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.