How is benign prostatic hyperplasia treated?
Treatment options for benign prostatic hyperplasia may include
Please also click here to skip to complications from treatment.
A health care provider treats benign prostatic hyperplasia based on the severity of symptoms, how much the symptoms affect a man’s daily life, and a man’s preferences. Men may not need treatment for a mildly enlarged prostate unless their symptoms are bothersome and affecting their quality of life. In these cases, instead of treatment, a urologist may recommend regular checkups. If benign prostatic hyperplasia symptoms become bothersome or present a health risk, a urologist most often recommends treatment.
Lifestyle Changes
A health care provider may recommend lifestyle changes for men whose symptoms are mild or slightly bothersome. Lifestyle changes can include
Reducing intake of liquids, particularly before going out in public or before periods of sleep
Avoiding or reducing intake of caffeinated beverages and alcohol
Avoiding or monitoring the use of medications such as decongestants, antihistamines, antidepressants, and diuretics
Exercising pelvic floor muscles
Preventing or treating constipation
Medications
A health care provider or urologist may prescribe medications that stop the growth of or shrink the prostate or reduce symptoms associated with benign prostatic hyperplasia:
Alpha blockers
These medications relax the smooth muscles of the prostate and bladder neck to improve urine flow and reduce bladder blockage:
Terazosin (Hytrin)
Doxazosin (Cardura)
Tamsulosin (Flomax)
Alfuzosin (Uroxatral)
Silodosin (Rapaflo)
Phosphodiesterase-5 inhibitors
Urologists prescribe these medications mainly for erectile dysfunction.
Tadalafil (Cialis) belongs to this class of medications and can reduce lower urinary tract symptoms by relaxing smooth muscles in the lower urinary tract.
Researchers are working to determine the role of erectile dysfunction drugs in the long-term treatment of benign prostatic hyperplasia.
5-alpha reductase inhibitors
These medications block the production of DHT (dihydrotestosterone), which accumulates in the prostate and may cause prostate growth:
Finasteride (Proscar)
Dutasteride (Avodart)
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.
Combination medications.
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
Alpha blockers and Antimuscarinics
A urologist may prescribe a combination of alpha blockers and antimuscarinics for patients with overactive bladder symptoms.
Overactive bladder is a condition in which the bladder muscles contract uncontrollably and cause urinary frequency, urinary urgency, and urinary incontinence. Antimuscarinics are a class of medications that relax the bladder muscles.
Minimally Invasive Procedures
Researchers have developed a number of minimally invasive procedures that relieve benign prostatic hyperplasia symptoms when medications prove ineffective. These procedures include:
Transurethral needle ablation
Transurethral microwave thermotherapy
High-intensity focused ultrasound
Transurethral electrovaporization
Water-induced thermotherapy
Prostatic stent insertion
iTIND
Minimally invasive procedures can destroy enlarged prostate tissue or widen the urethra, which can help relieve blockage and urinary retention caused by benign prostatic hyperplasia.
Urologists perform minimally invasive procedures using the transurethral method, which involves inserting a catheter—a thin, flexible tube—or cystoscope through the urethra to reach the prostate. These procedures may require local, regional, or general anesthesia. Although destroying troublesome prostate tissue relieves many benign prostatic hyperplasia symptoms, tissue destruction does not cure benign prostatic hyperplasia. A urologist will decide which procedure to perform based on the man’s symptoms and overall health.
Transurethral needle ablation. This procedure uses heat generated by radiofrequency energy to destroy prostate tissue. A urologist inserts a cystoscope through the urethra to the prostate. A urologist then inserts small needles through the end of the cystoscope into the prostate. The needles send radiofrequency energy that heats and destroys selected portions of prostate tissue. Shields protect the urethra from heat damage.
Transurethral microwave thermotherapy. This procedure uses microwaves to destroy prostate tissue. A urologist inserts a catheter through the urethra to the prostate, and a device called an antenna sends microwaves through the catheter to heat selected portions of the prostate. The temperature becomes high enough inside the prostate to destroy enlarged tissue. A cooling system protects the urinary tract from heat damage during the procedure.
High-intensity focused ultrasound. For this procedure, a urologist inserts a special ultrasound probe into the rectum, near the prostate. Ultrasound waves from the probe heat and destroy enlarged prostate tissue.
