BPH affects half of all men by age 50 and 75% by age 80.
As a man ages, his prostate gland continues to grow. Over time, the enlarged prostate (referred to as benign prostatic hypertrophy, or BPH) can cause a variety of problems with urinating.
Mild cases may not require any treatment. However, approximately half of all patients require intervention to reduce distressing symptoms.
Additionally, if the prostate grows large enough to severely obstruct urine flow, permanent damage to the bladder and kidneys may result. These patients will need treatment to restore the flow of urine and prevent further injury.
Treatments can consist of home interventions, medications, minimally-invasive procedures, and surgery. The patient’s age, health, symptoms, and degree of obstruction will be taken into consideration when choosing a course of treatment.
Home Interventions: When symptoms are mild, home interventions and regular check-ups may be the best option. Limiting liquids after dinner and emptying the bladder before bed can help manage overnight issues. Patients should avoid medications known to restrict urine flow such as antihistamines, decongestants, and certain diuretics. Avoiding smoking, alcohol, and coffee, especially after dinner, will also help reduce symptoms. Finally, Kegel exercises may strengthen the muscles used during urination, reducing leaking and incontinence.
Medications: Alpha blockers are used to relax the muscles of the bladder, making urination easier. Alpha reductase inhibitors help relieve symptoms by decreasing the size of the prostate. Although medications can be effective, side effects like dizziness, headaches, and sexual issues may cause some patients to seek other treatments.
Thermotherapies: For these procedures, tiny waves of heat energy or water vapor are used to destroy the enlarged prostate tissue. A flexible tube is inserted into the urethra to ensure closer access to the area. Performed under a local anesthesia, these are minimally-invasive options to help relieve symptoms and restore quality of life.
Prostatic Stents: Stents are narrow tubes used to push back the enlarged prostate tissue and help maintain an adequate opening in the urethra. Stents may be used if other treatments have failed.
UroLift Prostatic Urethral Lift: The UroLift device is minimally-invasive with no incisions or tissue removal. It helps restore the flow of urine by clipping back the enlarged prostate tissue, opening the urethra. This in-office procedure has proven to be safe and effective with no negative effects on sexual functioning.
Laser Surgery: A laser is inserted into the urethra and the excess prostate tissue is cut away. The risk of bleeding is less than other surgical options.
Transurethral Resection of the Prostate (TURP): This is the most common surgical intervention for BPH. Under general anesthesia, a flexible tube is inserted into the urethra and the extra prostate tissue is cut away.
Transurethral Incision of the Prostate: A scope is inserted into the urethra and tiny cuts are made to help widen the urethra and bladder.
Open Surgery: This is the most invasive treatment for BPH, involving an incision in the skin. This option is reserved for difficult cases where the prostate is very large, or if other areas are in need of repair.
With many of these procedures, it may take a few weeks for symptoms to resolve. Any time the prostate tissue is manipulated or removed, swelling and inflammation can occur. A catheter will be inserted and remain in place until the swelling subsides. Some procedures may affect sexual functioning as well.