Treatment for Enlarged Prostate Based on Severity of Symptoms

by Amy Krambeck, M.D.

Many options exist to treat benign prostatic hyperplasia (BPH), including watchful waiting, medications, nonsurgical therapies, and surgery. Treatment for BPH is based on the severity of symptoms.

BPH is a medical term for the enlargement of the prostate gland that occurs as men age. The prostate gland is the male organ that aids in the production of semen. It sits beneath the bladder and surrounds the urethra -- the tube that drains urine from the bladder for excretion. An enlarged prostate can put pressure on the urethra and cause difficulty urinating. Other symptoms may include increased frequency of urination at night, urgent need to urinate, and blood in the urine. In some cases, BPH may lead to urinary tract infection, bladder stones, kidney damage and bladder damage.

Treatment of BPH is taken step by step. If your symptoms are mild, you may choose to simply monitor them to see if they progress. If symptoms get worse, your physician may recommend that you start taking medication.

Two main types of medication are prescribed for BPH. The first are alpha blockers. They relax muscles around the bladder neck and in the prostate, making urination easier. Alpha blockers don't prevent further prostate enlargement. But, for many men, they effectively relieve BPH symptoms.

The second type of medication inhibits the enzyme 5-alpha reductase. They shrink the prostate gland. For men with large prostates, these drugs may produce a noticeable improvement in symptoms. But they're generally not effective for men who have only a mildly to moderately enlarged prostate.

If you don't want to take medications, don't tolerate the medications well, or your symptoms don't improve, the next step is nonsurgical therapies or surgery.

Nonsurgical therapies that can be administered in the doctor's office include transurethral microwave therapy (TUMT) and transurethral needle ablation (TUNA). TUMT uses heat in the form of microwave energy to destroy the inner portion of the prostate gland. TUNA uses radio waves to heat and destroy the part of the prostate that's impeding urine flow. Although these procedures can reduce prostate size, they haven't been shown to be effective long-term.

Surgery is the most effective therapy for relieving symptoms of an enlarged prostate. Although complications are uncommon, surgery has the highest risk of side effects, such as loss of bladder control.

Transurethral resection of the prostate (TURP) is a surgical option for most men with BPH. It involves threading a narrow instrument (resectoscope) into the urethra and using small cutting tools to cut away excess prostate tissue to allow urine to flow freely.

Transurethral incision of the prostate (TUIP) also involves special instruments inserted through the urethra. But instead of removing prostate tissue, the surgeon makes one or two small slices in the prostate gland to relieve pressure from the prostate and expand the urethra, making it easier to for urine to flow. TUIP is an option for those who have a small or moderately enlarged prostate gland.

The newest surgical treatments for BPH are laser surgeries. These procedures -- laser ablation of the prostate and holmium laser enucleation of the prostate (HoLEP) -- use a high-energy laser to destroy overgrown prostate tissue. Laser ablation is ideal for men whose glands are small or moderately enlarged. HoLEP is appropriate for glands of any size.

HoLEP is particularly promising because, of all the surgical options, it removes the most tissue possible without requiring an incision. After this procedure, only the outer skin of the prostate remains. That's important because the more prostate tissue removed, the lower the risk of recurrence. Even if the prostate re-grows after HoLEP, odds are that it won't grow enough to obstruct the urethra again.

A final surgical option for BPH is open prostatectomy. This surgery is generally performed only in cases of an excessively large prostate, bladder damage or other complicating factors. The surgery is called "open" because the surgeon makes an incision in the lower abdomen to reach the prostate, rather than going through the urethra. Because of the many other options available, the need for open prostatectomy is becoming limited.

With so many treatment options available, the best approach to managing BPH is to work with your doctor to assess your symptoms on a regular basis and determine which treatment best fits your needs and preferences.

Amy Krambeck, M.D., Urology, Mayo Clinic, Rochester, Minn.

Medical Edge from Mayo Clinic is an educational resource and doesn't replace regular medical care.

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