Munson Health
 
Benign Prostatic Hyperplasia

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by Alan R

(BPH; Benign Prostatic Hypertrophy; Prostatism; Bladder Outlet Obstruction)

 

Treatment

Treatment is not needed for mild cases. Most men with BPH eventually request medical intervention to help with urinary symptoms.
Treatments include:

Medication

Medication is often the first line of treatment to help reduce urinary symptoms. Medication options include:
Each group of medications has different side effects. Enzyme inhibitors may cause decreased sexual desire and problems with erection. Alpha-blockers may cause decreased blood pressure, dizziness, and stuffy nose. Antimuscarinics can cause dry mouth, constipation, dry eyes, trouble emptying the bladder, and confusion. You and your doctor will work to find the best medication or combination of medications to treat your symptoms with minimal side effects.
Your doctor may also recommend avoiding certain medications. For example, decongestant drugs containing alpha-agonists (eg, pseudoephedrine ) can worsen BPH symptoms.

Minimally Invasive Interventions

Minimally invasive procedures can decrease the size of the prostate by removing small portions of the prostate. These procedures may be used if medications were not able to reduce symptoms but surgery is not yet needed. Procedure options include:
  • Transurethral microwave thermotherapy (TUMT)—uses microwaves to destroy excess prostate tissue
  • Transurethral needle ablation (TUNA)—uses low levels of radio frequency energy to burn away portions of the prostate
  • Transurethral laser therapy—uses highly focused laser energy to remove prostate tissue

Surgery

Surgery may be recommended if medications and noninvasive procedures are not effective. The goal of surgery is to remove excess prostate tissue or widen the pathway for urine.
Portions of the prostate may be removed with:
  • Transurethral surgical resection of the prostate (TURP) —a scope is inserted through the penis to remove the enlarged portion of the prostate
  • Open surgery—removal of the enlarged portion of the prostate through an incision, usually in the lower abdominal area, much more invasive then TURP or TUIP
The urethra may be widened by:
  • Transurethral incision of the prostate (TUIP)—small cuts are made in the neck of the bladder to widen the urethra
  • Prostatic stents—tiny metal coils that are inserted into urethra to widen it and keep it open
    • Usually used for men who do not wish to take medication or have surgery
    • Does not appear to be a good long-term option

Alternative Treatments

Some herbal products have been studied as possible BPH treatments. Herbs that have shown some benefit include:
 

RESOURCES

National Kidney and Urologic Diseases Clearinghouse
http://kidney.niddk.nih.gov

Prostate Cancer Research Institute
http://prostate-cancer.org

 

CANADIAN RESOURCES

Canadian Urological Association
http://www.cua.org

The Prostate Centre at The Princess Margaret
http://www.prostatecentre.ca

 

References


Beta-sitosterol. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated August 2011. Accessed October 7, 2011.


Fagelman E, Lowe FC. Saw palmetto berry as a treatment for BPH. Rev Urol. 2001 Summer;3(3):134-8.


Fried NM. New laser treatment approaches for benign prostatic hyperplasia. Curr Urol Rep. 2007 Jan;8(1):47-52.


Greco KA, McVary KT. The role of combination medical therapy in benign prostatic hyperplasia. Int J Impot Res. 2008 Dec;20 Suppl 3:S33-43.


Marberger M. Drug insight: 5-alpha-reductase inhibitors for the treatment of benign prostatic hyperplasia. Nat Clin Pract Urol. 2006 Sep;3(9):495-503.


Prostate enlargement: Benign prostatic hyperplasia. National Kidney Urologic Diseases Information Clearinghouse website. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/prostateenlargement/ . Updated March 23, 2012. Accessed August 22, 2013.


Roehrborn CG, Siami P, Barkin J, et al; CombAT Study Group. The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study. Eur Urol. 2010 Jan;57(1):123-31. Epub 2009 Sep 19.


Ulbricht C, Basch E, Bent S, et al. Evidence-based systematic review of saw palmetto by the Natural Standard Research Collaboration. J Soc Integr Oncol. 2006;4(4):170-86.


Update on the UAU guideline on the management of benign prostatic hyperplasia. J Urol. 2011 May; 185(5):1793-803.


10/7/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Barry MJ, Meleth S, Lee JY, et al. Effect of increasing doses of saw palmetto extract on lower urinary tract symptoms: a randomized trial. JAMA . 2011;306(12):1344-1351.


10/14/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : US Food and Drug Administration. FDA approves Cialis to treat benign prostatic hyperplasia. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm274642.htm . Updated October 6, 2011. Accessed October 14, 2011.

 

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