At first, benign prostatic hyperplasia, also known as BPH, prostatic hyperplasia, or an enlarged prostate, displays only glimpses of the issues to come. However, BPH symptoms tend to ramp up methodically through the years. The main cause of benign prostate enlargement is hormonal changes as men age, but one runs an even greater chance of developing prostate enlargement if there is a family history of BPH, if overweight, diabetic, inactive, or experiencing heart disease or erectile dysfunction. Luckily, BPH treatment options are plentiful and can begin relieving prostate symptoms once initiated.
BPH can be treated without surgery, but only if symptoms remain mild to moderate, are tolerable and the bladder isn’t negatively impacted. BPH treatment becomes necessary when the prostate begins presenting bothersome symptoms and starts dictating lifestyle choices and changes. If symptoms become more severe, BPH can be addressed if the correct surgical treatment is chosen in consultation with a urologist.
One caveat is not allowing the bladder to suffer so much from prostatic hyperplasia that it is damaged permanently. When the bladder is blocked long enough by an obstructive condition such as benign prostatic hyperplasia, it can lose some or all of its capacity to contract and completely expel urine. If enough bladder damage is sustained, it could result in additional issues like urinary tract infections (UTIs), bladder stones, blood in the urine, urinary retention, or a decompensated bladder that could lead to permanent incontinence.
Fortunately, the treatment options for BPH are numerous, especially if symptoms are mild to moderate and addressed early. Men should expect significant relief for benign prostatic hyperplasia if the correct treatment is chosen based on the symptoms being experienced. BPH is diagnosed and evaluated by a urologist who is trained in urinary issues.
BPH treatment opportunities fall into these three categories
Watchful waiting – Includes the surveillance and monitoring of mild to moderate BPH symptoms and possibly employing simple lifestyle modifications or changes until such a point when medication or surgery for prostatic hyperplasia may be needed.
Medication – Two types of medication are available to address BPH symptoms when watchful waiting is no longer feasible or desirable and surgery isn’t yet being considered. Another variation to address benign prostatic hyperplasia is the combination of the two medications.
Alpha-blockers such as Tamsulosin (Flomax), Alfuzosin (Uroxatral), or Silodosin (Rapaflo) are effective for some men because they begin working immediately by relaxing the muscles of the bladder and prostate, making it easier to urinate.
5-alpha reductase inhibitors (5-ARI’s) like Finasteride (Propecia and Proscar) or Dutasteride (Avodart) may be another option for addressing prostatic hyperplasia. However, since they work instead to shrink the enlarged prostate, they can take up to six months to begin providing relief.
A combination of both types of medication may be prescribed by a doctor if one or the other is not providing relief of benign prostate enlargement symptoms on its own.
Surgery – Numerous BPH surgical procedures, both resective (prostate tissue is removed) and non-resective (no prostate tissue is removed during actual surgery), have been developed over the years to address moderate to severe BPH symptoms. These prostatic hyperplasia procedures include open and robotic resection, lasers, electrical loops, microwaves, radio waves, lifting implants, water vapor, artery embolization, and high-pressure water jets to ablate prostate tissue in patients with benign prostatic hyperplasia. What to expect during treatment for BPH depends on the respective surgery chosen and how large the prostate is.
6 of the most common surgical BPH treatments (in alphabetical order)
Aquablation therapy – An FDA cleared BPH treatment that can be performed on prostates of all sizes, this minimally invasive, one-of-a-kind procedure is one of the latest innovations for BPH and utilizes a heat-free waterjet controlled by a robotic device that follows a unique surgical map customized by the surgeon for each patient. Because of its map-guided robotic precision and no damaging heat, Aquablation is becoming popular for its effectiveness and safety profile, specifically its extremely low rate of urinary and sexual complications. Aquablation therapy is covered by Medicare and most commercial insurers around the country.
Holmium Laser Enucleation (HoLEP) – Also called laser prostatectomy, HoLEP is a minimally invasive prostatic hyperplasia procedure that removes prostate tissue using laser energy via a telescope inserted into the urethra. The laser cores out the inside of the enlarged prostate, leaving the outer layer of the prostate intact. HoLEP is one option for men with large prostates or who take blood thinners and can’t risk higher impact prostate enlargement surgery. Most men experience retrograde ejaculation and incontinence post-surgery with HoLEP.
Prostatectomy (Simple) – The simple prostatectomy is an open, more invasive surgical procedure for men with large prostates over 100 grams, damaged bladders, or other limitations. A large incision made in the abdomen allows access to the bladder and subsequent removal of the inside of the prostate, leaving the outside of the prostate intact. A higher risk of complications with this procedure includes a longer recovery time and retrograde ejaculation, with erectile dysfunction, and urinary incontinence is a possibility.
PVP GreenLight Laser – Laser photo-vaporization of the prostate (PVP) uses a GreenLight Laser to remove problematic prostate tissue via laser vaporization with minimal blood loss. Men who are on blood thinners or anticoagulants and those with large prostates may find this procedure beneficial. A cystoscope containing a thin laser fiber is inserted into the urethra and up to the prostate and bladder. The laser focuses its energy on the excess prostate tissue and vaporizes it. Individual treatment plans can be implemented. Risks include irritative symptoms and retrograde ejaculation.
Rezum – A newer minimally invasive procedure, Rezum harnesses the thermal energy from water vapor to remove excess prostate tissue. It was developed for small to medium size prostates up to 80 grams. A telescope is positioned into the urethra and a needle is inserted into the enlarged prostate tissue multiple times where radiofrequency energy creates water vapor that travels into the prostate and kills prostate cells. Urinary and sexual side effects are reported as very minimal; however, heat is involved during the procedure.
Urolift – This minimally invasive, non-resective procedure is for prostate sizes of 100 grams or less and utilizes small, permanently placed prostatic implants to lift and hold the prostate back from the urethra so urine can more freely flow again. The Urolift delivery device is like a telescope, and is inserted into the obstructed urethra and positioned between the prostate lobes. No prostate tissue is removed, so there is no cutting, heating, or destruction of tissue. However, larger prostates aren’t candidates for Urolift.
There are many BPH treatment options available to address benign prostatic hyperplasia. Whether prostatic hyperplasia symptoms are mild, moderate, or severe, the earlier an enlarged prostate is identified, the more treatment options are available. If a prostate is allowed to grow beyond the 80-gram limit for some BPH treatments, great options are still available, but they are fewer.
It’s a personal decision whether watchful waiting, medication, or surgery is chosen to address prostatic hyperplasia, but consulting with a urologist will provide additional feedback and a qualified point of view. Many men choose watchful waiting until their benign prostatic hyperplasia symptoms increase and they feel medication or surgery will help them more. When medication no longer makes a difference for those who chose that route, many will opt for prostate surgery. Some men don’t want to take medication in the first place and jump from watchful waiting directly to surgery.
The main takeaway is that everyone is their own best advocate when selecting treatment for prostatic hyperplasia. Some BPH treatments can offer everything back that was lost due to BPH but other BPH treatments can give only some of what was lost – back. With the above brief synopses featuring watchful waiting, medication, and six of the most common resective and non-resective BPH treatment surgeries, this should be a good introduction to the various benign prostatic hyperplasia treatments currently available for addressing prostate enlargement and its symptoms