Medicated (or not)
Watchful waiting means using tests and exams to watch BPH to see if signs or symptoms are getting worse. It is often used for men who have mild symptoms that don’t bother them. Other treatments will be started if BPH causes problems.
If you have mild symptoms, you may want to make some lifestyle changes to help manage them. Try to limit the fluids you drink, especially before bedtime. Also try to avoid fluids with caffeine (such as coffee or soda) and spicy foods. Some medicines can make the symptoms of BPH worse. Talk to your doctor if you are taking the following medicines:
- drugs that increase the amount of urine that the body makes (called diuretics)
You may want to try retraining your bladder. Instead of urinating every time you have the urge, try urinating only at certain times of the day or after a certain amount of time (such as every 3 hours).
Talk to your healthcare team about learning pelvic floor exercises. They can strengthen the muscles in the pelvic floor to help control urination.
Constipation can put pressure on the bladder. If you have constipation, talk to your healthcare team about ways you can manage it. They may recommend lifestyle changes, such as getting more fibre and drinking more fluids or taking medicines to help relieve constipation.
Most doctors begin treating BPH with medicines before using other treatments such as surgery. The following drugs can be used to relieve symptoms. Talk to your doctor about these medicines and their side effects.
Alpha-blockers are drugs that relax the muscles near the prostate, which relieves pressure on the urethra and allows urine to flow more easily. They don’t shrink the prostate. Alpha-blockers usually start working within a week. The most common alpha-blockers used for BPH are:
- terazosin (Hytrin)
- doxazosin (Cardura)
- tamsulosin (Flomax)
- silodosin (Rapaflo)
- alfuzosin (Xatral)
Side effects may include:
- low blood pressure
5-alpha-reductase inhibitors help shrink the prostate to relieve symptoms. These drugs prevent the enzyme 5-alpha-reductase from changing testosterone into dihydrotestosterone, which makes the prostate grow. They work best in men with large prostates. Finasteride (Proscar) and dutasteride (Avodart) are 5-alpha-reductase inhibitors used to treat BPH. It may take 6 months to a year before symptoms get better.
Side effects may include:
- reduction of sexual desire
- erectile dysfunction
- reduced amount of semen to ejaculation
- breast swelling or tenderness
Combination therapy may be an option for a man who has a large prostate and bothersome symptoms. It includes the alpha-blocker tamsulosin and the 5-alpha-reductase inhibitor dutasteride. These drugs are given together in one pill under the brand name Jalyn.
Phosphodiesterase-5 (PDE5) inhibitors relax muscles in the bladder, urethra and prostate. Tadalafil (Cialis) is a PDE5 inhibitor that is used to relieve symptoms of BPH. It is also used to treat erectile dysfunction.
Muscle relaxants can be used to help lessen bladder contractions, reduce leakage and reduce the urge to urinate. Doctors may give the muscle relaxant solifenacin (Vesicare) or mirabegron (Myrbetriq) with an alpha-blocker.
Surgery is used to treat BPH when drug therapy stops working or to treat men who can’t urinate at all. It can also be used to relieve severe symptoms.
Transurethral resection of the prostate (TURP)
TURP removes prostate tissue through the urethra. It is the surgery most commonly used to treat BPH. While TURP relieves urinary symptoms in most men, urinary problems can come back over time if the prostate starts to grow again. This is why younger men may need to have this surgery more than once.
This is the most common surgical procedure for BPH
- It is performed under general or spinal anesthesia.
- A special tube with light and a camera (resectoscope) is inserted into the urethra into the prostate.
- The surgeon can observe the inside of the urethra, prostate and bladder.
- The excess tissue of the prostate is removed in the region that surrounds the urethra.
- A catheter is placed in the bladder to allow the urine to flow.
- The catheter is removed as soon as there is no more blood in the urine (usually after 24 hours).
Side effects of TURP may include:
- retrograde ejaculation
- erectile dysfunction – rare
- incontinence – rare
But this surgery has a lower risk of these side effects than surgery to remove the prostate (called prostatectomy). Some men may have to undergo a second procedure (10% of men after 10 years).
Other surgeries and procedures
The following may also be used to relieve urinary symptoms caused by BPH.
Laser prostatectomy uses a laser to destroy prostate tissue. Doctors do this procedure with a laser that is passed through a cystoscope (a lighted magnifying instrument that is used to look at and treat areas inside the urethra and bladder). A laser prostatectomy can be done by holmium laser enucleation or photoselective vaporization (PVP).
Transurethral incision of the prostate (TUIP) uses a special tool on a cystoscope to make small incisions (surgical cuts) in the prostate. TUIP helps to relieve pressure on the urethra but it doesn’t remove any tissue. TUIP is mostly used in men with smaller prostates.
Transurethral electrovaporization (TUEVP) uses an electrode attached to a resectoscope. The electrode delivers electricity to heat prostate tissue until it is destroyed.
Prostatic urethral lifts are implants that the doctor places in the prostate to help pull it away from the urethra.
Prostatectomy is surgery to remove the prostate. Prostatectomy is only used in rare cases when other procedures or surgeries can’t be done. It may also be used if the urethra is completely blocked or if the prostate is very large.