Treatment for BPH focuses on reducing the symptoms associated with prostatic enlargement.
The decision on how to treat BPH depends on how bothersome your symptoms are. The American Urological Association (AUA) Symptom score is one way to measure how affected you are by your symptoms and how well you are responding to treatment.
Behavioral Changes
The first line treatment for BPH consists of behavioral changes, such as double voiding, timed voiding, avoidance of caffeine, alcohol and other diuretics, as well as night-time fluid restriction.
Medical Therapy
Medical therapy often consists of using alpha blockers, such as Flomax, Uroxatral, Rapaflo, Cardura, or Hytrin. Originally used to treat high blood pressure, these medications relax the muscle around the prostate and bladder neck, thereby increasing urinary flow and decreasing symptoms. Five-alpha reductase inhibitors (5ARIs), such as Proscar or Avodart, block the conversion of testosterone to dihydrotestosterone within cells of the prostate. This results in shrinkage of the prostate and a decrease in the associated blockage of urinary flow.
Often, alpha blockers and 5ARIs are used in combination to augment therapeutic effect. Anticholinergics, medications that inhibit bladder contractions, can also be used to further improve symptom relief. Finally, Cialis has been used to also help improve BPH-related symptoms.
Surgery
Surgery represents the most reliable way to relieve urinary symptoms, although it is typically reserved for patients for whom medications are not helpful, or for those unable to tolerate, or unwilling to take, medications.
Most surgeries for BPH today are endoscopic in nature and therefore do not require any incisions. Rather, surgical instruments are passed via the urethra to the level of the prostate.
The gold standard consists of transurethral resection of the prostate (TURP), where the core of the prostate is cut into small pieces and then removed. TURP may be performed using different types of electrosurgical as well as laser energy. Laser TURP is performed using lasers of various types and wavelengths (e.g. holmium laser, Greenlight™ laser) that carry the advantage of decreased risk of complications such as intraoperative bleeding and fluid absorption.
Newer electrosurgical technologies include the use of bipolar button or loop, which also decrease the risk of fluid absorption.
Other minimally invasive techniques include transurethral microwave therapy (TUMT), in which microwave energy is used to destroy a portion of the prostate through heating, as well as transurethral needle ablation (TUNA), in which a heated needle is used to destroy a portion of the prostate.
Finally, simple prostatectomy can be performed in open, laparoscopic, or robotic fashion, and is typically reserved for patients with very large prostates, where transurethral surgery would be difficult to perform safely. The prostate is accessed via incisions in the skin.
New Technologies for BPH
Newer technologies for BPH are continually being tested and evaluated. These include the Urolift procedure, which uses small anchors to mechanically retract enlarged prostatic tissue as well as Rezum therapy, which uses water vapor to destroy BPH tissue. Finally, the use of high pressure water jets, dubbed Aquablation therapy, is being tested to treat BPH.
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