BPH Treatment Options

Benign prostatic hyperplasia, or enlarged prostate, is a common and treatable condition that affects some men in their 40s and 50s, most men over age 60 and practically all men over 80. BPH isn’t related to prostate cancer, but it can be uncomfortable and can significantly affect your quality of life.

Depending on the severity of your symptoms, how they interfere with your daily life and your prostate anatomy, your doctor will discuss these treatment options with you.

Medication

Several types of medication usually provide mild to moderate improvement in urinary symptoms. Medications called alpha-blockers relax prostate muscle tissue to help open the urinary channel, allowing better urine flow. Medications called 5-alpha reductase inhibitors can shrink the enlarged prostate tissue to improve urinary symptoms.

• Advantages: Medications can work quickly — within a week in some cases — and may be appropriate if surgery presents high risk for you. Medication usually provides moderate symptom improvement.
• Disadvantages: You’ll usually need the medications for the rest of your life. Medications can cause side effects, including dizziness and changes in sexual function. Concerns exist that some bladder and prostate medications may increase the risk of dementia or diabetes.

Minimally Invasive Procedures

Several minimally invasive procedures can provide marked improvement in urinary symptoms in up to 90 percent of men. These outpatient procedures work to decrease the obstruction from the enlarged prostate. Two of the most effective minimally invasive procedures offered at PAMF are no-heat UroLift® prostate implants and Rezum® water vapor hydrotherapy.

• Advantages: Minimally invasive procedures are appropriate for up to 80 percent of men and provide significant symptom improvement that lasts at least five years. Symptom relief means you don’t need to take medications for the rest of your life. These less invasive, outpatient procedures offer faster recovery than do other types of prostate surgery.
• Disadvantages: These procedures involve passage of an endoscope through the penis into the prostate. You’ll receive either light anesthesia in an outpatient surgery center (UroLift) or local anesthesia in an office setting (Rezum). You may experience urinary irritation during the short recovery period.

Transurethral Prostate Surgery

Transurethral prostate surgery dates back to the 1930s and has a long track record of success. This surgery, done under spinal or general anesthesia, removes the enlarged prostate tissue from the inside of the prostate. TURP methods include instruments to shave out the enlarged tissue or vaporizing tissue with electrodes or laser fibers. You may spend one night in the hospital, and you’ll have a catheter for at least one day after surgery.

• Advantages: TURP surgery provides reliable symptom improvement with prostates of almost all shapes and sizes. It provides lifelong symptom improvement in 95 percent of men.
• Disadvantages: Risks include bleeding and infection. The procedure causes lack of ejaculation for most men. The surgery requires anesthesia and you must stop taking blood-thinning medication.

Robot-assisted Simple Prostatectomy

In some men the prostate enlarges so much that the obstructing tissue cannot be removed safely with an endoscope passed through the urethra. Urologists can remove the enlarged tissue using laparoscopy (looking into the abdomen through very small incisions). Urologists use the da Vinci robotic surgical system to open the bladder and remove the enlarged prostate tissue.

• Advantages: This is much less invasive than the open surgery used in the past and can be performed even on massively enlarged prostates. The technique allows safe removal of all enlarged prostate tissue and provides lifetime symptom improvement in 95 percent of men.
• Disadvantages: Robot-assisted simple prostatectomy requires general anesthesia and overnight hospitalization. A catheter is left in the urethra for seven to 10 days to allow the bladder and prostate to heal. Risks include bleeding or infection. The procedure causes a lack of ejaculation in most men.