Dr Marc Laniado
There are many treatments for BPE depending on the amount of bother the symptoms cause and the physical configuration of the prostate.
For men with mild symptoms, changes in lifestyle may be enough to make life comfortable again. Usually, avoiding caffeine and alcohol, preventing constipation, and restricting fluid consumption before times when toilets are unavailable are enough.
Some medications can improve symptoms by relaxing some of the muscles that tense up as BPE occurs. These drugs are known generally as alpha blockers e.g. tamsulosin and alfuzosin. They improve symptoms mildly and make only a slight difference to the urinary flow rate.
Other drugs such as finasteride or dutasteride can shrink the prostate by around 10 to 20%, but take between 6 and 24 months to work. They do not alleviate urinary symptoms as much as alpha blockers, but do reduce the chance of urinary retention and other problems due to BPH. There are side-effects such as breast enlargement and erectile dysfunction.
If tablets are not enough, then traditionally an operation called TURP was performed. After this procedure, urinary symptoms are significantly improved, but there can be sexual side-effects such as no semen ejaculated on orgasm, loss of erections and bleeding. TURP has been superseded by the following.
Two new procedures can improve urinary symptoms without affecting erections or ejaculation. Both are done as a day case either under local or general anaesthesia, and no catheter is required:
- UroLift: the prostate is pulled open and held in place by an implant containing metal tags at each end - like ‘treasury tag’
- Rezum: the prostate is vapourised in a highly selective manner without a permanent implant remain allowing ejaculation to occur normally with affecting erections.
Both procedures improve symptoms significantly but the Rezum is preferable as MRI scans of the prostate, if needed, to detect cancer will be of better quality. The metal implant of UroLift can impair MRI quality. Furthermore, both are not so good for men with large prostates
In men with big prostates, lasers can be used to shrink or vapourise the prostate. Holmium laser enucleation of the prostate (HoLEP) improves the urinary flow more than any other laser or procedure for BPE. It can be done as a day case or as an over-night stay with a rapid recovery. GreenLight laser is an alternative laser to the HoLEP.