BPH Treatment Options

Enlargement of the prostate gland, also known as benign prostatic hyperplasia (BPH), is a common and treatable condition that causes urinary symptoms. The percentage of men who get urinary symptoms increases with age. BPH isn’t related to prostate cancer, but its symptoms can be uncomfortable and may significantly affect quality of life.

Depending on your symptom severity and prostate anatomy, your doctor will discuss these treatment options with you.

Medication

Alpha-blockers relax the circular muscle tissue around the prostate gland and bladder opening, allowing better urine flow. 5-alpha reductase inhibitors (ARIs) can shrink the enlarged prostate and improve urinary symptoms; however, they take three to 12 months to become effective. Antimuscarinic drugs and beta-3 adrenergic agonists relax the bladder muscle and can reduce urinary urgency and frequency. They don’t directly affect the prostate gland.

Advantages

Except for ARIs, medications can work quickly to produce symptom relief.
Many (but not all) are covered by insurance.

Disadvantages

Except for ARIs, medications don’t eliminate the cause of symptoms.
You may need to use one or more medications for the rest of your life.
May cause mild side effects, such as dizziness, reduced blood pressure, dry orgasm (sexual climax without semen ejaculation), dry mouth and constipation. Some of these medications have been associated with mild cognitive problems in some men.

Surgery

Outpatient Prostate Surgery

Two outpatient procedures, UroLift® and Rezum®, are usually done in a urologist’s office with local anesthesia and mild sedation. In some men, these procedures provide significant improvement in urinary symptoms.

UroLift involves implants placed into the prostate’s side lobes to pull them apart and create more space for urine to exit the bladder. Rezum applies heated water vapor to the enlarged prostate area, vaporizing the tissue.

Advantages

Neither procedure requires general anesthesia or hospitalization.
UroLift rarely causes problems with ejaculation or erections.
Rezum usually doesn’t cause problems with ejaculation or erections.

Disadvantages

Urinary urgency and frequency may last for days or weeks after the procedure and may require a bladder catheter.

Aquablation® Prostate Surgery

Aquablation is the newest treatment for enlarged prostate. It uses robotic technology and a heat-free, high-power controlled waterjet to ablate (remove) enlarged prostate tissue. CPMC is the first hospital in San Francisco to offer Aquablation therapy.

Advantages

Provides long-lasting symptom resolution for most men, regardless of prostate size or shape.
Less than 5% risk of losing erectile function.
Less than 20% risk of losing ejaculatory function.
Takes less than an hour to perform.

Disadvantages

Requires general or spinal anesthesia and often one night in the hospital.
Small risks of urethral narrowing (stricture), bleeding, infection and symptom recurrence or persistence.
In many cases, requires a bladder catheter for one or more days.

Transurethral Prostate Resection (TURP)

TURP dates to the 1930s and has a long track record of success. TURP uses either an electrosurgical instrument to shave enlarged prostate tissue or a laser to vaporize the enlarged prostate tissue.

Advantages

Provides reliable symptom improvement with prostates of almost all shapes and sizes.
Need for retreatment or a second procedure is less than 20%.

Disadvantages

Requires general or spinal anesthesia.
Requires you to temporarily stop taking blood-thinning medication.
Usually requires a bladder catheter during one night in the hospital.
Risks include bleeding (higher with electrosurgical TURP) and infection.
Causes dry orgasm for most men.

Robot-Assisted Laparoscopic Prostate Surgery

In men with very large prostates, it’s difficult to remove the obstructing tissue adequately and safely through the urethra. Robotic-assisted laparoscopic surgery allows the urologist to place several narrow tubes into the abdomen to open the bladder and remove the enlarged tissue.

Advantages