Therapy for prostate symptoms is broad and shows a very different spectrum of treatment-related side effects and impairments. Your urologo cdmx urologist will start treatment with medication if the symptoms are mild, the side effects are minimal, and the success of the treatment is usually noticeable – even if the organic causes are not eliminated directly. If drug therapy is not sufficient or if there are compelling reasons for surgical treatment (see list below), your urologo cdmx urologist will usually refer you to a hospital for prostate surgery. A continuous worsening of the symptoms can also be a reason for surgical treatment in order to avoid permanent damage to the bladder and kidneys, but also to bladder sensitivity. If there is a risk of urinary retention (the inability to urinate at all) or if there is an incontinence to urinate (unwanted leakage of urine combined with a strong urge to urinate), the operation should not be delayed.
The resulting damage can lead to an overstretched, flaccid bladder requiring permanent catheter evacuation. In other cases, the excessive sensations of irritation or the urge to urinate become more and more intense over the years; In this situation, surgery cannot always eliminate these symptoms of nerve irritation or nerve overactivity. flaccid bladder with the need for permanent catheter emptying. In other cases, the excessive sensations of irritation or the urge to urinate become more and more intense over the years; In this situation, surgery cannot always eliminate these symptoms of nerve irritation or nerve overactivity. flaccid bladder with the need for permanent catheter emptying. In other cases, the excessive sensations of irritation or the urge to urinate become more and more intense over the years; In this situation, surgery cannot always eliminate these symptoms of nerve irritation or nerve overactivity.
The honest communication of the prostate complaints to your urologo cdmx urologist and the regular follow-up are therefore essential in order to initiate a suitable therapy in good time and to avoid permanent consequential damage.
- Compelling reasons for a short-term surgical treatment of the prostate disease [absolute surgical indications for BPS]:
- Multiple urinary retention
- Multiple urinary tract infections
- Multiple bleeding of the prostate (prostate varicose veins / varices)
- Urinary bladder stones
- Urinary transport disorder from the kidneys to the bladder (urinary stasis kidneys), often combined with high residual urine
If the prostate complaints are still tolerable and the examination results are okay (e.g. no high residual urine), attempts can first be made to alleviate the symptoms by making lifestyle changes: regulating the fluid intake (less in the evening), reducing alcohol and caffeine consumption, bladder training , copious consumption of fruit, vegetables and soy products, reduction in meat consumption. In accordance with the natural course of the disease, a slow increase in symptoms can be assumed over time. Regular specialist urological controls should therefore be carried out, for example every quarter.
Although many manufacturers offer herbal preparations for the treatment of prostate complaints, studies have not yet been able to provide reliable evidence that these have a long-term, verifiable effectiveness. After all, some studies show that plant extracts containing beta-sitosterol are well tolerated and improve urological symptoms and the urinary stream. Because of the lack of study data, herbal preparations [phytotherapeutic agents] have not been reimbursable through the statutory health insurance scheme in Germany since 2004.
A group of drugs that have been shown to work very quickly (randomized, placebo-controlled studies; onset of action within days) are the so-called alpha blockers [alpha-1 adrenoceptor antagonists]. The four active ingredients approved in Germany (e.g. tamsulosin) are all similarly effective at the appropriate dosage, but with different tolerability. Newer preparations release the active ingredient in a delayed manner [retard tablets] and are therefore usually better tolerated. Common side effects include low blood pressure, dizziness, gastrointestinal disorders, ejaculation disorders (semen gets into the bladder and is excreted when you urinate) and skin reactions (rash / itching).
The active ingredients dutasteride and finasteride are available in Germany as so-called 5-alpha reductase inhibitors. In particular, patients with a prostate volume of more than 30 ccm benefit from such a therapy. The prostate volume decreases by approx. 25% within half a year, and more if taken for a long time. Possible side effects are decrease in the amount of semen [ejaculate volume], reduction in sexual desire [loss of libido], enlargement of the male breast [gynecomastia] and potency problems [erectile dysfunction]. Its use in young or sexually active patients is therefore limited. Also noteworthy is the therapy-related halving of the PSA value when taking a 5-alpha reductase inhibitor.
Muscarinic receptor antagonists (also called anticholinergics) can be prescribed to reduce the irritative symptoms (increased urination, frequent urination, urge incontinence). Common side effects, however, are dry mouth, constipation and difficulty concentrating, depending on the active ingredient. With a severe narrowing of the prostatic urethra, the risk of urinary retention may increase somewhat, especially with higher doses within this group of drugs.
The combination of drugs from the last three groups mentioned is in many cases quite useful and also more effective than monotherapy. Here, the benefits and the range of side effects must be weighed against each other. In addition, it can be worthwhile to test different active ingredients, since the response can vary greatly from person to person, also in terms of the severity of the side effects.
methods (explanation of the procedures we perform more frequently) The standard operation: Monopolar TUR-P / TUR-Prostate / Transurethral Resection of the Prostate The removal of prostate tissue through the urethra using a 4-6 mm metal loop and a high-frequency current generator is Established for a long time and still by far the most frequently performed urological operation, it is still the reference procedure (approx. 75,000 procedures per year in Germany). With suitable patient selection and the use of modern resection techniques, excellent and permanent results can be achieved with low accompanying risks.
According to the literature, the complications after the procedure, which occur in just over 10% of the time, can usually be managed very well. These include: a second intervention that is necessary at short notice due to disruptive residual tissue or secondary bleeding (5.4%), urinary tract infections that can usually be easily treated with antibiotics (3.7%), higher blood loss that requires a blood transfusion (3.6%) and that so-called TUR syndrome – a shift in the electrolyte balance with increased fluid entrainment in the bloodstream due to the necessary electrolyte-free rinsing solution during the operation (1.1%). Serious, acutely life-threatening complications occur in significantly less than 1% of cases.
The success and safety of the procedure (as with all other techniques that remove prostate tissue directly) depend not least on the surgeon’s expertise; the procedure has a relatively long “learning curve”. The more experienced the surgeon is, the more tissue can be safely removed. In our clinic we see the upper limit of this surgical procedure at approx. 80-90 ccm prostate volume. The clear advantages of this technique are the direct tissue contact with the resection loop, the high amount of tissue removal over time and the relatively good visibility conditions. This makes it easy to safely remove large parts of the middle lobe of the prostate, which can protrude far into the bladder and are therefore close to the ureter orifice. The prostate tissue near the sphincter muscle can also be removed extremely precisely with the loop. In addition, the resection technique usually only leads to very slight urge or irritation symptoms after the operation and is therefore suitable for patients with pronounced urge symptoms.