Treatment for Benign Prostatic Hyperplasia

Benign Prostatic Hyperplasia (BPH) is common in men, especially as they age. While BPH is not cancerous, it can significantly affect quality of life.

Fortunately, several effective treatments are available, including active surveillance, lifestyle modifications, medications, minimally invasive procedures, surgical interventions, and Holmium Laser Enucleation of the Prostate (HoLEP).

Who is Suitable for BPH Treatments?

• The Severity of Symptoms: Men with mild to moderate BPH symptoms may initially try lifestyle modifications or medications before considering more invasive treatments. However, those with severe symptoms that significantly impact their quality of life may be candidates for more aggressive interventions.
• Prostate Size: The prostate gland's size can influence the surgical treatment choice. Minimally invasive procedures like UroLift or Rezum may be suitable for men with moderately enlarged prostates. At the same time, surgical options such as TURP, HoLEP or robotic simple prostatectomy may be necessary for those with very large prostates.
• Overall Health: The presence of other medical conditions can impact treatment decisions. For example, men with certain medical conditions or taking specific medications may not be suitable candidates for certain medications or surgical procedures due to potential interactions or increased risks.
• Age: While age alone does not determine suitability for BPH treatments, older adults may have different treatment goals or risk tolerances than younger men. Doctors may consider life expectancy and overall health factors when recommending treatment options.
• Preference and Lifestyle: Some men may prefer certain treatment modalities based on factors such as recovery time, potential side effects, and invasiveness. Lifestyle factors like work obligations or travel plans may also influence treatment decisions.
• Potential Risks and Complications: Each treatment option for BPH carries its own set of risks and potential complications. For example, surgical procedures like TURP or HoLEP may have a higher risk of complications such as bleeding, infection, or urinary incontinence compared to minimally invasive procedures or medications. Doctors will assess individual risk factors and discuss potential complications with patients before recommending a specific treatment.
• Response to Previous Treatments: For men who have already tried conservative measures or medications without adequate symptom relief, further evaluation may be needed to determine the most appropriate next steps, including a different medication or a more invasive treatment option.

Benefits of BPH Treatments

BPH treatments offer numerous benefits aimed at improving urinary symptoms, enhancing quality of life, and reducing the risk of complications associated with untreated BPH. Here are the key benefits of undergoing BPH treatments:

• Relief of Urinary Symptoms
• Improved Quality of Life
• Enhanced Bladder Health
• Prevention of Acute Urinary Retention
• Reduction in Medication Use
• Preservation of Renal Function
• Long-term Symptom Relief

Types of BPH Treatments

Several treatments are available for BPH, each with its benefits and considerations.

• Medications:
• Alpha-Blockers: Relax the prostate and bladder neck muscles to improve urine flow. Examples include tamsulosin, silodosin, alfuzosin, doxazosin, and terazosin.
• 5-Alpha Reductase Inhibitors: Shrink the prostate gland by blocking the conversion of testosterone to dihydrotestosterone (DHT). Examples include finasteride and dutasteride.
• Urolift for Enlarged Prostate: A minimally invasive procedure that uses small implants to lift and hold the enlarged prostate tissue away from the urethra, improving urine flow. It preserves sexual function and does not typically cause ejaculatory dysfunction.
• Rezum Therapy for BPH: A minimally invasive procedure that uses steam to ablate excess prostate tissue, reducing obstruction and improving urinary symptoms. It provides symptom relief with minimal risk of sexual side effects.
• Prostate HoLEP Laser Therapy: An advanced surgical technique that uses a laser to remove obstructive prostate tissue. It provides comprehensive tissue removal with low rates of complications and long-term symptom relief.
• Prostate Artery Embolization (PAE): A non-surgical procedure that involves blocking the blood supply to the prostate, leading to shrinkage of the gland and symptom improvement. It is minimally invasive, with a short recovery time and preservation of sexual function.
• Green Light Laser Prostatectomy: A surgical procedure that uses a laser to remove obstructive prostate tissue while minimising bleeding and complications. It has a shorter recovery time than traditional surgery with short to medium-term symptom relief.
• Simple Robot-Assisted Prostatectomy: A surgical keyhole procedure performed with the assistance of robotic technology to remove obstructive prostate tissue. It offers precise tissue removal, shorter hospital stays, and faster recovery than open surgery.
• Open Prostatectomy: A traditional surgical procedure that involves making an incision to remove obstructive prostate tissue. It provides complete tissue removal with long-term symptom relief, particularly for large prostates.
• Transurethral Prostate Resection (TURP): A traditional surgical treatment for BPH that involves removing obstructive prostate tissue using a special instrument inserted through the urethra. It offers effective symptom relief with a short hospital stay and rapid recovery.
• Bladder Neck Incision: A procedure that involves making small incisions in the bladder neck to widen the opening and improve urine flow. It is minimally invasive, with a low risk of complications and preservation of sexual function for smaller prostates.