Transurethral electrovaporization. For this procedure, a urologist inserts a tubelike instrument called a resectoscope through the urethra to reach the prostate. An electrode attached to the resectoscope moves across the surface of the prostate and transmits an electric current that vaporizes prostate tissue. The vaporizing effect penetrates below the surface area being treated and seals blood vessels, which reduces the risk of bleeding.
Water-induced thermotherapy. This procedure uses heated water to destroy prostate tissue. A urologist inserts a catheter into the urethra so that a treatment balloon rests in the middle of the prostate. Heated water flows through the catheter into the treatment balloon, which heats and destroys the surrounding prostate tissue. The treatment balloon can target a specific region of the prostate, while surrounding tissues in the urethra and bladder remain protected.
Prostatic stent insertion. This procedure involves a urologist inserting a small device called a prostatic stent through the urethra to the area narrowed by the enlarged prostate. Once in place, the stent expands like a spring, and it pushes back the prostate tissue, widening the urethra. Prostatic stents may be temporary or permanent. Urologists generally use prostatic stents in men who may not tolerate or be suitable for other procedures.
Urolift. For this procedure, a urologist places small, permanent implants into the prostate to lift and hold the enlarged tissue out of the way, relieving pressure on the urethra and allowing the urine to flow. It was designed to open the prostatic urethra (the inside of the prostate) without applying incisions (cuts), surgical resection (scraping of prostate), or thermal ablation (heating) to the prostate. Urolift delivers immediate results, rapid symptom relief, preservation of sexual function, quick return to normal activity, small likelihood of a catheter placed after the operation, and an increased quality of life.
Surgery
For long-term treatment of benign prostatic hyperplasia, a urologist may recommend removing enlarged prostate tissue or making cuts in the prostate to widen the urethra. Urologists recommend surgery when:
Medications and minimally invasive procedures are ineffective
Symptoms are particularly bothersome or severe
Complications arise
Although removing troublesome prostate tissue relieves many benign prostatic hyperplasia symptoms, tissue removal does not cure benign prostatic hyperplasia. Surgery to remove enlarged prostate tissue includes
Transurethral resection of the prostate (TURP)
Laser surgery
Open prostatectomy
Transurethral incision of the prostate (TUIP)
A urologist performs these surgeries, except for open prostatectomy, using the transurethral (through the penis) method. Men who have these surgical procedures require local, regional, or general anesthesia and may need to stay in the hospital.The urologist may prescribe antibiotics before or soon after surgery to prevent infection. Some urologists prescribe antibiotics only when an infection occurs.
Immediately after benign prostatic hyperplasia surgery, a urologist may insert a special catheter, called a Foley catheter, through the opening of the penis to drain urine from the bladder into a drainage pouch.
TURP
With TURP, a urologist inserts a resectoscope through the urethra to reach the prostate and cuts pieces of enlarged prostate tissue with a wire loop. Special fluid carries the tissue pieces into the bladder, and the urologist flushes them out at the end of the procedure. TURP is the most common surgery for benign prostatic hyperplasia and considered the gold standard for treating blockage of the urethra due to benign prostatic hyperplasia.
Laser surgery
With this surgery, a urologist uses a high-energy laser to destroy prostate tissue. The urologist uses a cystoscope to pass a laser fiber through the urethra into the prostate. The laser destroys the enlarged tissue. The risk of bleeding is lower than in TURP and TUIP because the laser seals blood vessels as it cuts through the prostate tissue. However, laser surgery may not effectively treat greatly enlarged prostates.
Open prostatectomy
In an open prostatectomy, a urologist makes an incision, or cut, through the skin to reach the prostate. The urologist can remove most of the prostate through the incision. This surgery is used most often when the prostate is greatly enlarged, complications occur, or the bladder is damaged and needs repair. Open prostatectomy requires general anesthesia, a longer hospital stay than other surgical procedures for benign prostatic hyperplasia, and a longer rehabilitation period. The three open prostatectomy procedures are retropubic prostatectomy, suprapubic prostatectomy, and perineal prostatectomy. The recovery period for open prostatectomy is different for each man who undergoes the procedure. However, it typically takes anywhere from 3 to 6 weeks.
TUIP
A TUIP is a surgical procedure to widen the urethra. During a TUIP, the urologist inserts a cystoscope and an instrument that uses an electric current or a laser beam through the urethra to reach the prostate. The urologist widens the urethra by making a few small cuts in the prostate and in the bladder neck. Some urologists believe that TUIP gives the same relief as TURP except with less risk of side effects.
