalent condition in which the prostate gland increases in size. It is not cancer, but as the gland grows, it can compress the urethra passing through it, leading to various urinary problems. BPH symptoms, known as lower urinary tract symptoms (LUTS), can significantly impair men's quality of life, manifesting as frequent urges to urinate, difficulty initiating urination, a weak urine stream, a feeling of incomplete bladder emptying, and waking up at night to urinate.
Modern Approaches to BPH Treatment
The choice of BPH treatment method depends on numerous factors, including symptom severity, prostate size, the patient's general health, and personal preferences. Modern urology offers a wide range of therapeutic solutions, from active surveillance and drug therapy to various surgical interventions. The goal of treatment is to relieve symptoms, improve quality of life, and prevent potential complications.
Drug Therapy: Phosphodiesterase Inhibitors in Urology
Medical treatment is the first step for many BPH patients, especially those with moderate symptoms. Among various drug classes, phosphodiesterase (PDE) inhibitors hold a special place. These drugs, specifically PDE5 inhibitors (cyclic GMP PDE), act on the smooth muscle of the lower urinary tract and genitals, relaxing it and improving urine outflow [3].
- Mechanism of Action: PDE5 inhibitors promote relaxation of the smooth muscle in the prostate gland and bladder neck, which reduces resistance to urine outflow and facilitates urination [3].
- Drug Examples: This group includes well-known agents such as avanafil, sildenafil, tadalafil, vardenafil, and others [3].
- Benefits: These drugs demonstrate high efficacy, a rapid onset of action, and a favorable benefit-to-side-effect ratio. They can be taken on demand, which is convenient for many patients [3]. In addition to treating LUTS, PDE5 inhibitors are also widely used to correct erectile dysfunction, making them particularly attractive for men suffering from both conditions.
Innovative Surgical Methods: Aquablation
For patients with severe symptoms or when drug therapy is ineffective, surgical methods may be recommended. One of the innovative and promising approaches is Aquablation, a robotic procedure that uses a high-velocity water jet to precisely remove excess prostate tissue.
The WATER II study, a multi-center prospective clinical trial, evaluated the safety and efficacy of aquablation in men with large-volume symptomatic BPH. The study enrolled 101 men with moderate to severe BPH symptoms and a prostate volume between 80 and 150 ml [1].
- Patient Characteristics: The average prostate volume of the study participants was 107 ml (range 80-150 ml) [1].
- Procedure Duration: The average operative time was 37 minutes, while the actual aquablation resection time was significantly shorter—averaging 8 minutes (range 3-15 minutes) [1].
- Results: The procedure demonstrated high efficacy in removing adenomatous tissue. Adequate adenoma resection was achieved in a single pass in 34 patients, and in the remaining patients with the help of additional passes [1]. This indicates the precision and controllability of the method, which is a key advantage when dealing with large prostate volumes.
Aquablation offers a minimally invasive approach with a potentially lower risk of certain side effects characteristic of traditional surgical methods, while still providing effective symptom relief.
When Should You See a Doctor?
If you notice symptoms such as frequent urges to urinate, especially at night, a weak or intermittent urine stream, a feeling of incomplete bladder emptying, or any other changes in urination, do not delay a visit to a urologist. Early diagnosis and timely initiated BPH treatment can significantly improve the prognosis and quality of life while preventing the development of complications.
Sources
- 1. WATER II (80-150 mL) procedural outcomes. BJU international, 2019. https://pubmed.ncbi.nlm.nih.gov/29694702/
- 2. Phosphodiesterase inhibitors in clinical urology. Expert review of clinical pharmacology, 2013. https://pubmed.ncbi.nlm.nih.gov/23656343/
The information provided in the article is for informational purposes only and cannot replace an in-person consultation with a specialist. Be sure to consult a doctor before starting any treatment.