What treatments are available to men with BPH?

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As men age, prostate tissue can grow resulting in obstruction of the urinary tract.  By 50 years of age 50% of men will have some degree of BPH and at 85, 75% will have BPH.  The signs and symptoms of benign prostatic hyperplasia are related to urination because the enlarging of the prostate puts pressure on the urethra which decreases the flow of urine.  Common symptoms include:

·       Decreased force of stream

·       Hesitancy

·       Intermittent stream

·       Dribbling

·       Nocturia: nighttime waking in order to urinate.

In its most severe form, patients can develop kidney problems secondary to incomplete bladder emptying. Your doctor will use the AUA index to evaluate your symptoms. The American Urologic Association (AUA) has developed a symptom score for BPH. AUA scores: 0-7 are mild; 8-19 are moderate; 20-35 are severe symptoms. AUA scores are calculated by circling the answer to each question and adding up the numbers. Talk to your doctor about your score to determine what treatment you may need.

Because BPH progresses slowly, most men can make the decision on their own about if and when they should be treated. In few cases, BPH symptoms are severe enough to require immediate treatment. The treatment options available for BPH depend on the severity of your symptoms. The most common treatment options include watchful waiting, prescription medications, or surgery.  Treatment for BPH is divided into two main types—medical and surgical.

Medical therapy:

Medical therapy includes alpha-blockers and 5 a-reductase inhibitors.

·       Alpha-blockers: alpha-1-andrenergic receptor are found within the bladder neck and prostate

      • By inhibiting these receptors the bladder neck and prostate relax resulting in improved voiding
      • This class of medication includes: terazosin, doxazosin, alfuzosin, tamsulosin and silodosin.
    • 5 a-Reductase inhibitors: block the creation of dihydrotestosterone or DHT a potent hormone that promotes prostate growth
      • Drugs include: proscar and avodart

Surgery:

  1. TUNA ( Transurethral Needle Ablation) Radiofrequency wave heat and destroy excess prostate tissue
  2. TUMT (Transurethral Microwave Thermotherapy) Microwaves heat and destroy excess prostate tissue
  3. TURP (Transurethral Resection of the prostate) small pieces of excess prostate are physically removed