Treatments Options for BPH
Some men with BPH eventually find their symptoms to be bothersome enough to need treatment. BPH cannot be cured, but drugs or surgery can often relieve its symptoms. Talk with your primary care physician or a UCA urologist about the best choice for you. Your symptoms may change over time, so be sure to tell your doctor about any new changes.
Men with mild symptoms of BPH who do not find them bothersome often choose this approach. Watchful waiting means getting annual checkups. Treatment is started only if symptoms become too much of a problem.
If you choose watchful waiting, these simple steps may help lessen your symptoms:
- Limit drinking in the evening, especially drinks with alcohol or caffeine.
- Empty your bladder all the way when you pass urine.
- Use the restroom often. Don’t wait for long periods without passing urine.
- Some medications can make BPH symptoms worse, so talk with your doctor or pharmacist about any medicines you are taking such as over the counter cold and cough medicines (especially antihistamines) and blood pressure medicines.
Many American men with mild to moderate BPH symptoms choose prescription drugs over surgery. Three main types of drugs are used. Two types relax muscles near the prostate, and the other type shrinks the prostate gland. Some evidence shows that taking drugs together may work best to keep BPH symptoms from getting worse.
- Alpha-blockers are drugs that help relax muscles near the prostate to relieve pressure and let urine flow more freely, but they don’t shrink the size of the prostate. For many men, these drugs can improve urine flow and reduce the symptoms of BPH within days. Possible side effects include dizziness, headache, and fatigue.
- 5 alpha-reductase inhibitors are drugs that help shrink the prostate. They relieve symptoms by blocking the activity of an enzyme known as 5-alpha reductase. This enzyme changes the male hormone testosterone into dihydrotestosterone (DHT), which stimulates prostate growth. When the action of 5-alpha reductase is blocked, DHT production is lowered and prostate growth slows. Rare side effects include erectile dysfunction and breast enlargement.
- PDE-5 inhibitors are drugs that relax the prostate and alleviate the symptoms of BPH, but don’t reduce the enlargement of the prostate. This medication also alleviates erectile dysfunction. Some insurance plans do not cover this drug and men on certain medications cannot take it.
BPH Surgery Options
While the number of prostate surgeries has declined over the past few years, surgical operations for BPH are still among the most common procedures for American men. Surgery is used when symptoms are severe or drug therapy has not worked well. Be sure to discuss options with your doctor and ask about the potential short- and long-term benefits and risks with each procedure.
Types of surgery for BPH include:
- TURP (transurethral resection of the prostate). The most common surgery for BPH, TURP accounts for 90 percent of all BPH surgeries. The doctor passes an instrument through the urethra and trims away extra prostate tissue. Tissue is sent to the laboratory to check for prostate cancer. TURP generally avoids the two main dangers linked to another type of surgery called open prostatectomy (complete removal of the prostate gland through a cut in the lower abdomen): including incontinence and/or impotence. However, TURP can have serious side effects, such as bleeding. In addition, men may have to stay in the hospital and need a catheter for a few days after surgery.
- TUIP (transurethral incision of the prostate). This surgery, which is similar to TURP, is used on slightly enlarged prostate glands. The surgeon places one or two small cuts in the prostate. This relieves pressure without trimming away tissue. It has a low risk of side effects. Like TURP, this treatment helps with urine flow by widening the urethra.
- TUNA (transurethral needle ablation). Radio waves are used to burn away excess prostate tissue. TUNA helps with urine flow, relieves symptoms, and may have fewer side effects than TURP. Most men need a catheter to drain urine for a period of time after the procedure.
- TUMT (transurethral microwave thermotherapy). Microwaves are used to destroy excess prostate tissue. This can be an option for men who prefer less invasive procedures.
- TUVP (transurethral electroevaporation of the prostate). An electrical current is used to vaporize prostate tissue.
- Laser surgery. The doctor passes a laser fiber through the urethra into the prostate, using a cystoscope, and then delivers several bursts of laser energy. The laser energy destroys prostate tissue and helps improve urine flow.
- Open prostatectomy. This may be the only option in rare cases, such as when the obstruction is severe, the prostate is very large, or other procedures can’t be done.
- Urolift. A device is placed into the prostate to lift and hold enlarged prostate tissue out of the way so it no longer blocks the urethra. This procedure is less likely to cause retrograde ejaculation. Long term efficacy of this new option in not well established.