Typical medical treatment for BPH includes the use of so-called alpha-blockers, such as tamsulosin (Flomax), alfuzosin (Uroxatral) or silodosin (Rapaflo). These medications can decrease tension in the enlarged prostate tissue so that urine can flow more easily. These medications are usually very well tolerated. Possible side effects include 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 of these medications inhibit an enzyme in the prostate that converts testosterone into a more potent form, promoting enlargement of the prostate. The medications can shrink the prostate, decreasing obstruction of the urethra. Both of these medications are usually well tolerated. However, the maximum benefit does not typically appear until six to 12 months after starting the medication. Side effects may include a decrease in libido and tenderness of the breasts.
A low dose of tadalafil (Cialis) may be recommended either in addition to other medications or as a single therapy. This 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 desire improved erectile function. A low dose of this medication is usually well tolerated, but side effects may include muscle pain, headaches and a drop in blood pressure.
Some procedures to treat BPH can be performed in the office under local anesthesia, using a camera to access the prostate through the patient’s penis. Although this may sound invasive and painful, it is typically well tolerated, likely due to the combination of local anesthesia and the short duration of the procedure (three to five minutes).
We offer the latest procedural BPH treatment options, including two minimally invasive treatments, UroLift and Rezum.
- During this treatment, four to six small implants are placed into the prostate to compress the tissue obstructing the urethra, thus opening up the urinary channel. The reported success rate is about 90%, with success being defined as a patient being mostly happy with his urinary situation. Large studies have shown that this success continues well after the treatment.
- Side effects
- A catheter may be needed for urination for up to three days following the procedure. Approximately one third of patients who undergo UroLift require a catheter due to a temporary swelling of the prostate.
- Patients may experience bladder irritation, in which one feels the need to urinate in short intervals despite an empty bladder. This can occur in about 50% of patients and typically resolves within seven days. Pyridium, a prescription bladder anesthetic, often relieves these symptoms.
- Treatment with Rezum consists of the injection of hot steam into the prostatic tissue, which leads to the destruction of the tissue. This procedure is reported to be effective in more than 90% of patients and improvements typically last as long as those achieved with UroLift. Symptoms will improve over the course of a few weeks as the body reabsorbs the prostatic tissue that was destroyed by the steam.
- Rezum has been described as the in-office version of transurethral resection of the prostate (TURP) , a surgical procedure, due to its effectiveness and patient satisfaction. Compared to TURP:
- This procedure is much shorter, with a duration of less than five minutes.
- It does not pose a risk of significant bleeding.
- It does not require hospitalization.
- Side effects
- The prostate may swell considerably for a few days after this procedure, so a Foley catheter is usually needed for the first three to five days.
- Bleeding from the prostate may occur.
Surgical Treatments for BPH
Surgical treatments can be highly effective for BPH management. However, they are more invasive than office procedures and require a hospital stay for a night or two. Surgical treatments may be optimal for patients with very large prostates or with prostates that have a specific shape, and for patients with bladder stones and BPH.
Transurethral Resection of the Prostate
Transurethral resection of the prostate (TURP) is the gold standard of BPH treatment and has been used for several decades due to its high effectiveness. During this procedure, an electric knife attached to a camera is inserted through the penis to remove the obstructing tissue.
A catheter is placed after the procedure and kept in place for two to three days to flush any residual bleeding out of the bladder.
The vast majority of cases are well tolerated. Side effects may include post-operative bleeding, and urethral and bladder injury. These side effects may require longer-term catheter use.
GreenLight Laser TURP
In this modification of the classic TURP, prostate tissue is removed by a laser beam rather than an electric knife. It is especially useful in patients who require blood thinners. Its effectiveness is similar to that of the classic TURP.
As with TURP, patients usually stay in the hospital overnight. Risks of this procedure include bleeding, and urethral and bladder injury.
Robotic Simple Prostatectomy
This procedure is reserved for patients who have very large prostates that do not respond to other treatments. During this procedure, robotic technology is used to remove prostate tissue. Five small incisions, each about 1 inch, are made in the abdomen. The incisions are used for insertion of a camera, three robot arms and the surgical assistant’s instruments.
Patients are typically hospitalized for one or two days, and a catheter is required for a week. Rare side effects include bleeding, wound infection and prolonged catheterization.
This surgery is different from a radical prostatectomy, which is used to treat prostate cancer. Side effects such as erectile dysfunction and incontinence, which are common with radical prostatectomy, are very rare in simple prostatectomies.
Open Simple Prostatectomy
If a robotic approach is not possible, for example in patients with extensive scarring in the abdomen due to prior surgeries, the prostate can be removed though an open lower abdominal incision. Before the development of the robotic approach, this surgery had been the gold standard for the treatment of large prostates.
Patients are hospitalized for several days, and a catheter is placed for about a week. Risks of this surgery include bleeding, wound infection and prolonged catheterization.
Prostatic Artery Embolization
This minimally invasive treatment is offered in conjunction with the Northwestern Medicine Department of Interventional Radiology. During embolization, the blood vessels feeding the prostate are blocked, leading to a shrinkage of the prostate and improvement of symptoms. These blood vessels are accessed through blood vessels in the groin. Embolization has the advantage of minimal patient discomfort, similar to an office-based procedure.
Important to note:
- Improvement can take several months, and the procedure may have to be repeated.
- Patients with larger prostates usually have higher success rates.
- Risks of the procedure include bleeding from the access site and injuries to blood vessels, but these events occur only rarely.