The mainstay of medical treatment are the so-called alpha-blockers, for example, tamsulosin (Flomax®), alfuzosin (Uroxatral®) and silodosin (Rapaflo®). The mechanism of the medication is to decrease tension in the enlarged prostate so that urine can flow easier past the obstructive tissue. This class of medications is usually very well tolerated, with one side effect being dizziness due to lowered blood pressure.
If therapy with a single alpha-blocker does not relieve symptoms, finasteride or dutasteride can be added to the treatment plan. Both medications inhibit an intra-prostatic enzyme that converts testosterone in a more potent form, which promotes obstructive growth of the prostate. Inhibition of this enzyme results in the shrinking of the prostate and decreased obstruction. Both medications are usually very well tolerated, but it is important to note that the maximum benefit does not typically appear until you have been taking it for six to 12 months. Side effects may include a decrease in libido, tenderness of the breasts, and in some patients, erectile dysfunction.
A low-dose formulary of tadalafil (Cialis®) may be recommended either in addition to other medications or as a single therapy. The medication is taken daily and works by decreasing the tension within the prostatic tissue, thus easing the symptoms of BPH. An additional benefit of taking this medication is improved erectile function, making it a good alternative for men with BPH who also seek improved erectile function. Although the daily low-dose formulary is usually well tolerated, side effects can include muscle pain, headaches, and a drop in blood pressure.
Office-based interventions are performed using local anesthesia and a camera to access the prostate through the patient’s penis. Although this may sound invasive and painful, it is very well tolerated, likely because of the local anesthesia and short duration of the procedure (3–5 minutes).
We offer all established state-of-the-art procedural BPH treatment options, including minimally invasive treatments, UroLift® and Rezum™.
- During this treatment, four to six small implants are placed into the prostate and compress the obstructive prostate tissue, thus opening up the urinary channel. The initial success rate is high, with success being defined as a patient being mostly happy with his urinary situation. One benefit of UroLift is it has a low risk of the patient developing retrograde ejaculation, also known as dry ejaculation.
- Side effects of UroLift can include the need for a transient catheter for one to three days after the procedure. Approximately one third of patients undergoing UroLift require a catheter because of temporary swelling of the prostate.
- Patients may also experience bladder irritation, in which you feel the need to urinate in short intervals despite having an empty bladder. This can occur in about 50% of patients and typically resolves within one to seven days. Taking the prescribed phenazopyridine (Pyridium®), a bladder anesthetic, often relieves these symptoms.
- Treatment with Rezum involves injecting hot steam into the prostatic tissue, which leads to the destruction of the tissue. The prostate may swell considerably for a few days after the procedure, so a urinary catheter is usually placed for three to five days. This procedure is effective for more than 90% of properly screened patients and similarly long lasting. It has been described as the in-office version of the TURP surgery (see below) because of its effectiveness and patient satisfaction. Compared with TURP, the Rezum procedure is much shorter, with a duration of less than 5 minutes; does not pose a risk of significant bleeding; and does not require hospitalization.
- Bleeding from the prostate may occur. Patients may need a catheter for several days.
- Symptoms improve over the course of a few weeks as the body reabsorbs the prostatic tissue that was injected with the steam.