Treatment for Benign Prostatic Hyperplasia in Germany

What does BPH mean?

Statistics in urology show that benign prostatic hyperplasia (BPH) is detected in almost half of men over 50. Medicine has proved that the development of benign prostatic hyperplasia (BPH) is somewhat age-dependent.

Although it is a completely benign mass that is not necessarily justified to be called prostate cancer, it nevertheless tends to grow. As the tumor grows, the gland itself enlarges. Benign prostatic hyperplasia (BPH) aggravates urination impairment because the channel through which the urine passes is compressed. Therefore, there is discomfort when urinating, as this process requires more muscle tension in this health condition.

What causes the development of benign prostatic hyperplasia?

Causes for occurrence of the health condition are insufficiently researched. Nevertheless, numerous studies in this field have proven that hormonal changes that start when men age 45-55 years and are being called the "male menopause" give a way for a pathology to develop.

This is caused by the prostate gland gradually enlarging and the increased tone of the smooth muscles of the bladder neck, resulting in compression of the urethra and narrowing of its lumen. Another important reason is the weakening of the bladder muscle contractility, which is mainly caused by the worsening of its blood supply. 

At the initial stage of the pathology, urination is complete, does not cause any discomfort  and no kidney damage is detected. At the final stage, the patient has "residual urine" (incomplete emptying of the bladder after urination), resulting in the formation of stones in the bladder. Against the background of impaired urine outflow, the ureters and renal pelvis gradually become distended, in which there is chronic inflammation – pyelonephritis. In the absence of adequate treatment for benign prostatic hyperplasia (BPH), in the final stages, chronic renal failure develops, which is life-threatening for the patient.

Symptoms of BPH

The occurrence of the pathology is accompanied by a number of clinical signals that are somewhat similar to the manifestation of prostate cancer, which can be roughly divided into two groups: irritative and obstructive. The first group of symptoms includes frequent, persistent urge to urinate, with occasional night episodes of urinary incontinence. Obstructive symptoms include difficulty in urination, feeling of incomplete bladder emptying, urine excretion in an intermittent thin stream or drops. Thus, the main clinical manifestation of prostate adenoma is impaired urination in one form or another. In the early compensated stage, patients have only minor phenomena of dysuria, which may remain unnoticed for a long time.

As the adenoma progresses, urinary disorders become more pronounced. At the subcompensation stage, the hypertrophy of the bladder muscular layer is replaced by degenerative changes of its walls, which gradually leads to organ dysfunction, the development of renal disorders, and finally to chronic renal failure.

If treatment of the prostate at the first two stages is not undertaken, the disease develops into the last, decompensated stage that is accompanied by symptoms of severe chronic kidney failure such as thirst, polyuria, bladder overflow and inability to urinate that is associated with frequent urge to urinate. Lack of treatment of patients currently at the third stage can rarely pose a threat for prostate cancer, but the development of chronic intoxication of the body with products of impaired urinary metabolism is a likely outcome.

Treatment tactics

Urology does not propose direct indications for surgical treatment for all patients with BPH. The condition, unlike prostate cancer, does not metastasize to other organs. However, as it grows, the adenoma begins to press the surrounding structures, first of all, the urethra, which leads to violation of the outflow of urine. Also quite often there is the prostate tissue overgrowth inside the bladder, leading to similar consequences.

One of the widespread and accessible therapies for BPH treatment is drug therapy. Specialists in urology use the well-known all over the world effective preparations, which influence the function of the prostate gland and help to get rid of urination disorders. Also, conservative treatment is aimed at reducing prostatic hyperplasia, relieving pain and other symptoms.

Non-drug options for benign prostatic hyperplasia (BPH)

Surgical options

Today, transurethral resection of the prostate (TURP) remains the gold standard in surgical BPH treatment. This endoscopic procedure removes the prostate adenoma through the urethra without external incisions. The adenoma is resected using a special loop and electrosurgical equipment, with fragments washed out through an endoscopic instrument. A catheter is inserted for 2-3 days post-operation. TURP offers a shorter hospital stay compared to open surgery and immediate improvement in urine flow. It's also safe for men with artificial pacemakers. However, there are risks of bleeding, TURP syndrome, and the need for temporary catheterization.

• Benefits: shorter hospital stay compared to open surgery, spinal or general anesthesia, and immediate improvement in urine flow.
• Limitations: risk of bleeding, TURP syndrome development, need for catheterization.

Transurethral enucleation of the enlarged prostate is similar but involves mechanical removal of the prostate adenoma. The excised adenoma is fragmented and flushed out, with visible vessels cauterized to reduce blood loss. This method is suitable for larger prostates and typically requires shorter catheterization time. However, it has a longer operative time and limited availability, with a potential for incomplete enucleation.

• Benefits: suitable for larger prostates, lower risk of bleeding, shorter catheterization time.
• Limitations: longer operative time, limited availability, and potential for incomplete enucleation.

Minimally invasive options

Transurethral needle ablation, TUNA uses radiofrequency energy to treat BPH with minimal invasiveness. It delivers energy through needles, heating tissue to 70-110°C. The procedure is performed under local anesthesia and typically takes 30-60 minutes. TUNA is an outpatient procedure with a lower risk of sexual side effects and minimal bleeding. However, it provides moderate symptom relief and may be less effective for larger prostates.

• Benefits: outpatient procedure, lower risk of sexual side effects, and minimal bleeding.
• Limitations: provides moderate symptom relief, is less effective for larger prostates, and may require retreatment.

