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Benign prostatic hyperplasia - Treatment

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of benign prostatic hyperplasia (BPH).

Alternative Names

Enlarged prostate; BPH

Treatment:

Because BPH rarely causes serious complications, men usually have a choice between treating it or opting for watchful waiting:

Watchful Waiting. Watchful waiting (also known as active surveillance) involves lifestyle changes and an annual examination. (Even when choosing watchful waiting, it is important to have a doctor perform an initial examination to rule out other disorders.) BPH is a progressive condition and as it worsens it can cause urinary tract infections, bladder damage, and kidney damage. Your doctor needs to monitor your condition to determine when it may be time to start treatment.
Treatment. The primary goals of treatment for BPH are to improve urinary flow and to reduce symptoms. Many options are available. They include drug therapies to help shrink or relax the prostate, minimally invasive procedures that use heat to reduce excess prostate tissue, and major surgery to remove part of the prostate.

Deciding Between Treatment and Watchful Waiting

The choice between watchful waiting and treatment usually depends on symptoms severity. The American Urological Association� ' s BPH Symptom Score uses seven questions to evaluate a patient� ' s urinary symptoms during the past month. (The International Prostate Symptoms Score is another index that is also used.) The questions are:

How often have you had a sensation of not emptying your bladder completely after you finished urinating?
How often have you had to urinate again less than two hours after you finished urinating?
How often have you stopped and started again several times when you urinated?
How often have you found it difficult to urinate?
How often have you had a weak urinary stream?
How often had you had to push or strain to begin urination?
How many times did you most typically get up to urinate from the time you went to bed at night until the time you got up in the morning?

Responses for the first six questions are scaled from “not at all” to “almost always.” (The last question uses answers ranging from “none” to “5 or more times”.) Each response is assigned a number on a scale of 0 to 5, and totaled into a symptom score. The symptom score can fall anywhere between 0 and 35.

Patients with mild symptoms will have low scores and may decide to delay treatment. Higher scores indicate more severe symptoms. Treatment can reduce the score:

A score reduction of 5 points indicates modest symptom relief
A score reduction of 5 to 10 points indicates moderate symptom relief
A score reduction of more than 10 points indicates large symptom relief

Your doctor can discuss with you the various treatment options and the likelihood of symptom relief they may provide. All treatments have various side effects, which need to be taken into consideration. Quality of life is as important as symptom severity.

Treatment Options

Medications. In general, there is no reason to treat BPH with medications unless symptoms become very uncomfortable. The size of the prostate, determined by exam or ultrasound, cannot indicate the need for medications. Evidence suggests that:

Medications are the best choice for men with mild symptoms who want treatment. There are two standard choices: Alpha-blockers and anti-androgens. Specific factors indicate the best choice, although most men take an alpha-blocker. Men with mild symptoms who choose surgery only experience minor improvement afterward but face the same risks as patients with more severe symptoms.
Men with moderate-to-severe symptoms often respond to the same medications as men with mild symptoms. Recent developments in drug therapy have reduced the number of surgical procedures needed and delayed their use.

Surgery. A quarter of men with moderate symptoms, and even more men with severe symptoms, eventually need surgery. If a man chooses surgery, there are many choices. Transurethral resection of the prostate (TURP) is the standard procedure, but less invasive procedures, particularly those using heat or lasers to destroy prostate tissue, are becoming more common.

TURP - series
Click the icon to see an illustrated series detailing transurethral resection of the prostate surgery.

The most common reason for choosing surgery is obstruction of the bladder outlet, which causes urinary retention. Surgery is also typically a reasonable option when BPH is clearly related to one or more of the following conditions:

Recurrent urinary tract infection
Blood in the urine (hematuria). Studies have suggested that when hematuria is left untreated, two-thirds of patients continue to bleed and one third require surgery. The drug finasteride may help some men with this condition and should probably be tried before surgery.
Bladder stones
Kidney problems
Moderate-to-severe symptoms that are not well controlled with medications

Increased urinary flow and reduced urine retention are the greatest improvements resulting from surgery. Often, however, the benefits of surgery are not permanent.

Resources

www.niddk.nih.gov -- National Institute of Diabetes and Digestive and Kidney Diseases
www.urologyhealth.org -- American Urological Association

References

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Reviewed last on: 7/8/2009
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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