After surgery, the prostate, urethra, and surrounding tissues may be irritated and swollen, causing urinary retention. To prevent urinary retention, a urologist inserts a Foley catheter so urine can drain freely out of the bladder. A Foley catheter has a balloon on the end that the urologist inserts into the bladder. Once the balloon is inside the bladder, the urologist fills it with sterile water to keep the catheter in place.
Men who undergo minimally invasive procedures may not need a Foley catheter.
The Foley catheter most often remains in place for several days. Sometimes, the Foley catheter causes recurring, painful, difficult-to-control bladder spasms the day after surgery. However, these spasms will eventually stop.
A urologist may prescribe medications to relax bladder muscles and prevent bladder spasms. These medications include
Oxybutynin chloride (Ditropan)
Solifenacin (VESIcare)
Darifenacin (Enablex)
Tolterodine (Detrol)
Hyoscyamine (Levsin)
Propantheline bromide (Pro-Banthine)
What are the complications of benign prostatic hyperplasia treatment?
The complications of benign prostatic hyperplasia treatment depend on the type of treatment.
Complications from Medications
Medications used to treat benign prostatic hyperplasia may have side effects that sometimes can be serious. Men who are prescribed medications to treat benign prostatic hyperplasia should discuss possible side effects with a health care provider before taking the medications. Men who experience the following side effects should contact a health care provider right away or get emergency medical care:
Hives
Rash
Itching
Shortness of breath
Rapid, pounding, or irregular heartbeat
Painful erection of the penis that lasts for hours
Swelling of the eyes, face, tongue, lips, throat, arms, hands, feet, ankles, or lower legs
Difficulty breathing or swallowing
Chest pain
Dizziness or fainting when standing up suddenly
Sudden decrease or loss of vision
Blurred vision
Sudden decrease or loss of hearing
Chest pain, dizziness, or nausea during sexual activity
These side effects are mostly related to phosphodiesterase-5 inhibitors. Side effects related to alpha blockers include:
Dizziness or fainting when standing up suddenly
Decreased sexual drive
Problems with ejaculation
Complications from Minimally Invasive Procedures
Complications after minimally invasive procedures may include:
UTIs
Painful urination
Difficulty urinating
An urgent or a frequent need to urinate
Urinary incontinence
Blood in the urine for several days after the procedure
Sexual dysfunction
Chronic prostatitis––long-lasting inflammation of the prostate
Recurring problems such as urinary retention and UTIs
Most of the complications of minimally invasive procedures go away within a few days or weeks. Minimally invasive procedures are less likely to have complications than surgery.
Complications from Surgery
Complications after surgery may include:
Problems urinating
Urinary incontinence
Bleeding and blood clots
Infection
Scar tissue
Sexual dysfunction
Recurring problems such as urinary retention and UTIs
Problems urinating.
Men may initially have painful urination or difficulty urinating. They may experience urinary frequency, urgency, or retention. These problems will gradually lessen and, after a couple of months, urination will be easier and less frequent.
Urinary incontinence.
As the bladder returns to normal, men may have some temporary problems controlling urination. However, long-term urinary incontinence rarely occurs. The longer urinary problems existed before surgery, the longer it takes for the bladder to regain its full function after surgery.
Bleeding and blood clots.
After benign prostatic hyperplasia surgery, the prostate or tissues around it may bleed. Blood or blood clots may appear in urine. Some bleeding is normal and should clear up within several days. However, men should contact a health care provider right away if:
They experience pain or discomfort
Their urine contains large clots
Blood clots from benign prostatic hyperplasia surgery can pass into the bloodstream and lodge in other parts of the body––most often the legs. Men should contact a health care provider right away if they experience swelling or discomfort in their legs.
Their urine is so red it is difficult to see through
Blood clots from benign prostatic hyperplasia surgery can pass into the bloodstream and lodge in other parts of the body––most often the legs. Men should contact a health care provider right away if they experience swelling or discomfort in their legs.
Infection.
