BPH Management: Four Treatment Options

1. Watchful Waiting for the Treatment of BPH


Benign prostatic hyperplasia (BPH) is a very common disease among older men and it affects almost every man at some point. However, sometimes treating the disease is not the best course of treatment. In the case of patients who have mild symptoms which are not particularly bothersome, physicians often recommend watchful waiting or active surveillance as the best course of treatment. Watchful waiting does not mean ignoring the condition. Instead, patients are expected to visit their physician regularly, who will conduct examinations to evaluate when or if other types of treatment are needed.

Alongside regular visits to the doctor, it is also recommended that patients engage in a series of lifestyle alterations during this time, including the reduction of liquid intake, especially before going out in public or before going to bed. In addition, avoiding or reducing their intake of caffeinated beverages and alcohol. The National Institutes of Health (NIH) also recommend that patients avoid using medication such as decongestants, antihistamines, antidepressants, and diuretics, as well as training their bladder to hold more urine for longer periods, exercising pelvic floor muscles, and preventing or treating constipation.

2. Medication for the Treatment of BPH


Medication is also a possible treatment option for BPH, which is designed to stop the growth of the prostate, to shrink the gland, or to decrease the symptoms of the disease. Drugs used for BPH are alpha blockers, phosphodiesterase-5 inhibitors, 5-alpha reductase inhibitors, or a combination of these. Alpha blockers work by relaxing the muscles of the prostate and bladder neck, which result in improved urine flow and reduced bladder blockage. These include terazosin (Hytrin), doxazosin (Cardura), tamsulosin (Flomax), alfuzosin (Uroxatral), and silodosin (Rapaflo). The most common phosphodiesterase-5 inhibitor is called Tadalafil (Cialis) and this type of medication is used particularly in the case of erectile dysfunction, but also to decrease urinary tract symptoms. It also works through muscle relaxation.

In addition, 5-alpha reductase inhibitors like finasteride (Proscar) or dutasteride (Avodart) are used to block the production of dihydrotestosterone (DHT) and, consequently, stop prostate enlargement. “These medications can prevent progression of prostate growth or actually shrink the prostate in some men. Finasteride and dutasteride act more slowly than alpha blockers and are useful for only moderately enlarged prostates,” state the Urology Care Foundation. “Several studies, such as the Medical Therapy of Prostatic Symptoms (MTOPS) study, have shown that combining two classes of medications, instead of using just one, can more effectively improve symptoms, urinary flow, and quality of life. The combinations include finasteride and doxazosin, dutasteride and tamsulosin (Jalyn), a combination of both medications that is available in a single tablet, [or] alpha blockers and antimuscarinics.”

3. Minimally Invasive Procedures for BPH Treatment


Medication is often the first course of treatment, but sometimes it is ineffective. Therefore, there are minimally invasive procedures that can be helpful in improving the symptoms of BPH. These include Prostatic Stent, High Intensity Focused Ultrasound (HIFU), Holmium Laser Enucleation of Prostate (HoLEP), Interstitial Laser Coagulation (ILC), Transurethral Electroevaporation of The Prostate (TUVP), Transurethral Microwave Thermotherapy (TUMT), Transurethral Needle Ablation (TUNA), Photoselective Vaporization (PVP), UroLift, and Catheterization.

One of the most common is TUNA, which consists of the use of heat from radio frequency energy to destroy the tissue in the prostate. A TUMT is similar, but microwaves are used instead of radio frequency. During a TUVP, the physician inserts a resectoscope through the urethra with an electrode attached, which provides electric current and vaporizes the tissue, while a prostatic stent consists of inserting a prostatic stent through the urethra to the area narrowed by the enlarged prostate in order to push back the prostate tissue, widening the urethra. The choice of the most appropriate minimally invasive procedure depends on the size of the prostate, how healthy is the patient and the patient’s preference.

4. Surgery for the Treatment of BPH


Surgery is usually the last resource for the treatment of BPH due to the potential complications and adverse effects that might occur. Surgical procedures for BPH include transurethral resection of the prostate (TURP), laser surgery, open prostatectomy, and transurethral incision of the prostate (TUIP). “Transurethral Resection of the Prostate (TURP) is the most common surgery for BPH. In the United States, about 150,000 men have TURPs each year. TURP uses electric current or laser light. After anesthesia, the surgeon inserts a resectoscope through the tip of the penis into the urethra. The resectoscope has a light, valves for irrigating fluid, and an electrical loop,” explain the foundation.

“The loop cuts tissue and seals blood vessels. The removed tissue flushes into the bladder and out of the body. A catheter is placed in the bladder through the penis.” During a laser surgery, a high-energy laser is used to destroy the tissue, while in an open prostatectomy, a large incision is made for the surgeon to  reach the prostate and remove all or part of the prostate. The TUIP consists of widening the urethra, which is done inserting a cystoscope and an instrument that uses an electric current or a laser beam through the urethra to reach the prostate.

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BPH News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

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