Treatments

Medicated (or not)

Watchful waiting & lifestyle changes

Watchful waiting consists in carefully observing the person without administering any treatment, since a certain proportion of men may see a spontaneous improvement in symptoms. Changes in lifestyle habits include avoiding certain foods (coffee, tea, alcohol), decreasing the amount of fluids ingested before bedtime, moderating daily fluid intake (1.5-2.0L / day), and avoiding constipation.

5-alpha-reductase inhibitors

These drugs block the transformation of testosterone into dihydrotestosterone in the prostate. Dihydrotestosterone appears to be the cause for enlargement of the prostate. They take several months to reduce the size of the prostate and relieve symptoms. These medications can prevent secondary BPH complications (acute urinary retention, bleeding, etc.). By reducing the size of the prostate, they also decrease the level of PSA that will need to be closely followed. The two drugs in this category are:

• finasteride (Proscar)
• dutasteride (Avodart)

Side effects may include:

• decreased sexual desire
• erectile dysfunction
• reduced amount of semen in ejaculation
• breast swelling or tenderness

Alpha-blockers

They are drugs that relax the muscles around the prostate to reduce pressure on the urethra and decrease symptoms affecting urine flow. They have a quick effect (24-72 hours) on urinary symptoms. The most common alpha-blockers used for BPH are:

• terazosine (Hytrin)
• doxazosine (Cardura)
• tamsulosine (Flomax)
• alfuzosine (Xatral)
• silodosine (Rapaflo)

Side effects may include:

• dizziness
• fatigue
• headache
• low blood pressure

Surgery

Surgery may be used to treat BPH in cases where the symptoms are severe severe, if the man is totally unable to urinate, when drug therapy has been ineffective, or if the man does not want to take daily medication.

Transurethral resection of the prostate (TURP)

TURP removes prostate tissue in order to reduce the size of the prostate. It is the surgery most commonly used to treat BPH. This is the most common surgical procedure for BPH.

• It is performed under general or spinal anesthesia.
• A special tube with light and a camera (resectoscope) is inserted into the urethra into the prostate.
• The surgeon can observe the inside of the urethra, prostate and bladder.
• The excess tissue of the prostate is removed in the region that surrounds the urethra. The excision can be done using a variety of techniques (electric, laser, etc.)
• A catheter is placed in the bladder to allow the urine to flow.
• The catheter is removed as soon as there is no more blood in the urine (usually after 24 hours).

Side effects of TURP may include:

• bleeding
• infection
• retrograde ejaculation
• new or minimally improved irritative urinary symptoms (frequent urination, urgency, etc.)
• erectile dysfunction – rare
• incontinence – rare

Some men may have to undergo a second intervention (10% of men after 10 years). Other surgical or radiological techniques performed under local anesthesia may be performed, but their long-term effectiveness remains to be determined.