Use of a Foley catheter after benign prostatic hyperplasia surgery may increase the risk of a UTI. Anesthesia during surgery may cause urinary retention and also increase the risk of a UTI. In addition, the incision site of an open prostatectomy may become infected. A health care provider will prescribe antibiotics to treat infections. Scar tissue. In the year after the original surgery, scar tissue sometimes forms and requires surgical treatment. Scar tissue may form in the urethra and cause it to narrow (stricture). A urologist can solve this problem during an office visit by stretching the urethra. Rarely, the opening of the bladder becomes scarred and shrinks, causing blockage. This problem may require a surgical procedure similar to TUIP.
Sexual dysfunction.
Some men may experience temporary problems with sexual function after benign prostatic hyperplasia surgery. The length of time for restored sexual function depends on the type of benign prostatic hyperplasia surgery performed and how long symptoms were present before surgery. Many men have found that concerns about sexual function can interfere with sex as much as the benign prostatic hyperplasia surgery itself. Understanding the surgical procedure and talking about concerns with a health care provider before surgery often help men regain sexual function earlier. Many men find it helpful to talk with a counselor during the adjustment period after surgery. Even though it can take a while for sexual function to fully return, with time, most men can enjoy sex again.
Most health care providers agree that if men with benign prostatic hyperplasia were able to maintain an erection before surgery, they will probably be able to have erections afterward. Surgery rarely causes a loss of erectile function. However, benign prostatic hyperplasia surgery most often cannot restore function that was lost before the procedure. Some men find a slight difference in the quality of orgasm after surgery. However, most report no difference.
Prostate surgery may make men sterile, or unable to father children, by causing retrograde ejaculation—the backward flow of semen into the bladder. Men flush the semen out of the bladder when they urinate. In some cases, medications such as pseudoephedrine, found in many cold medications, or imipramine can treat retrograde ejaculation. These medications improve muscle tone at the bladder neck and keep semen from entering the bladder.
Recurring problems
Men may require further treatment if prostate problems, including benign prostatic hyperplasia, return. Problems may arise when treatments for benign prostatic hyperplasia leave a good part of the prostate intact. About 10 percent of men treated with TURP or TUIP require additional surgery within 5 years. About 2 percent of men who have an open prostatectomy require additional surgery within 5 years.
In the years after benign prostatic hyperplasia surgery or treatment, men should continue having a digital rectal exam once a year and have any symptoms checked by a health care provider. In some cases, the health care provider may recommend a digital rectal exam and checkup more than once a year.
Researchers have not found a way to prevent benign prostatic hyperplasia. Men with risk factors for benign prostatic hyperplasia should talk with a health care provider about any lower urinary tract symptoms and the need for regular prostate exams. Men can get early treatment and minimize benign prostatic hyperplasia effects by recognizing lower urinary tract symptoms and identifying an enlarged prostate.
Eating, Diet, and Nutrition
Researchers have not found that eating, diet, and nutrition play a role in causing or preventing benign prostatic hyperplasia. However, a health care provider can give information about how changes in eating, diet, or nutrition could help with treatment. Men should talk with a health care provider or dietitian about what diet is right for them.
Quick Summary
Benign prostatic hyperplasia––also called BPH––is a condition in men in which the prostate gland is enlarged and not cancerous.
The prostate is a walnut-shaped gland that is part of the male reproductive system.
The cause of benign prostatic hyperplasia is not well understood; however, it occurs mainly in older men.
Benign prostatic hyperplasia is the most common prostate problem for men older than age 50.
Lower urinary tract symptoms suggestive of benign prostatic hyperplasia may include:
Urinary frequency—urination eight or more times a day
Urinary urgency—the inability to delay urination
Trouble starting a urine stream
A weak or an interrupted urine stream
Dribbling at the end of urination
Nocturia—frequent urination during periods of sleep
Urinary retention––the inability to empty the bladder completely
Urinary incontinence—the accidental loss of urine
Pain after ejaculation or during urination
Urine that has an unusual color or smell
The complications of benign prostatic hyperplasia may include:
Acute urinary retention
Chronic, or long lasting, urinary retention
Blood in the urine
Urinary tract infections (UTIs)
Bladder damage
Kidney damage
Bladder stones
A health care provider diagnoses benign prostatic hyperplasia based on
A personal and family medical history
A physical exam
Medical tests
Treatment options for benign prostatic hyperplasia may include
Lifestyle changes
Medications
Minimally invasive procedures
Surgery
The complications of benign prostatic hyperplasia treatment depend on the type of treatment.
Researchers have not found a way to prevent benign prostatic hyperplasia.
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