BPH treatment

Patients with only mild signs and symptoms of benign prostatic hyperplasia may not require¹⁶ medical treatment other than watchful waiting (continued observation of one’s symptoms for any changes).

If you do need treatment for BPH, there are a wide variety of options available. These include medications, minimally invasive therapies, and surgery. The best course of treatment¹⁷ for you depends on a number of factors:

• Age
• Overall health
• Size of the prostate
• Severity of symptoms or level of discomfort

Medication for BPH

Medication is the most frequently used treatment for mild to moderate symptoms of BPH. Some medications used to treat benign prostatic hyperplasia include:

• Alpha blockers: Alpha blockers work to make urination easier by relaxing the muscles in the bladder’s neck and the fibers of the prostate. This type of medication usually works quickly in men with relatively small prostates.
• 5-alpha reductase blockers: These medications prevent the hormonal changes that cause the prostate to enlarge, causing the gland to shrink. It may take up to six months for 5-alpha reductase blockers to be effective.
• Combination drug therapy: Your healthcare provider may recommend that you take both alpha blockers and 5-alpha reductase blockers simultaneously if either medication alone isn’t effective.
• Tadalafil: Some studies suggest that tadalafil (generic Cialis), which is frequently used to treat erectile dysfunction, can also work to treat an enlarged prostate.

BPH medication

Your healthcare provider may prescribe the following medication to treat BPH:

Minimally invasive therapies and surgery for BPH

Your healthcare provider may recommend using minimally invasive therapies or surgery to treat your BPH if:

• Your symptoms are moderate to severe
• Medication has not been successful in relieving your symptoms
• You have a urinary tract obstruction, blood in your urine, bladder stones, or kidney problems

Your provider may recommend against minimally invasive or surgical therapies if you have:

• An untreated urinary tract infection (UTI)
• Urethral stricture disease
• A history of prostate radiation therapy or urinary tract surgery
• A neurological disorder, such as multiple sclerosis (MS) or Parkinson’s disease

There are several types of minimally invasive and surgical therapies available for treating benign prostatic hyperplasia. These include:

• Transurethral resection of the prostate (TURP): All but the outer portion of the prostate gland is removed. TURP usually relieves the symptoms of BPH quickly.
• Transurethral incision of the prostate (TUIP): One or two small incisions are made in the prostate gland, making it easier for urine to pass through the urethra. This procedure can be a good option for men with small or moderately enlarged prostate glands.
• Transurethral microwave thermotherapy (TUMT): An electrode is inserted into the prostate area through the urethra. Using microwave energy, the electrode destroys the inner portion of the prostate, shrinking the gland and making it easier for urine to flow. This procedure may only partially relieve the symptoms of BPH, and it may take some time before you notice positive results.
• Transurethral needle ablation (TUNA): Radio waves pass through needles placed into the prostate by a surgeon. These waves heat and destroy the excess prostate tissue that is causing urine blockage. This procedure is rare and is only used in select cases.
• Laser therapy: A high-energy laser is used to destroy or remove enlarged prostate tissue. This treatment may be used in men who should not undergo other prostate procedures because they take blood-thinning medications. Laser therapies include ablative procedures (which vaporize obstructing prostate tissues) and enucleation (which removes all prostate tissue blocking urine flow and prevents the regrowth of tissue).
• Prostatic urethral lift (PUL): The sides of the prostate are compressed using special tags, increasing the flow of urine. This procedure may be recommended for patients experiencing lower urinary tract symptoms or those who are concerned about ED or ejaculatory problems (which may arise from TURP).
• Embolization: This experimental procedure involves selectively blocking the blood supply to or from the prostate, causing the gland to shrink. Long-term data on the effectiveness of embolization is not yet available.
• Open or robot-assisted prostatectomy: An incision is made in the lower abdomen to reach the prostate and remove tissue. This procedure is usually performed on men whose prostate glands are very large, as well as those who have bladder damage or other complication factors.

Lifestyle changes for BPH

If your signs and symptoms are mild, your healthcare provider may only recommend making some healthy lifestyle changes¹⁸ to manage your BPH. These can include:

• Reducing liquid intake, especially before sleeping or going out in public
• Avoiding or reducing intake of caffeine and alcohol
• Avoiding or monitoring the use of certain medications, such as antihistamines, decongestants, antidepressants, and diuretics (medications that increase the body’s production of urine)
• Training the bladder to hold larger volumes of urine for longer periods of time
• Practicing exercises that strengthen the muscles of the pelvic floor (Kegel exercises)
• Preventing or treating constipation