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Treatment for BPH

A wide variety of treatments are available for enlarged prostate. They include medications, surgery and minimally invasive procedures. The best treatment choice for you depends on several factors, including how much your symptoms bother you, the size of your prostate, other health conditions you may have, your age and your preference. If your symptoms aren't too bad, you may decide not to have treatment and wait to see whether your symptoms become more bothersome over time. Your doctor will have you fill out a symptom questionnaire and may do certain studies such as urinalysis, uroflow (a study to determine rate of urine speed/flow), and postvoid bladder residual determination (PVR) to help guide in management.

 

Behavioral Therapy

This includes avoiding foods/beverages that are irritating to the urinary tract (e.g. caffeine, alcohol) and fluid restriction to help your symptoms.

 

Medications

Medications are the most common treatment for moderate symptoms of prostate enlargement. Medications used to relieve symptoms of enlarged prostate include:

  • Alpha blockers. These medications relax bladder neck muscles and muscle fibers in the prostate itself and make it easier to urinate. These medications include terazosin, doxazosin (Cardura), tamsulosin (Flomax), alfuzosin (Uroxatral) and silodosin (Rapaflo). Alpha blockers work quickly. Within a day or two, you'll probably have increased urinary flow and need to urinate less often. These may cause a harmless condition called retrograde ejaculation — semen going back into the bladder rather than out the tip of the penis. Other side effects may include nasal congestion and light-headedness.  It is wise to not take these medications at the same time as other medications that can lower your blood pressure and to exercise caution when going from a sitting to standing position until you know how these medications will effect you.
  • 5 alpha reductase inhibitors. These medications shrink your prostate by preventing hormonal changes that cause prostate growth. They include finasteride (Proscar) and dutasteride (Avodart). They generally work best for very enlarged prostates. It may be several weeks or even months before you notice improvement. Rarely, these medications may cause sexual side effects including impotence (erectile dysfunction), decreased sexual desire or decreased ejaculate volume.
  • Combination drug therapy. Taking an alpha blocker and a 5 alpha reductase inhibitor at the same time is generally more effective than taking just one or the other by itself.
  • Tadalafil (Cialis). This medication, from a class of drugs called phosphodiesterase inhibitors, is often used to treat impotence (erectile dysfunction). It also can be used as a treatment for prostate enlargement. Tadalafil should be used with caution in combination with alpha blockers. It can't be taken with medications called nitrates, such as nitroglycerin.

 

Surgery

Your doctor may recommend surgery if medication isn't effective or if you have severe symptoms. There are several types of surgery for an enlarged prostate. They all reduce the size of the prostate gland and open the urethra by treating the enlarged prostate tissue that blocks the flow of urine. The decision about which type of surgery may be an option is based on a number of factors, including the size of your prostate and the severity of your symptoms.

Any type of prostate surgery can cause side effects, such as semen flowing backward into the bladder instead of out through the penis during ejaculation (retrograde ejaculation), loss of bladder control (incontinence) and impotence (erectile dysfunction). Fortunately, incontinence and erectile dysfunction are extremely rare side effects. Ask your doctor about the specific risks of each treatment you're considering.

Surgeries

Standard surgeries for an enlarged prostate include:

 

Minimally invasive procedures

Minimally invasive treatments are less likely to cause blood loss during surgery and require a shorter, if any, hospital stay. These treatments also typically require less pain medication. Depending on the procedure — and how well it works for you — you may need follow-up treatments.

Minimally invasive treatments include:

Urolift (click link to see more information)

The doctor places small, permanent implants into the prostate to lift and hold the enlarged tissue out of the way, relieving pressure on the urethra and allowing urine to flow. There is no cutting, heating, or removal of prostate tissue required which means a minimally invasive, straightforward procedure and less downtime for patients. 

Laser surgery

Laser surgeries (also called laser therapies) use high-energy lasers to destroy or remove overgrown prostate tissue. Laser surgeries generally relieve symptoms right away and have a lower risk of side effects than does TURP. Some laser surgeries can even be used in men on anticoagulant (blood thinner) medications.

Laser surgery can be done with different types of lasers and in different ways.

  • Ablative procedures (including vaporization) remove prostate tissue pressing on the urethra by burning it away, easing urine flow. Ablative procedures may cause irritating urinary symptoms after surgery and may need to be repeated at some point.
  • Enucleative procedures are similar to open prostatectomy, but the tissue is removed through the urethra.  A laser is used to resect the prostate tissue.  A specimen will be available for pathologic evaluation unlike ablative procedures.

 

 

Transurethral microwave thermotherapy (TUMT)

With this procedure, your doctor inserts a special electrode through your urethra into your prostate area. Microwave energy from the electrode generates heat and destroys the inner portion of the enlarged prostate gland causing it to shrink and ease urine flow. This surgery has a lower risk of complications than does TURP, but is generally only used on small prostates in special circumstances, because re-treatment may be necessary.

 

 

Transurethral needle ablation (TUNA)

With this outpatient procedure, a lighted scope (cystoscope) is passed into your urethra. Your doctor uses the scope to place needles into your prostate gland. When the needles are in place, radio waves pass through them, heating and destroying excess prostate tissue that's blocking urine flow. TUNA basically scars the prostate tissue, which causes it to shrink and open up, easing urine flow. This type of surgery may be a good choice if you bleed easily or you have certain other health problems. Like TUMT, TUNA may only partially relieve your symptoms and it may take some time before you notice results.

 

Transurethral resection of the prostate (TURP)

TURP has been a common procedure for enlarged prostate for many years, and it is the surgery with which other treatments are compared. With TURP, a surgeon places a special lighted scope (resectoscope) into your urethra and uses small cutting tools to remove all but the outer part of the prostate (prostate resection). TURP generally relieves symptoms quickly, and most men have a stronger urine flow soon after the procedure. Following TURP, there is risk of bleeding and infection, and you will temporarily require a catheter to drain your bladder after the procedure. You'll be able to do only light activity until you're healed.

 

Transurethral incision of the prostate (TUIP or TIP)

This surgery is an option if you have a small prostate gland causing obstructive urinary symptoms. Like TURP, TUIP involves special instruments that are inserted through the urethra. But instead of removing prostate tissue, the surgeon makes two small cuts in the prostate gland to open up a channel in the urethra — making it easier for urine to pass through.

 

Open or laparoscopic subtotal prostatectomy

This type of surgery is generally done if you have a very large prostate, bladder damage or other complicating factors, such as bladder stones. It's called open because the surgeon makes an incision in your lower abdomen to reach the prostate. Subtotal prostatectomy is the most effective treatment for men with severe prostate enlargement, but it is more invasive and often has a longer recovery period. It generally requires a short stay in the hospital and is associated with a higher risk of needing a blood transfusion. This type of procedure can also be performed in a laparoscopic and robot-assisted laparoscopic manner.