BPH Treatment: Options for Treating Benign Prostatic Hyperplasia

Don’t delay in seeking help if you feel that you might have an enlarged prostate. Talk to your doctor as soon as possible. After all, knowledge gives you power to take action.

That said there’s no single solution, as different factors affect how we decide to treat your BPH (benign prostatic hyperplasia).  After our initial consultation and testing, we may first recommend further observation and lifestyle changes. This may be a good measure for some before turning to medication or surgery.

The following are some signs that you may have an enlarged prostate:

  • A need to urinate more frequently than in the past
  • The feeling that you can’t empty your bladder even after going to the bathroom
  • A sudden unexpected urge to urinate
  • A weak stream or dribbling at the end
  • Some issue starting the urine flow
  • Having to stop in the middle of peeing and restarting
  • Leakage of urine

So if these symptoms are mild, we may start you on a program of careful observation. The hope is to avoid the side effects of medications and/or the complications and hardship of surgery.

For example, we may ask you to make adjustments such as not drinking too much liquid before going to bed or reducing caffeine and/or alcohol consumption. Eliminating certain over-the-counter medicine such as decongestants or antihistamines (such as Benadryl).

That said, if your symptoms persist or increase in severity, we will discuss options related to medications or surgery.

The two classes of drugs for an enlarged prostate are:

  • Alpha blockers relax muscles of the prostate and neck of the bladder. Examples include: Alfuzosin (Uroxatral), Doxazosin (Cardura), Tamsulosin (Flomax), and Terazosin (Hytrin).
  • 5-alpha reductase inhibitors (5-ARIs) minimize the size of the prostate. Examples include: Finasteride (Proscar) and Dutasteride (Avodart).
  • Phosphodiesterase 5 inhibitors (PDE5 inhibitors): Tadalfil (Cialis), Sildenafil, (Viagra), Vardenafil (Levitra).  (PDE5) inhibitors can help with flow rate.

We may also recommend a combination of these medications. Always work with a doctor who is very careful with managing the potential side effects that may come with these prescription medications.

Procedures

Sometimes BPH doesn't respond enough to lifestyle changes, medications, or supplements. If that's true for you, there are surgical options as well.

You and your doctor look to surgery when you can’t pee at all or have:

  • Kidney damage
  • Lots of urinary tract infections or bleeding
  • Stones in the bladder

One of your options would be what’s called “minimally invasive” surgery. In these types, doctors make much smaller cuts or are able to work with probes they insert through your penis. These types of procedures often mean faster recoveries and less pain and scarring.

Traditional, open surgery is the other option. You should talk with your doctor about what’s best for your case.

There are several types of minimally invasive or surgical therapies.

Laser therapy

This is an outpatient minimally invasive surgical procedure using laser energy delivered to the prostate to remove blocking prostate tissue with minimal bleeding risk postoperatively.

Transurethral needle ablation (TUNA)

This is an outpatient procedure that uses radio waves to reduce the size of your prostate. The radio waves are transmitted through needles placed in your prostate guided by a scope.

REZUM

This is an outpatient minimally invasive surgical procedure using heat energy conducted by water delivered to the prostate to shrink blocking prostate tissue with minimal bleeding risk postoperatively.

Urolift

This is an outpatient minimally invasive surgical procedure using small stay sutures that are implanted into the to the prostate to open the blocking prostate tissue with minimal bleeding risk postoperatively.

Seeking help with low testosterone

Testosterone naturally declines as we get older. Symptoms might include lower sex drive, increase in body far, hair loss, decrease in sleep quality and mood shifts. Fortunately, a urologist can perform a blood test do determine if your testosterone levels are below healthy levels. If our office determines you have low testosterone, we will present you options for testosterone replacement therapy.

Low testosterone (low T) occurs when levels fall below 300 nanograms per deciliter (ng/dL). A normal range for men is typically 300–1,000 ng/dL, according to the U.S. Food and Drug Administration.

Other health conditions may lead to low testosterone, including high blood pressure, diabetes, obesity, high cholesterol, HIV/AIDS, and chronic opioid use.

Treatment options, testosterone replacement therapy, include gels and creams; a mouth patch applied the upper gums; a skin patch; or injections or implants. Each protocol has its pros and cons and ultimately the method may be matched to your lifestyle.

No matter what, if you think you may have low testosterone, speak to a qualified urologist about your symptoms. We can get you on the path to feeling better.

Common issues men can seek help with from an urologist

Many people suffer from conditions they may be able to find help with. A good urologist can properly diagnose and prescribe proper treatment for. Here are some of the most common issues that urologists can help with.

1. Benign Prostatic Hyperplasia (BPH)

BPH is the condition of having an enlarged prostate, which is quite common in older men. Men will have difficulty urinating and some may feel full in the bladder because they aren’t completing urination.  It can be very uncomfortable, disrupt sleep and cause issues when traveling.

2. Erectile dysfunction (ED)

Erectile dysfunction is when a man has issue getting or maintaining an erection. There are many ways to treat this condition, including medication, psychological counseling, or lifestyle changes to reduce stress and increase overall blood flow.

3. Urinary Tract Infection (UTI)

Men can get urinary tract infections too. If you experience pain while urinating, see a urologist to make sure it’s not a sign a of a bigger issue. In most cases, a round of anti-biotics will treat the UTI.

4. Prostatitis

Prostatitis is inflammation of the prostate and may cause pain while urinating, a fever or pain the abdomen or lower back. Get this checked out and can usually be taken care of with medication.

5. Infertility

Quite often, men aren’t checked when it comes to couples having difficulty conceiving. Men can have low sperm count or other conditions that causes infertility. An urologist can make the proper diagnosis and get you on the right program.

6. Kidney stones

Kidney stones are a result of mineral and chemicals accumulating in the kidney or along the urinary tract. It can be very painful for the stone to pass if left untreated. Medication to reduce the size of a stone may be an option, and for more severe cases surgery may be the solution.

The bottom line: Don’t hesitate to check a condition that’s bothering you checked out by a qualified urologist. Many conditions can be treated fairly easily and early detection is always very important if the condition is more serious such as in the case of prostate cancer.

How to choose your urologist

Choosing the right urologist is very important. Much of what goes into the decision, beyond experience and qualifications, is the manner in which the urologist interacts with patients. Is he or she a good listener? How is the office staff? Does he or she explain everything well?

Here are some tips on choosing your urologist:

Referrals

Ask your friends or family for some recommendations. Ask your primary care physician about the topic. Start here and you’ll be able to narrow down your choice at least a bit.

Credentials

Consider where he went to school, what areas he specializes in and what certifications he holds.  These credentials matter and always ask if you need more proof of an urologist’s training. Check out websites like Healthgrades.com that list doctors’ credentials.

Experience 

Again, ask a lot of questions. Find out how many successful procedures your prospective urologist has done in the area in which you need. Does he or she have more experience with certain procedures?

Personality

This is key. Make sure you are comfortable speaking with your urologist about anything. Does he or she communicate well and explain and the ins and outs of your treatment? While there are many qualified urologists, the one that is the best fit for you comes down to how they make you feel during before, after and during the visit.

Reviews

Online reviews can be tricky as sometimes only negative people bother to post a review. That said, you can gain a lot of insight from reviews. Read them with a grain of salt, but if you see there is a particular aspect of the a review that resonates with you, use that in your decision making process.