How is benign prostatic hyperplasia (BPH) treated?

If your doctor finds that you have benign prostatic hyperplasia, you will be given a variety of treatment options. Treatment usually begins with the least invasive options that do not involve surgery.

The first treatment for BPH is often making lifestyle changes. You may be advised to avoid alcohol and caffeine, drink less liquid, and do exercises to strengthen your pelvic muscles.

The next level of treatment for benign prostatic hyperplasia is usually medications such as tamsulosin (Flomax®). This is a type of drug called an alpha blocker. It is meant to relax the bladder neck muscles and prostate muscles to increase urinary flow and decrease the urge to urinate.

Other drugs called alpha reductase inhibitors, such as finasteride (Propecia®, Proscar®) and dutasteride (Avodart®), can be used to reduce the size of the prostate and reduce urine flow.

If lifestyle changes and medications do not help with BPH, surgery is the next option. Surgical options range from minimally invasive therapies to full surgery.

What are the reasons for benign prostatic hyperplasia (BPH) surgery?

Benign prostate surgery is recommended if less invasive treatments have failed, or if you have severe symptoms such as:

  • An inability to urinate
  • Frequent urinary tract infections
  • Excessive blood in the urine
  • Bladder stones
  • Kidney damage

What are the kinds of minimally invasive surgical treatments for benign prostatic hyperplasia (BPH)?

Several minimally invasive surgeries may be used for BPH. These include:

Greenlight laser: Photoselective vaporization of the prostate (PVP) is a treatment that vaporizes prostate tissue to create a channel in the urethra for free urination. This is an office-based therapy and requires an anesthetic.

Plasma button electrovaporization: Prostate tissue is removed using low temperature plasma energy. Tissue is vaporized. This is an operating room-based therapy and requires an anesthetic.

Rezum: Water vapor is directly delivered to the prostate tissue. Over a 3-month period the tissue is destroyed and reabsorbed by the body. This is an office-based therapy and is performed under a local tissue block.

Urolift: A mechanical approach that places implants to pin the lateral prostate lobes out of the way to reduce obstruction. This is an office-based procedure performed under a local tissue block.

What are other benign prostatic hyperplasia (BPH) surgery options?

If your symptoms are severe or minimally invasive surgical treatments do not help with your enlarged prostate, your doctor will likely recommend another kind of surgery. Several surgical options include:

Transurethral resection of the prostate (TURP): This is the most common treatment for BPH. During this procedure, your urologist will insert a rigid instrument called a resectoscope into the urethra. This is why it is called transurethral. Inserting the tube this way means no cutting into the prostate. He or she will then use the charged resectoscope to remove the excess tissue that is blocking the urine from exiting the bladder.

You may be put to sleep with general anesthesia. Local anesthesia for the lower part of the body may be used for this procedure. The average in hospital stay for TURP is 1 to 2 days.

Transurethral incision of the prostate (TUIP): This is a similar procedure to TURP. Instead of prostate tissue being removed the bladder neck and prostate are cut to relax the bladder opening, allowing urine to flow more freely. TUIP is most successful on men with smaller prostates.

Simple prostatectomy: A surgical procedure in which an incision is made through the abdomen or performed laporoscopically. The inner portion of the prostate gland is removed, leaving the outer segment intact.

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