How is benign prostatic hyperplasia (BPH) treated?

Patients who have mild symptoms may not require treatment other than continued observation to make sure their condition doesn't get worse. This approach is sometimes called "watchful waiting" or surveillance. There are a number of treatment options available if your symptoms are severe.

Medications

Finasteride (Proscar®) and dutasteride (Avodart®) work by decreasing the production of the hormone dihydrotestosterone (DHT), which affects the growth of the prostate gland. These appear to be most beneficial for men with larger prostates.

Drugs that relax the muscle in the prostate (to reduce the tension on the urethra) are more commonly used. These include terazosin (Hytrin®), doxazosin (Cardura ®), tamsulosin (Flomax®), alfuzosin (Uroxatral®), and silodosin (Rapaflo®). The most common side effects are lightheadedness, weakness and retrograde ejaculation.

Medications are sometimes combined to help treat symptoms and improve the flow of urine. One such medication is dutasteride and tamsulosin (Jalyn®).

Surgery

Several different types of surgery can be used to remove the prostate tissue that blocks the flow of urine, including:

  • Transurethral resection of the prostate (TURP): The urologist removes the tissue blocking the urethra with a special instrument. Side effects include bleeding, infection, impotence (inability to maintain an erection suitable for sex), incontinence (inability to control the flow of urine) and retrograde ejaculation.
  • Transurethral incision of the prostate (TUIP): The urologist makes two small cuts in the bladder neck (where the urethra and bladder join) and in the prostate to widen the urethra to improve urine flow.
  • Transurethral electrovaporization: This technique uses electrical energy applied through an electrode to rapidly heat prostate tissue, turning the tissue cells into steam. This allows the doctor to vaporize an area of the enlarged tissue and relieve urinary blockage.
  • The GreenLight laser: This procedure removes prostate tissue with a laser. It is associated with less bleeding during and after the procedure.

Minimally invasive treatments

New treatments for BPH have been developed that are less invasive and less damaging to healthy tissue than surgery. In general, minimally invasive procedures are done on an outpatient basis, result in fewer side effects, are less costly and allow for quicker recovery. The most common side effects reported with these treatments include urinary frequency and irritation while the prostate is healing. Because these techniques are new, little is known about their long-term effectiveness and complications.

Minimally invasive treatments include:

  • Prostatic urethral lift: A prostatic urethral lift is a procedure that separates the enlarged prostate lobes to make the urethra wider, so that it is easier to urinate. The urologist inserts an instrument into the urethra and moves it forward. When the device reaches the lateral (side) wall of the prostate, it ejects small, thin implants into both sides of the prostate, pulling the urethra and prostate to open the channel. Depending on the size of the prostate, the urologist will place from 2 to 6 implants.
  • Water vapor therapy: The urologist inserts an instrument into the urethra and moves it to the prostate. A needle is injected from the instrument into the prostate and emits steam vapor. The vapor turns into water in the prostate, and the thermal energy created by the water kills the cells of the prostate. The patient reabsorbs the dead cells and the prostate shrinks.

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