When an enlarged prostate starts causing frequent urination, a weak stream, nighttime bathroom trips, or difficulty emptying the bladder, surgery is not always the first answer. For many men with benign prostatic hyperplasia (BPH), treatment can begin with lifestyle changes, medications, or minimally invasive procedures.
Not every enlarged prostate requires immediate treatment.
If urinary symptoms are mild and do not significantly interfere with daily activities, a urologist may recommend monitoring rather than immediately prescribing medication or performing a procedure.
This approach can involve:
Some people with mild BPH symptoms can remain stable for an extended period, while others eventually need treatment.
Lifestyle adjustments may reduce bothersome urinary symptoms, particularly when symptoms are mild.
Common measures include:
These measures do not shrink the prostate, but they may make urinary symptoms easier to manage.
For men with mild to moderate BPH symptoms, medications are commonly considered before invasive treatment.
Alpha blockers relax smooth muscle around the prostate and bladder neck, making it easier for urine to pass.
Examples include:
These medications can work relatively quickly, although they do not actually shrink the prostate. Possible side effects include dizziness and changes in ejaculation.
Another approach involves 5-alpha reductase inhibitors.
Common examples include:
These medications reduce hormonal stimulation that contributes to prostate growth.
They can be particularly useful when the prostate is substantially enlarged. However, they work gradually and may take several months to produce their full effect. Sexual side effects can occur.
Some men benefit from combining an alpha blocker with a 5-alpha reductase inhibitor.
The combination can address two different aspects of BPH:
Alpha blocker: relaxes the prostate and bladder neck to improve urine flow.
5-alpha reductase inhibitor: gradually reduces prostate size.
A urologist may consider combination therapy when symptoms are significant and the prostate is enlarged.
Tadalafil is commonly associated with erectile dysfunction, but it can also improve urinary symptoms associated with BPH.
For men experiencing both erectile dysfunction and BPH symptoms, a urologist may consider tadalafil as part of the treatment plan.
Whether it is appropriate depends on medications, cardiovascular health, and other medical factors.
When medication does not provide enough relief, several procedures can treat BPH without traditional open prostate surgery.
These treatments are generally designed to improve urine flow while minimizing tissue disruption, recovery time, or sexual side effects compared with some conventional procedures.
The best choice depends heavily on prostate size and anatomy.
A prostatic urethral lift, often known by the brand name UroLift, uses small implants to pull enlarged prostate tissue away from the urethra.
The goal is to create a wider channel for urine to pass through without removing prostate tissue.
It can be attractive to some patients because it generally has a lower likelihood of sexual side effects than several tissue-removing procedures. However, it is not appropriate for every prostate shape or size.
Another minimally invasive treatment uses steam to treat enlarged prostate tissue.
Water vapor thermal therapy places a device through the urethra and delivers controlled steam into targeted areas of the prostate. The treated tissue gradually breaks down, helping open the urinary channel.
Mayo Clinic notes that water vapor thermal therapy can relieve BPH symptoms and is less likely to cause sexual side effects than many other surgical treatments.
Results may take some time because the body gradually removes the treated tissue.
For men with larger prostates or more substantial obstruction, holmium laser enucleation of the prostate (HoLEP) can be an alternative to traditional prostatectomy.
The procedure is performed through the urethra rather than through an abdominal incision. A laser separates and removes obstructing prostate tissue.
Mayo Clinic describes HoLEP as a treatment that can remove nearly all of the prostate tissue blocking urine flow and can be particularly useful for very large prostates or certain patients with significant urinary retention.
Although HoLEP is minimally invasive, it is still a surgical procedure and can have side effects.
Photoselective vaporization of the prostate (PVP) uses a laser to remove or vaporize prostate tissue blocking urine flow.
Compared with traditional prostate surgery, laser PVP generally involves less bleeding and can offer a faster recovery. It may be particularly useful for some men who take blood-thinning medication.
The appropriate laser technique depends on prostate anatomy, symptoms, medications, and the urologist's experience.
Robotic waterjet treatment, commonly called Aquablation, uses imaging guidance and high-pressure water to remove targeted prostate tissue.
It is designed to relieve obstruction while using a more precise, image-guided approach.
Mayo Clinic lists robotic waterjet treatment among the available BPH procedures, although it can still cause some side effects associated with prostate tissue-removing procedures.
Prostate artery embolization (PAE) is another alternative for selected men.
Instead of entering the prostate through the urinary channel, an interventional radiologist blocks selected blood vessels supplying the prostate. Reduced blood flow causes the prostate to shrink over time.
Mayo Clinic notes that PAE can improve urinary symptoms for certain patients, but it should be performed by an appropriately trained interventional radiologist and discussed carefully with the healthcare team.
Transurethral incision of the prostate (TUIP) may be considered when the prostate is small or only mildly enlarged.
Rather than removing substantial amounts of tissue, the physician makes one or two small cuts that widen the urinary channel.
Mayo Clinic notes that TUIP can have advantages such as a lower risk of bleeding and a lower likelihood of retrograde ejaculation compared with some other BPH treatments.
There is no single procedure that works best for every man.
Urologists generally consider:
Mayo Clinic emphasizes that BPH treatment is individualized according to symptoms, prostate size, overall health, and treatment preferences.
Medication may not adequately control symptoms for everyone.
A procedure may become appropriate when:
These complications can make procedural treatment more important than simply managing symptoms.