BPH Treatment

Some researchers question the need for early treatment when the gland is just mildly enlarged. The results of studies indicate that such treatment may not be needed because as many as one-third of all mild cases become asymptomatic without treatment. They suggest regular checkups to watch for early problems. If the condition begins to cause a major problem for the patient, then treatment will be recommended. Since BPH can cause urinary tract infections, it is best to clear up infection before treating the BPH itself.

Treatments commonly used for BPH:

Drug Treatment
The FDA has approved several drugs to relieve common symptoms associated with an enlarged prostate. Finasteride (Proscar®) and dutasteride (Avodart®) inhibit production of the hormone DHT Terazosin (Hytrin®), doxazosin (Cardura®), tamsulosin (Flomax®) and alfuzosin (Uroxatral®) act by relaxing the smooth muscle of the prostate and bladder neck

Minimally Invasive Therapy
When drugs are ineffective to reduce the size of an enlarged prostate, one may consider a number of procedures that relieve BPH symptoms but are less invasive than conventional surgery. The UroLift® System (www.urolift.com) uses a revolutionary approach to treat BPH that lifts and holds the enlarged prostate tissue so it no longer blocks the urethra. It is the only BPH treatment performed by a urologist that does not require heating, cutting, or removal of the prostate tissue. The procedure is typically performed using local anesthesia.  The UroLift System is the only BPH procedure shown not to cause new and lasting erectile or ejaculatory dysfunction, while being a safe and effective treatment of lower urinary tract symptoms due to BPH. (i), (ii), (iii), (iv), (v)

Rezūm™ Water Vapor Therapy (www.rezum.com) is a minimally invasive procedure that uses the natural energy stored in a few drops of water to treat the excess prostate tissue causing BPH symptoms. The vapor from this water goes into the prostate and destroys some of the cells, thereby reducing the size of the organ.

Surgical Treatment for BPH
The best long-term solution for patients with BPH involves removal of the enlarged part of the prostate. Only the tissue that is pressing against the urethra is removed. Surgery usually relieves both the obstruction and incomplete bladder emptying.

“Transurethral resection of the prostate” (TURP) is used for most BPH prostate surgeries. An instrument called a resectoscope is inserted through the penis. It contains a light, valves for controlling irrigating fluid, and an electrical loop that cuts tissue and seals blood vessels. The surgeon removes the obstructing tissue one piece at a time. Transurethral procedures are less traumatic than open forms of surgery and require a shorter recovery period. A possible side effect of TURP is retrograde ejaculation wherein semen flows backward into the bladder during climax instead of out the urethra.

When transurethral procedure cannot be used, open surgery may be done. This is usually reserved for cases where the gland is greatly enlarged, when there are complicating factors, or when the bladder has been damaged and needs to be repaired.

Lasers can also be used to vaporize prostate tissue. The doctor passes the laser fiber through the urethra into the prostate using a cystoscope and then delivers several bursts of energy, destroying prostate tissue. Among the advantages of laser surgery over TURP are the reduced blood loss and quicker recovery than the standard TURP.

“Photoselective vaporization of the prostate” (PVP) uses a GreenLight™ laser
(www.bostonscientific.com/en-US/patients/health-conditions/enlarged-prostate/our-treatments/greenLight-laser-therapy.html) high-energy laser to destroy prostate tissue and seal the treated area.


Notes

(i) Roehrborn, J Urol 2013, L.I.F.T. Study
(ii) Roehrborn et al. Can J Urol 2017
(iii) Roehrborn, Can J Urol 2015, 3-Year L.I.F.T. Study
(iv) Roehrborn, Urology Practice 2015, 2-Year L.I.F.T. Study
(v) Roehrborn Urology Clinics 2016