Transurethral microwave thermotherapy, TUMT employs microwave energy to treat BPH symptoms. A specialized catheter is inserted into the urethra to emit microwave energy, heating prostate tissue while a cooling system protects the urethra. TUMT is well-tolerated with minimal bleeding and a lower risk of sexual side effects. It's best suited for moderate BPH symptoms, though some men may require retreatment in the future.

• Benefits: well-tolerated, minimal bleeding, and a lower risk of sexual side effects.
• Limitations: suitable for men with moderate BPH symptoms, some men may require retreatment in the future.

Laser options

The GreenLight Laser uses a unique green light laser for BPH treatment. The laser beam is selectively absorbed by hemoglobin, causing water in prostate tissue to boil and create a "microscopic furnace". This treatment is effective for various prostate sizes and suitable for patients on blood thinners, with reduced blood loss and complications. However, it's not ideal for extremely large prostates and requires specialized equipment and training.

• Benefits: effective for prostates of various sizes, can be used in patients taking blood thinners, reduced blood loss, and lower risk of complications.
• Limitations: not suitable for extremely large prostates, requires specialized equipment and training, potentially limiting availability.

The holmium laser enucleation of the prostate (HoLEP) is an advanced technique using a holmium laser for precise tissue removal. A surgeon inserts an urethroscope through the urethra to separate enlarged tissue from the outer capsule, which is then removed. HoLEP offers the lowest incidence of various complications and provides durable results, but requires specialized equipment and expertise.

• Benefits: the lowest incidence of recatheterization, urinary retention, urinary tract infection, stress urinary incontinence, and retrograde ejaculation.
• Limitations: requires specialized equipment and surgical expertise.

REZUM water vapor therapy

This is a novel approach using water vapor to treat enlarged prostate tissue. Sterile water vapor is injected into the prostate in short bursts, releasing thermal energy that causes targeted cell death. This outpatient procedure takes about 10-15 minutes and is performed under local anesthesia and sedation. REZUM offers quick recovery times and a lower risk of sexual side effects. However, some men may require retreatment, and long-term efficacy data is limited.

• Benefits: minimally invasive, quicker recovery time, lower risk of sexual side effects.
• Limitations: some men may require retreatment in the future, absence of long-term data on the efficacy.

Complications of untreated BPH

If the problems caused by an enlarged prostate and a present adenoma are left untreated, the man's health condition worsens greatly. Stagnant urine leads to the intoxication of the body, provokes the formation of bladder stones and kidney stones. There is pain that radiates to the glans penis. It intensifies with walking and standing. When lying down, the pain decreases.

There may also be a variety of infectious diseases like chronic prostatitis, urethritis, pyelonephritis, and others.

If benign prostatic hyperplasia (BPH) is not treated, kidney failure, constipation, vomiting, weight loss and anemia develop.

Often patients complain about lack of sleep and frequent, sometimes futile, nightly attempts to urinate. Besides, total urinary retention is possible even at the initial stage. In this case, an urgent surgery is needed.

Prognosis for patients with BPH

Lack of timely care increases the risk of inflammatory process dynamics, deterioration of general health condition, and well-being of a man. The recurrent stage of the disease is more difficult to treat and can be life threatening for the patient.

How sufficient the therapeutic measures will depend not only on the method used, but also on timely diagnosis. At the early stage, prostate adenoma is more amenable to treatment.

Positive changes can be observed in a few months after the start of therapy. At later stages, the pathological process can develop into a chronic form, which complicates not only the diagnosis, but also the treatment.

Best German hospitals for treatment

The medical standard is equally high in all of Germany. Whichever region of Germany you go to for treatment, you will receive diagnostic and therapeutic services that meet the generally high German standard. Since prices for treatment in Germany are subject to the uniform government regulation for calculating the cost of treatment for each patient, all patients receive the same high standard of medical care in German hospitals, regardless of their social status or country of residence.

Many German specialists and specialized medical centers focus on interdisciplinary cooperation. With that said, the top-rated German hospitals for the treatment of benign prostatic hyperplasia (BPH) are listed on the Booking Health website. Therefore, if you would like to find the right hospital for you, contact Booking Health for the qualified assistance.

The cost of treatment in Germany

The average prices for procedures for the treatment of benign prostatic hyperplasia (BPH) in German hospitals are listed below:

• The cost of treatment with transurethral resection starts at 4,065 EUR.
• The cost of treatment with prostatectomy starts at 4,013 EUR.
• The cost of treatment with transurethral needle ablation starts at 4,001 EUR.
• The prices for general therapeutic rehabilitation start at 565, 57 EUR.

Even though Germany has a unified pricing policy with stable prices for medical procedures, in each clinical case, the prices are calculated individually based on the number and type of procedures required.

If you want to know what the cost of treatment for benign prostatic hyperplasia (BPH) is going to be like for you, contact Booking Health.

Treatment in Germany with Booking Health

It is no less important to the staff of Booking Health than to the patients themselves that treatment is as effective as possible, that help in organizing the treatment in Germany be professional, and that the patient's experience is the most positive one. It is this approach that enables Booking Health to be among the leading companies in the world supporting foreign patients seeking treatment in Germany.

We know how hard it can be for people battling with a specific health condition to deal with organizational nuances, while preparing mentally and physically for complex procedures. Booking Health takes upon itself all of the organizational issues, while you take your time to prepare for treatment and subsequent recovery.

To get started with treatment for benign prostatic hyperplasia in Germany, fill in the request form on the Booking Health website, and our medical advisor will contact you.

Authors: 

The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova and Dr. Vadim Zhiliuk. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!

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Sources:

Johns Hopkins Medicine

National Library of Medicine

Urology Care Foundation