Benign Prostatic Hyperplasia (BPH): 3 Treatment Options

There are different medications and surgical procedures available for Benign Prostatic Hyperplasia treatment.

#1 Medications

Medications work best for patients who have mild to moderate symptoms of benign prostatic hyperplasia (BPH). There are two main classes of drugs used for BPH treatment

Alpha-blockers

• These drugs act on smooth muscles of the bladder and prostate.
• These drugs relieve symptoms of BPH by causing relaxation of the hypertrophic muscles.
• Examples of Alpha-blockers include Doxazosin and Alfuzosin
• They help to improve the flow of urine and prevent bladder obstruction. However, these do not reduce the prostate size and are not useful in cases of enlarged prostate.

5-alpha-reductase inhibitors

• They inhibit the enzyme alpha-reductase to convert testosterone into dihydrotestosterone (DHT, which is responsible for stimulating cellular proliferation in prostate).
• These drugs are beneficial in reducing the size of enlarged prostate as well as increasing the urinary flow.

Sometimes, doctors prescribe a combination therapy to control the symptoms effectively in patients with significantly enlarged prostates and severe symptoms. Medications act slowly and therefore have to be taken for a longer duration, nearly 6 months to 1 year for complete cure.

Medications may cause few side effects such as headache, low blood pressure especially when you are standing, dizziness, fainting and nasal congestion. It is advised to take these medicines at bedtime to avoid symptoms. Certain alpha-reductase inhibitors may produce erectile dysfunction and decreased libido.

#2 Surgical procedures

When the symptoms have aggravated to severe levels and medications prove to be ineffective, surgical approach is recommended. Take a quick look at the various surgical procedures available for BPH treatment.

1. Transurethral Resection of the Prostate (TURP)

   • It is invasive procedure in which the inner part of the prostate is cut and removed by inserting an endoscope into the urethra.
   • No stitches are required.
   • It is the most superior treatment for BPH but also the most invasive one.
   • The symptoms disappear immediately.
   • It requires hospital stay for 2-3 days during which a catheter is placed for urination.
   • Patient may temporarily feel spasms or pain in the bladder for few days. It takes at least 2 months for full recovery.
   • TURP can cause short or long-term complications such as bleeding and urinary tract infections.
   • In some cases, there occur urinary incontinence, erectile dysfunction and repeat surgery.
   • Repeat surgery is required if there is scarring in the bladder.

2. Transurethral Incision of the Prostate (TUIP)

   • It involves making incision in the prostate to reduce its size and thus release the excess pressure from urethra.
   • This is recommended for patients who have not significantly enlarged prostates blocking the bladder neck.
   • Being a less invasive procedure as compared to TURP, it does not require a long hospital stay.

3. Open Prostatectomy

   • It is a standard surgical procedure in which incision is made on the abdomen to remove the enlarged prostate.
   • It is prescribed for severe cases of benign prostatic hyperplasia (BPH) when there are serious associated conditions like bladder damage etc.
   • It is a major surgery and requires longer stay in hospital.
   • It may cause scarring of bladder, urinary incontinence and erectile dysfunction

4. Laser surgery

   • It is the most advanced technological procedure in which laser are used to remove the unwanted tissues in prostate.
   • This is performed on an out-patient basis under the effect of general anaesthesia.

#3 Minimally Invasive Procedures

Though minimally invasive procedures have lower risk of complications but there long-term efficacy is still not proven.

1. Transurethral Microwave Thermotherapy (TUMT)

   • It uses microwaves to destroy the overgrown connective tissues in prostate.  It takes just an hour to two.

2. Transurethral Needle Ablation (TUNA)

   • It uses radio waves of high-frequency to destroy prostate tissues by heating them.

3. Transurethral Electrovaporization (TUVP)

   • It uses electrical current of high voltage to coagulate the blood vessels in prostate. This blood and nutrient deprived excess tissues of prostate eventually dies off over a period of time.

4. Prostatic Stents

   • These are flexible tubes like a net which are placed in the urethra. These are advised for high-risk patients with low life expectancy.

Some tips for faster recovery from BPH surgery

• Don't drive, lift heavy weights or make sudden movements
• Drink lot of water. A minimum of 8 glasses of water every day is recommended.
• Eat fruits and vegetables to avoid constipation.
• Do pelvic floor exercises to strengthen the muscles.
• Check with your doctor before resuming sexual activities.