Benign Prostatic Hyperplasia, or BPH, is a condition characterized by the non-cancerous enlargement of the prostate gland. The prostate surrounds the urethra, and as it grows, it can compress this tube, leading to a variety of urinary symptoms that become more common as men age. It is estimated that by age 60, about half of all men will have BPH, and that figure rises to 90% for men over 80. The underlying cause is believed to be connected to hormonal shifts that occur throughout a man’s life.
Initial Management and Lifestyle Adjustments
For individuals with mild symptoms of BPH, the initial approach is often “watchful waiting,” or active surveillance. This means a healthcare provider will monitor the condition’s progression without prescribing immediate medical treatments. During this time, the focus shifts to behavioral changes that can help manage symptoms and improve quality of life.
A primary strategy is fluid management. This involves being mindful of how much and when you drink liquids, particularly reducing intake in the hours before bed to minimize nighttime urination. Dietary modifications also play a part; limiting bladder irritants such as caffeine and alcohol can prevent the worsening of symptoms. Another technique is bladder training, which includes practices like timed voiding and “double voiding,” where after urinating, you wait a moment and then try again to ensure the bladder is as empty as possible.
Prescription Medications for BPH
When lifestyle changes are not sufficient, prescription medications are a common next step for treating mild to moderate BPH symptoms. Several types of drugs are used to alleviate the urinary issues caused by an enlarged prostate.
- Alpha-blockers, which include medications like tamsulosin, do not shrink the prostate but instead relax the muscles at the neck of the bladder and in the prostate itself. This makes it easier for urine to flow and often provides relatively quick relief.
- 5-alpha reductase inhibitors function by directly shrinking the size of the prostate gland. Drugs such as finasteride and dutasteride accomplish this by blocking the hormonal changes that contribute to prostate growth. These medications may take up to six months to become fully effective and are often better suited for men with larger prostates.
- Combination therapy may be recommended, where a physician prescribes both an alpha-blocker and a 5-alpha reductase inhibitor to achieve better results than either drug could alone.
- Phosphodiesterase-5 (PDE5) inhibitors, such as tadalafil, can also be used. Often prescribed for erectile dysfunction, these drugs have been shown to relax muscles in the bladder and prostate, improving urinary symptoms.
Minimally Invasive Procedures
For men whose symptoms do not respond adequately to medication, or for those who wish to avoid long-term drug use, minimally invasive procedures offer an intermediate solution. These treatments are performed in an outpatient setting, do not require general anesthesia, and involve a shorter recovery time than traditional surgery.
One such procedure is Rezūm, a convective water vapor therapy that uses targeted steam to destroy excess prostate tissue. The targeted cells die and are reabsorbed by the body over time, which reduces the size of the prostate. Another option is the UroLift System, which uses tiny, permanent implants to lift and hold the enlarged prostate tissue away from the urethra, clearing the channel for urine to pass.
A more recent development is Aquablation therapy, a procedure that combines real-time ultrasound imaging with a robotic system. A surgeon uses this technology to guide a heat-free waterjet to remove prostate tissue with high precision. Because it is performed through the urethra, no external incisions are necessary.
Surgical Interventions
When BPH symptoms are severe, or if other treatments have proven ineffective, surgical intervention is often recommended. These procedures are more invasive than minimally invasive options but provide the most significant and long-lasting relief from urinary obstruction. The most common surgery for BPH is the Transurethral Resection of the Prostate (TURP). During a TURP, a surgeon inserts an instrument through the urethra to remove excess prostate tissue piece by piece.
Modern laser-based surgeries offer an alternative to traditional TURP. Procedures like Holmium Laser Enucleation of the Prostate (HoLEP) and Photoselective Vaporization of the Prostate (PVP) use laser energy to either remove or vaporize the obstructive tissue. Laser therapies often result in less bleeding compared to TURP. Enucleation procedures such as HoLEP are thorough, removing all of the prostate tissue that is causing the blockage.
For cases involving a very large prostate, a simple prostatectomy may be necessary. This is a more invasive surgery performed either through an open incision in the lower abdomen or using laparoscopic or robotic techniques with smaller incisions. This approach allows the surgeon to remove the inner part of the prostate gland and is reserved for situations where other surgical methods are not suitable.