Preparation Before a BPH Treatment

• Consultation with doctor: Schedule a consultation with a doctor specialising in BPH management to discuss treatment options, potential risks, benefits, and expected outcomes. This consultation may involve a physical examination, medical history review, and diagnostic tests such as a prostate-specific antigen (PSA) test, digital rectal exam (DRE), urinalysis, or imaging studies.
• Medication Review: Inform your doctor about any medications, supplements, or herbal remedies you currently take. Some medications may need to be adjusted or discontinued before the procedure to minimise the risk of complications or interactions.
• Preparation Instructions: Follow any preoperative instructions provided by your doctor, which may include fasting for a certain period before the procedure, stopping certain medications, or using bowel preparation techniques to empty the colon before surgery.
• Arrange Transportation: If you are undergoing a surgical procedure requiring anaesthesia, arrange transportation to and from the hospital or surgical centre, as you may be unable to drive yourself home afterwards.
• Plan for Recovery: Make arrangements for postoperative care and recovery, including time off work, assistance with household chores, and support from family or friends during the initial recovery period.

BPH Treatment Procedure

• Preparation: Before the procedure, you may be given anaesthesia or sedation to ensure your comfort during the treatment. Local anaesthesia or sedation may be sufficient for minimally invasive procedures, while general anaesthesia may be necessary for surgical interventions.
• Procedure: The specific details of the procedure will depend on the chosen treatment option. Minimally invasive procedures such as UroLift, Rezum therapy,  HoLEP or TURP are typically performed using specialised equipment inserted through the urethra or guided by imaging technology. Surgical procedures such as open prostatectomy or robotic-assisted prostatectomy involve making incisions to access and remove obstructive prostate tissue.
• Monitoring: Doctors will monitor your vital signs throughout the procedure, ensuring your safety and comfort. Endoscopic cameras guide the treatment and ensure precise tissue removal.

After the procedure, you will be taken to a recovery room, where doctors will monitor your vital signs and provide pain management if necessary. Depending on the procedure type and overall health, you may need to stay in the hospital or surgical centre for a few hours or overnight for observation.

Recovery After BPH Treatments

• Adhere to your doctor's postoperative instructions, including medication schedules, dietary guidelines, activity restrictions, and wound care protocols.
• Attend all scheduled follow-up appointments with your doctor to monitor your recovery progress, address any concerns or complications, and make necessary adjustments to your treatment plan.
• Take prescribed pain medications as directed to manage postoperative pain and discomfort. Over-the-counter pain relievers may also be recommended for mild discomfort.
• Drink plenty of fluids to help flush out the bladder and prevent urinary tract infections. However, avoid excessive fluid intake before bedtime to minimise nighttime urination.
• Gradually resume normal activities as tolerated, but avoid heavy lifting, strenuous exercise, or activities that may strain the pelvic area until cleared by your doctor.
• Monitor your urinary symptoms and promptly report any changes or worsening symptoms to your doctor.
• Get plenty of rest, eat a balanced diet, and practise relaxation techniques to support overall healing and well-being during recovery.

BPH Treatment Prognosis

Most men experience significant improvement in urinary symptoms and quality of life following BPH treatment. Minimally invasive procedures often have shorter recovery times and fewer complications than surgical interventions, while surgical procedures may provide more durable symptom relief in men with severe BPH. 

Many men can expect a good long-term prognosis and improved urinary function with appropriate treatment and follow-up care.

BPH Treatment Risks

While BPH treatments are generally safe and effective, they carry certain risks and potential complications, which may include:

• Bleeding
• Infection
• Urinary Incontinence
• Erectile Dysfunction
• Urinary Retention
• Rare Complications

What if BPH Treatments are Delayed?

Delaying BPH treatments can lead to worsening symptoms, decreased quality of life, and an increased risk of complications such as acute urinary retention, urinary tract infections, bladder stones, or kidney damage. 

Additionally, untreated BPH may progress to more severe complications over time, including bladder dysfunction, urinary retention, or kidney failure.

Therefore, it's important for individuals experiencing BPH symptoms to seek timely evaluation and treatment to prevent these potential complications and improve long-term outcomes. Delaying BPH treatments may also necessitate more aggressive interventions or surgical procedures in the future to manage advanced symptoms or complications.