+ Watchful Waiting

This treatment option is good for patients who have mild symptoms of BPH but are not bothered by their symptoms. Patients suffering from kidney problems as a result of BPH, urinary retention (suddenly being unable to urinate) or frequent urinary tract infections, recurrent bladder stones, and urinary incontinence are not good candidates for this treatment option. During watchful waiting, a patient is closely monitored by his physician but does not receive any active treatment. Many patients’ symptoms can be controlled and/or managed by changing their current medications and diet. Patients will be examined yearly, and findings from the tests will be used to determine if additional treatment is needed in order to control a patient’s BPH. The risk of watchful waiting may be that the patient’s symptoms cannot be reduced after active treatment is started.

+ Medical Therapies

Alpha Blockers

These drugs, originally used to treat high blood pressure, work by relaxing the smooth muscle of the prostate and bladder to improve urine flow and reduce bladder outlet obstruction. Although alpha blockers may relieve the symptoms of BPH, they do not reduce the size of the prostate. They are usually taken orally once or twice a day, and work almost immediately. Commonly prescribed alpha-blockers include: Silodosin (Rapaflo®) Alfuzosin (Uroxatral) Tamsulosin (Flomax) Doxazosin (Cardura) Terazosin (Hytrin) All of these drugs have the same level of effectiveness and side effects. Side effects can include headaches, dizziness, light-headedness, fatigue and ejaculatory dysfunction. These medications are beneficial for patients who have bothersome to moderate-severe BPH. Patients who are undergoing cataract surgery may be advised by their physician against taking these medications until after surgery.

5-Alpha Reductase Inhibitors

Finasteride (Proscar) and dutasteride (Avodart) are oral medications used to treat BPH. In select men, finasteride and dutasteride can relieve BPH symptoms, increase urinary flow rate and actually shrink the prostate, although these medications must be used indefinitely to prevent symptoms. Studies suggest that these medications may be best suited for men with relatively large prostate glands. These drugs reduce the risk of BPH complications such as acute urinary retention (suddenly being unable to urinate) and the eventual need for BPH surgery. Side effects generally are sexually related and include erectile dysfunction, decreased libido and reduced semen released during ejaculation. Some of these side effects can persist after the medication has been discontinued. Finasteride and Avodart should not be used if men do not have prostate enlargement.

Combination Therapy

The use of both alpha blockers and 5-alpha reductase inhibitors have shown to be superior to single drug therapies in men with larger prostates. The combination approach prevents the progression of the disease and improves bothersome symptoms. However, this improved benefit may be associated with more side effects (possible side effects from both medications).

Anticholinergics

Another medical therapy that is an appropriate and effective treatment alternative for the management of symptoms related to BPH. These medicines focus on overactivity of the bladder, that may or may not be associated with BPH.

Complementary and Alternative Medicines/Phytotherapies These compounds, also known as herbal therapies, are very popular self-treatment remedies. Currently, there is no dietary supplement, complementary alternative medicine or therapy that is recommended for the management of BPH. Furthermore, the quality and purity of these over-the-counter supplements are not rigorously monitored, adding further uncertainty about the value and safety of these products. Saw palmetto, one of the more popular dietary supplements used by men, has been shown to provide no benefit over a placebo for the treatment of BPH conditions and LUTS.

+ Advanced Minimally Invasive Therapies

Since the advent of medical therapy for symptomatic BPH with 5-alpha reductase inhibitors and alpha-adrenergic blockers, the need for immediate surgical intervention in symptomatic prostatic obstruction has been reduced substantially. However, alpha blockers do not modify prostate growth, and even the use of prostatic growth inhibitors such as finasteride or dutasteride often fails to prevent the recurrent LUTS of BPH and urinary retention. In the past, these patients would almost certainly have undergone more invasive treatment earlier in the disease process.

The UroLift® System

The UroLift® System is a revolutionary, minimally invasive approach to treating an enlarged prostate, or BPH, that lifts or holds the enlarged prostate tissue out of the way so it no longer blocks the urethra. There is no cutting, heating or removal of prostate tissue. This procedure does not cause erectile dysfunction or dry ejaculation.

The Rezūm® System

This system uses the stored thermal energy in steam to destroy the cells in the excess prostate tissue. With the tissue damaged, pressure on the urethra is relieved so normal urine flow can resume. Over time, the body naturally reabsorbs the treated prostate tissue. This procedure does not cause erectile dysfunction and rarely dry ejaculation.

Transurethral Microwave Thermotherapy (TUMT)

TUMT is a minimally invasive treatment that uses microwaves to cause thermal injury to the prostate while providing relief for bladder obstruction.

+ Surgical Techniques

There are many surgical procedures to treat BPH. Surgery is the most invasive approach and is typically reserved for patients suffering from moderate to severe BPH-related LUTS or complications which arise from BPH (e.g., urinary retention, progressive LUTS, recurrent urine infection). It is generally reserved for patients who have not been able to successfully treat the condition with other treatment options or for those who present with moderate to severe BPH. The following are the generally accepted surgical treatment options: Transurethral resection of the prostate (TURP) – Has excellent outcomes and is the gold standard. All treatment options are generally compared to this approach. Simple Prostatectomy – This surgery involves the removal of the inner portion of the prostate via a minimally-invasive robotic, open or conventional approach. It is reserved for men with significantly enlarged prostate glands. The major risks associated with this treatment are the potential blood loss, need for transfusion and a longer hospital stay. Outcomes are generally very effective with this approach in these patients. Transurethral holmium laser ablation of the prostate (HoLAP) Transurethral holmium laser enucleation of the prostate (HOLEP) Holmium laser resection of the prostate (HoLRP) Photoselective vaporization of the prostate (PVP) Transurethral incision of the prostate (TUIP) Transurethral vaporization of the prostate (TUVP)

+ Aquablation® Therapy

Aquablation® is a minimally invasive surgical treatment option for an enlarged prostate. Enlarged prostate tissue is targeted and removed with a heat-free waterjet, under the supervision of your surgeon, utilizing the robotic AquaBeam System.