Benign prostatic hyperplasia (BPH) is a common condition that can make everyday life more difficult. A slow urine stream, frequent bathroom trips, and the feeling of never fully emptying your bladder can interfere with sleep, work, and comfort.
Many men start with medications for BPH to relieve symptoms and avoid more invasive treatment. These medications can relax the muscles around the prostate or gradually shrink its size. For some, that’s enough. For others, symptoms may persist or become more severe, making surgery a better option.
The best BPH treatments depend on your symptoms, prostate size, and how well you respond to the treatments you try.
Medications for BPH
For many men, medications are the first step in managing BPH, especially when symptoms are mild to moderate. These medicines can reduce discomfort and improve urine flow without the need for a procedure.
There are different types of medications for BPH.
- Alpha-blockers, such as tamsulosin or alfuzosin, relax the muscles in the prostate and bladder neck. This allows urine to flow more freely and can provide relief within days.
- 5-alpha-reductase inhibitors like finasteride or dutasteride work by shrinking the prostate over time. These are often used when the prostate is significantly enlarged, but they can take several months to show full benefits.
- Combination therapy uses both an alpha-blocker and a 5-alpha-reductase inhibitor. This option is sometimes recommended when symptoms are more bothersome or the prostate is large.
- Tadalafil, a medication also used to treat erectile dysfunction (ED), is approved for BPH as well. If you have both BPH and ED, this one medication may help with both conditions.
While BPH drugs can be effective, they're not a perfect solution for everyone. Side effects can include:
- Dizziness
- Low blood pressure
- Reduced sexual function
- Delayed ejaculation
Sometimes, even with medications, symptoms don't improve enough to avoid further treatment.
When Surgery Might Be a Better Option
Surgery is usually an option if medications fail, cause side effects, or when the prostate is quite large. It may also be necessary if you develop complications like:
- Bladder stones
- Repeated urinary tract infections
- An inability to fully empty your bladder
There are several surgical options available. They range from less invasive office-based treatments to more traditional surgeries.
Minimally invasive procedures
These options are usually outpatient treatments and involve little or no cutting.
- Rezūm water vapor therapy uses steam to destroy excess prostate tissue. It's typically done in a urologist's office and is best for men with small to moderate prostate enlargement.
- UroLift involves placing tiny implants that pull back prostate tissue to open the urethra. It preserves sexual function and provides quick recovery. This makes it a good option for men with smaller prostates and no middle lobe enlargement.
- GreenLight laser therapy uses a high-powered laser to vaporize excess prostate tissue and quickly restore urine flow. It's usually done as an outpatient treatment. It causes minimal bleeding, making it a good option for men who are on blood thinners or at higher surgical risk.
- Prostatic artery embolization (PAE) is a procedure where the blood supply to parts of the prostate is blocked. This causes the tissue to shrink over time. It is performed by an interventional radiologist using a catheter inserted through a blood vessel, usually in the groin. PAE is a minimally invasive option that may be suitable for men with larger prostates who want to avoid traditional surgery.
These procedures may be a good fit for men who want to avoid long recovery times. However, they aren't ideal for everyone, especially those with significantly enlarged prostates.
More traditional surgical procedures
For larger prostates or more severe blockage, more extensive surgery may be recommended:
- TURP (transurethral resection of the prostate) is the most common BPH surgery. It involves removing parts of the prostate through the urethra using a scope. Most men experience long-term symptom relief.
- HoLEP (holmium laser enucleation of the prostate) uses a laser to remove large sections of prostate tissue. It's highly effective for large prostates.
- Simple prostatectomy is usually reserved for very large prostates. This procedure involves surgically removing the inner portion of the prostate. It requires a hospital stay and a longer recovery.
Which Treatment Is Best?
Medications for BPH can work well for many men and often come with fewer risks. They're usually the best place to start if your symptoms are manageable and your prostate isn't very large.
But if medications don't provide enough relief, or if they cause side effects, then surgery might be a better long-term option. Some men choose minimally invasive procedures to avoid daily medication. Others may need more advanced surgery based on prostate size or bladder complications.
With the range of options available, your urologist will guide your treatment decisions. Most men with BPH can find an effective treatment that fits their situation.
Don't continue to live with the unwanted symptoms of BPH - schedule an appointment today!