• ALPHA 1-BLOCKERS:

  Current medical therapy may involve a trial use of alpha 1-blockers (doxazosin, prazosin, tamsulosin, and terazosin), which are also used to treat high blood pressure. These medications are used to treat BPH because they relax the muscles of the bladder neck, allowing easier urination. Two thirds of the people treated with alpha 1-blocker medications report an improvement in symptoms.

• FINASTERIDE:

  Finasteride lowers prostate hormone levels, thus reducing the size of the prostate. This drug has been shown to increase the urine flow rate and decrease the symptoms of BPH. It may take up to 6 months before you notice a significant improvement in your symptoms. Potential side effects related to use of finasteride include decreased sex drive (3.3%) and impotence (2.5 - 3.7%).

• OTHER MEDICATIONS:

  Antibiotics may also be prescribed to treat chronic prostatitis, which commonly accompanies BPH. Some men note symptom relief after a course of antibiotics.
  

SURGERY:

Surgery is usually indicated for men with symptoms of incontinence, recurrent blood in the urine, urinary retention, and recurrent urinary tract infections. The choice of a specific surgical procedure is usually based on the severity of symptoms and the size and shape of the prostate gland.

Surgical treatment options include transurethral resection of the prostate (TURP), transurethral incision of the prostate (TUIP), and open prostatectomy. Various studies are underway to evaluate the effectiveness of other treatments, such as hyperthermia, laser therapy, and prostatic stents.

• TURP:

  Transurethral resection of the prostate (TURP) is the most common surgical treatment for BPH. The TURP is performed by inserting a scope through the penis. The primary advantage of this procedure is that it does not involve an incision, thus reducing the risk of infection.

  Other surgical approaches include the retropubic (behind the pubic structures), and supra pubic (above the pubic structures) open prostatectomies which are done through an abdominal incision. The perineal (through the region from the scrotum to the anus) surgical approach is rarely used because the impotence rate after surgery may be as high as 50%.
  
  Among men who have had a TURP, 88% reported an improvement in symptoms lasting from 10 to 15 years. Impotence occurred in 13.6% and one percent of the men reported urinary incontinence after a TURP.

• TUIP:

  Transurethral incision of the prostate (TUIP) is similar to TURP, but is usually performed in men who have a relatively small prostate. This procedure is usually performed on an outpatient basis and does not require a hospital stay.

  The procedure is done through the penis without an incision. A small incision is made in the prostatic tissue to enlarge the lumen (opening) of the urethra and bladder outlet, thus improving the urine flow rate and reducing the symptoms of BPH. Eighty percent of the men who had this procedure reported some improvement in their symptoms. Possible complications include bleeding, infection, urethral stricture, and impotence.

• OPEN PROSTATECTOMY:

  An open prostatectomy is usually performed using general or spinal anesthesia. An incision is made through the abdomen or perineal area (through the pelvic floor including the region from the scrotum to the anus in men). This is a lengthy procedure, and it usually requires a hospital stay of 5 to 10 days.

  Most of the men (98%) who had open prostatectomy surgery reported some improvement in their symptoms. Possible complications include impotence (16 to 32% depending on surgical approach) and urinary incontinence (less than 1%).

LIFESTYLE:

Self-help measures may prove beneficial if the degree of obstruction is minimal. These include hot baths, urinating upon the earliest urge to do so, sexual activity or ejaculation on a regular basis, and avoiding alcohol or excessive fluid intake (especially at night). Herbalists suggest that saw palmetto berries and extracts may potentially ease prostate symptoms.

You can reduce the frequency of nighttime trips to the bathroom by eliminating fluids a few hours before you go to sleep. Symptoms of urinary incontinence may be improved by spreading out your fluid intake over the course of the day. You should avoid drinking large amounts of fluids at one time and only take sips of fluids with meals.

Men with BPH should avoid taking over-the-counter cold and sinus medications that contain decongestants since these medications can increase the symptoms of BPH.

"WATCHFUL WAITING":

Less than half of all men with BPH have symptoms of the disease, or their symptoms are minor and do not severely restrict their lives. These patients can simply be monitored over time for onset or increased symptoms.

Studies show that of the men who receive no treatment for BPH, 31 to 55% show an improvement, and only 1 - 5% ever develop complications. Men who choose "watchful waiting" should receive yearly exams to monitor progression of the disease.

MONITORING:

All men who have BPH should receive a yearly exam to monitor the progression of symptoms.

Prognosis

About 70% of all men with BPH are relatively symptom free, and only 30% require some form of treatment.

Complications

Men who have had long-standing BPH with a gradual increase in symptoms may develop an acute (sudden) inability to urinate, urinary tract infections, urinary stones, damage to the kidneys, and blood in the urine. Even after surgical treatment, a recurrence of BPH may develop over time.

Call Your Health Care Provider If:

Call for an appointment with the health care provider if symptoms of BPH occur.

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