Benign Prostatic Hyperplasia

Treatment

The following treatment options are available at Mayo Clinic for patients with benign prostatic hyperplasia (BPH). Treatment decisions are based on each patient's condition. The pros and cons of each option are discussed in detail during treatment planning. Surgery, if needed, can often be scheduled the next day, if desired.

Behavioral Therapy

Several changes in behavior can help some patients avoid surgery. Examples include reducing fluid intake in the evening and eliminating bladder irritants from the diet.

Medications

In patients who have moderate symptoms, drugs are often used to control BPH. The main options are:

• Alpha-blockers make urination easier by relaxing the muscles where the bladder narrows toward the urethra. Several forms of alpha-blockers have been approved for treatment of BPH by the U.S. Food and Drug Administration.
• 5-alpha reductase inhibitors shrink the prostate gland but may only cause noticeable improvements for men with significantly enlarged prostates and may take months to be effective.
• Anticholinergics are used to increase the bladder's capacity, inhibit involuntary contractions and delay the urge to urinate.
• In some patients, a combination of several drugs may be more beneficial than one drug alone.

Minimally Invasive Therapies

With the exception of some laser procedures, minimally invasive therapies are slower to produce results than conventional surgical procedures. The reason is because it takes time for the dead prostate tissue to be broken down and reabsorbed naturally. Men not troubled by severe BPH symptoms are often willing to accept this trade-off to avoid hospitalization and the chance of more serious complications.

These minimally invasive therapies tend to produce similar side effects: some degree of swelling of the prostate gland, temporary catheterization, irritation, and an urgency to urinate. These problems can be easily managed by occasional use of a urinary catheter or medications after the procedure.

Depending on the procedure, some men also have changes in the amount of semen they ejaculate because surgery to the bladder neck may allow semen to flow backwards into the bladder. Major complications are rare and problems such as impotence (erectile dysfunction) and incontinence are almost never seen as a result of these less invasive procedures.

Microwave thermal therapy, also known as transurethral microwave thermotherapy (TUMT), is an outpatient procedure that takes about one hour. With the aid of a urinary catheter, a tiny antenna is inserted into the urethra. The antenna delivers microwave energy to heat and destroy the overgrown tissues while avoiding damage to normal tissues. The procedure does not require anesthesia; sedatives are given to minimize pain and discomfort.

Mayo Clinic urologists published the only randomized, double-blind clinical trial of microwave thermal therapy, which found it to be safe and effective compared to a placebo procedure. See PubMed reference.

Needle Ablation

In this technique, needles are used to deliver energy to destroy overgrown prostate tissue.

Transurethral Needle Ablation

TUNA uses radiofrequency energy to heat and destroy enlarged prostate tissue. Unlike microwave thermal therapy, TUNA requires some anesthesia — either pelvic blocks, a spinal anesthetic, or a general anesthetic. It is an outpatient procedure usually performed in a hospital setting. TUNA can be used to target sections of the gland that may not be accessible to the microwave antenna. For example, if an overgrown lobe is protruding into the bladder, the radiofrequency needles can be placed in that area to destroy the overgrown tissue.

Indigo Laser Therapy

Laser energy is delivered through a needle, causing the prostate to resemble Swiss cheese. This minimally invasive BPH treatment is done in the outpatient surgery department under sedation or light anesthesia. The laser destroys prostate cells deep in the gland, which are sloughed off during healing. Because the central urethra is not treated, significant bleeding rarely occurs. This type of laser therapy improves urine flow in about two-thirds of patients. It rarely causes bleeding, and retrograde ejaculation (where the seminal fluid is ejaculated into the bladder instead of outside through the urethra) occurs in less than 20 percent of patients. The procedure is best for men with mild to moderate symptoms in prostates of small to moderate size. A catheter may have to be worn for three to seven days after the procedure until the swelling subsides.

Laser Therapy

High-energy laser therapy, a form of heat therapy which vaporizes overgrown prostate tissue, is often used to provide more immediate relief of symptoms. The benefit of laser therapy is that it generally doesn't cause impotence or prolonged incontinence. However, some laser procedures require temporary use of a catheter. Urologists at Mayo Clinic pioneered the development of KTP laser therapy and led the initial clinical trials. Some Mayo urologists favor the high-energy Holmium laser. Other laser therapies include:

• Transurethral evaporation of the prostate (TUEP) uses laser therapy to destroy prostate tissue. Patients often experience a noticeable improvement in urine flow.
• Visual laser ablation of the prostate (VLAP) uses the laser to dry up and destroy excess prostate cells.
• Interstitial laser therapy kills tissue from the inside out.
• Photosensitive vaporization of the prostate (PVP) is similar to the transurethral resection of the prostrate (TURP) procedure (described below).
• Indigo laser therapy (see description above)

Transurethral Resection of the Prostate (TURP)

TURP has been the gold standard for surgical treatment of BPH for many years. It remains a very effective treatment for patients who retain urine and have moderate to severe symptoms. A surgeon threads a narrow instrument (resectoscope) into the urethra and uses small cutting tools to scrape away excess prostate tissue. Patients can expect to stay in the hospital for one to three days after surgery.

Open Prostate Resection

In some cases of extreme prostate enlargement, open surgery (superpubic prostate resection) is necessary to remove the swollen tissue. The procedure is also used in cases where the bladder is damaged, bladder stones are present or the patient has urethral strictures. A surgeon makes an incision in the lower abdomen to reach the prostate. During the procedure, the inner portion of the prostate is removed while the outer portion remains intact. Patients are often hospitalized for five to seven days. The procedure requires catheterization.