BENIGN PROSTATIC HYPERPLASIA TREATMENT

Treatments for BPH can help to reduce urinary symptoms. Treatment options include medicines and
surgery.
Men with mild BPH might not need treatment. In this case, most experts recommend a "wait and
watch" approach. This means that you will watch your symptoms over time. In some cases, BPH
symptoms improve without treatment. However, men with moderate to severe symptoms usually
require treatment.
Medicines — There are two types of medicine used to treat BPH: alpha blockers and alpha-
reductase inhibitors. Most men with BPH who start taking a medicine will need to take it forever.
(See "Medical treatment of benign prostatic hyperplasia".)
Alpha blockers — These medications relax the muscle of the prostate and bladder neck, which
allows urine to flow more easily. There are at least four medications in this category:
terazosin (Hytrin®), doxazosin (Cardura®), tamsulosin (Flomax®), alfuzosin (Uroxatral®), and
silodosin (Rapaflo®). Terazosin and doxazosin were initially developed to treat high blood
pressure, but were later found to be useful for men with BPH.
Alpha blockers begin to work quickly and are usually recommended as a first-line treatment for
men with mild to moderate symptoms.
• Side effects — The most important side effects of alpha blockers are dizziness and low
blood pressure after sitting or standing up. Terazosin and doxazosin are usually taken at
bedtime (to reduce lightheadedness). The dose can be increased over time if needed.
You should not take terazosin and doxazosin if you take a medicine for erectile dysfunction (ED),
such as sildenafil (Viagra®), vardenafil (Levitra®), and tadalafil (Cialis®). Tamsulosin and
alfuzosin usually do not interact with ED medications.
Alpha-reductase inhibitors — Alpha-reductase inhibitors are medicines that can stop the prostate
from growing further or even cause it to shrink. Finasteride (Proscar®) and dutasteride (Avodart®)
are alpha-reductase inhibitors.
This type of medicine works better in men with a larger prostate. It can reduce the risk of urinary
retention (not being able to empty the bladder) and the need for surgery. Most men see an
improvement within six months of starting treatment.
• Side effects — A small percentage of men who take alpha-reductase inhibitors have
decreased sex drive or difficulty with erection or ejaculation. Rarely, this problem causes
men to stop BPH treatment. This side effect is reversed when the drug is stopped.
PSA levels decrease by about 50 percent in men who take finasteride or dutasteride. This is
important to remember if you have PSA testing to screen for prostate cancer. (See "Patient
information: Prostate cancer screening (Beyond the Basics)".)
Combination treatment — A combination of an alpha blocker and an alpha-reductase inhibitor
might be recommended for certain men. This may benefit men:
• With severe symptoms
With a large prostate
• Who do not improve with the highest dose of an alpha blocker
Herbal medicines — Herbal therapies for BPH, such as saw palmetto, are commonly used in
Europe for treatment of BPH. However, the best studies of saw palmetto have shown no benefit in
reducing the symptoms of BPH. For this reason, we do not recommend the use of saw palmetto or
other herbal medicines to treat BPH. (See "Clinical use of saw palmetto".)
Lifestyle changes — All men with BPH should avoid medicines that can worsen symptoms or cause
urinary retention. These include certain antihistamines (such as diphenhydramine [Benadryl®]) and
decongestants (eg, pseudoephedrine [found in some cold medicines]).
Lifestyle changes are also recommended if you are bothered by having to go to the bathroom
frequently. This includes:
• Stop drinking fluids a few hours before bedtime or going out
Avoid or drink less fluids that can make you go more often, like caffeine and alcohol
• Double void. This means that after you empty your bladder, you wait a moment and try to go
again. Do not strain or push to empty.
Surgical treatments — If medicines do not relieve your symptoms of BPH, a surgical treatment may
be recommended. Surgery is used to reduce to reduce the amount of prostate tissue around the
urethra (figure 1). This may be done by:
• Removing some prostate tissue
• Shrinking the prostate with heat
Each treatment has advantages and disadvantages, and the best treatment depends on the size and
location of the excess prostate tissue and your preferences. (See "Surgical and other invasive
therapies of benign prostatic hyperplasia".)
Transurethral resection of the prostate (TURP) — Transurethral resection of the prostate (TURP) is
the most common surgical treatment for BPH. The surgeon inserts a device through the urethra to
remove strips of the enlarged prostate. The procedure is done while you are asleep and takes 60 to
90 minutes. Most men stay in the hospital overnight after TURP.
Serious complications are rare with TURP. The most common complications include:
• Needing to wear a catheter to empty the bladder temporarily
Bleeding for up to several weeks after surgery
• Injury of the prostate
After surgery, most men have less semen with ejaculation because much of the semen is directed
into the bladder. However, difficulties with erection and pain with ejaculation often improve after
surgery.
Transurethral needle ablation (TUNA) — In this procedure, specific areas of the enlarged prostate
are burned away. TUNA can usually be performed using only local anesthesia (usually
lidocaine gel, which is inserted into the urethra), and the man is usually able to go home after the
procedure. This procedure improves the flow of urine and reduces BPH symptoms.
TUNA is often preferred for men with medical problems, particularly men who must take blood-
thinning medications like warfarin (Coumadin®). TUNA is also an alternative for men who prefer a
procedure that has a lower risk of urine leakage and sexual side effects. However, men treated with
TUNA are more likely to need another BPH procedure over time compared with men who have
TURP.
Other procedures — A number of other surgical procedures are available for men with BPH.
• Microwave thermotherapy — This procedure uses heat to destroy excess prostate tissue. It is
performed as a day surgery, and most men are able to go home after the procedure.

Thermotherapy does not cure BPH or problems emptying the bladder (retention). However,
 it does improve symptoms of needing to rush to the bathroom frequently, the need to strain,
and slow urine flow.
• Transurethral incision of the prostate (TIP) — In this procedure, a surgeon widens the
urethra (figure 1). Prostate tissue is not removed. Transurethral incision of the prostate (TIP)
is performed with anesthesia and generally requires a 24-hour stay in the hospital.

TIP might be recommended for men who cannot empty their bladder and do not have a large
prostate, especially if the man has other medical problems. Another surgical treatment for
BPH is sometimes needed a few years after TIP.
• Removal of the prostate — Surgery to remove the prostate (prostatectomy) might be
recommended for men who are healthy and have a very enlarged prostate.
• Laser surgery — With laser surgery, a surgeon uses laser to destroy prostate tissue and
shrink the prostate. Laser surgery is similar to a TURP but causes less bleeding.

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