Benign prostatic enlargement (BPE) is often associated with lower urinary tract symptoms (LUTS) such as weak stream, urgency, nocturia, feeling of residual urine, difficulties to start urination. If causes bladder outflow obstruction (BOO) this may very well be the case. But very often, BPE and LUTS are poorly correlated. It is therefore important to come to the right diagnosis. In BOO, several non-surgical treatment options exist: alpha blockers (foremost Tamsulosin), 5-alpha reductase inhibitors (Finasteride and Dutasteride), PDE-5 inhibitors (Tadalafil) and combination therapy. Low intensity shockwave therapy (ESWT) is emerging as another effective option that doesn’t involve any medication. Dr. med. Dr. phil. Stefan Buntrock, urologist from Göttingen, explains in this video on UroChannel which treatment options exist and how they work.
Hello and welcome to euro channel you probably clicked on this video because you have the urge to go to the bathroom often even at night there’s a weak stream and you feel you don’t empty your bladder well your doctor might have told you that your prostate is enlarged and causing all of this and you might ask yourself whether this misery will continue until the end
Of your life then you’ve come to the right place because in this video i am going to give you non-surgical treatment options how to make life easier again first of all benign prosthetic enlargement is a very common condition in the aging male it is estimated that 40 percent of men over 50 years are affected in 80 year olds it is nearly 90 percent benign prosthetic
Enlargement often leads to what we call benign prosthetic obstruction and is associated with a number of symptoms by the name of lutz lower urinary tract symptoms i named a few of these symptoms in the beginning lutz is a significant disrupter of quality of life my first advice to you is to get a proper diagnosis this includes to get your prostate volume measured by
Ultrasound and an examination by finger plus getting your psa checked all of this is to rule out any prostate cancer prostate cancer has nothing to do with benign prostatic enlargement but it may cause luts as well prostate cancer may serve as an example for conditions that may cause luts but are unrelated to prosthetic size i’ll skip that part for now and give you
Some treatment options for the enlarged prostate that will cause obstruction and prevent the bladder from emptying properly selective alpha blockers are always a good starting point they target the bladder neck only and won’t interfere with alpha receptors in other parts of the body as you might know some alpha blockers like doxosozine and terrazosine are prescribed
For high blood pressure drugs like tamsulosin have almost no effect on blood pressure but only act at the bladder neck it will cause the bladder neck and prostate smooth muscle to relax it will be easier to empty the bladder there will be a better urinary flow and overall lots will be reduced one of the downsides of alpha blockers is interference with ejaculation
Volume under the influence of the drug semen volume will be markedly reduced this is especially true for tamsulosin it is also possible to block the conversion from testosterone into dihydrotestosterone within the prostate you might have heard about drugs that do that their names are finasteride and detasteride if the prostate runs short of dihydrotestosterone it
Will start to shrink the effect is not that pronounced and it takes time but on the long run it will be possible to reduce prostate size by 10 to 20 percent science has found that prostate size and psa level are predictors so a relatively large prostate together with an elevated psa level prostate cancer has been excluded of course will do best with a combination of
An alpha blocker with finasteride or dutasteride in my office i’m using tadella fill in daily dosing a lot it is a long-acting pde5 inhibitor initially marketed by the name of cyalis it works well in many men especially when it comes to nocturia the number of visits to the bathroom at night gets significantly reduced in many of my patients similar to alpha blockers
Pda5 inhibitors act through smooth muscle relaxation in the prostate and urethra as men who suffer from luts also very often suffer from erectile dysfunction this drug is of dual use there are some contraindications with pd5 inhibitors though as they may not be used together with nitrates the potassium channel opener nicorendyl and the alpha blockers doxazosin and
Terazosin a combination with the alpha blocker tamsulosin is possible however another non-surgical option might be low intensity shock waves eswt one of the properties of shock waves is their muscle relaxing ability a recent pilot study in 32 men with bpe luts showed a significant improvement of symptoms after being treated with eswt additionally the researchers
Noted a better erectile function too ok this is a pilot study and general conclusions can’t be drawn however for me this is a very interesting study since it confirms my own experience with five years of shock wave treatment so maybe we are looking at the breakthrough here we’ll see what large scale studies will show if you want to try this kind of treatment i
Advise you to get treated with focused shock waves as radial waves most probably don’t have the same effect my device is adornier areas too the mode of shockwave generation is electromagnetic to my knowledge the arius is not approved in the us but if you’re watching from the states the storz duralith sd1 has fda approval this is also a machine with focused shock
Waves from an electromagnetic generator by the way i’m not getting paid from any of these companies to say this there is one thing about benign prosthetic enlargement not to be forgotten it is only one possible cause of luts so always blaming lutz on the prostate wouldn’t be correct but i’m leaving out this part here but if you’re interested i already uploaded a
Video that explains what i mean thanks for watching bye bye bye
Transcribed from video
Benign prostatic enlargement – non-surgical treatment options | UroChannel By UroChannel