Alternatives to Surgery for Enlarged Prostate

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Up to 90 percent of men in their 70s can expect to develop and live with an enlarged prostate and the symptoms that accompany it. That makes for a lot of men who will need to make decisions about how to treat this condition, which in some cases can mean surgery. However, there are many alternatives to surgery for enlarged prostate treatment, and men are urged to discuss them with their physician.

What is an enlarged prostate?

An enlarged prostate, or benign prostatic hyperplasia (BPH) is a condition characterized by a benign enlargement of the prostate, which blocks the flow of urine through the urethra. Prostate cells gradually multiple, which in turn places pressure on the urethra.

As the urethra narrows, the bladder has to work harder to transport urine through the body. The bladder muscle may eventually become thicker and hypersensitive, causing it to contract even when there are only small amounts of urine in the bladder. This pressure can then manifest as urinary urgency, urinary frequency, getting up often during the night to urinate, dribbling, pain when urinating, weak flow, and an inability of the bladder to empty completely. This last symptom can result in urinary tract infections.

Fortunately, there are many alternatives to surgery for men who have an enlarged prostate.

Alternatives to surgery for enlarged prostate

Surgery for an enlarged prostate is usually reserved for men who have not responded to other treatments and for whom the condition has significantly damaged their quality of life. BPH surgery involves removing part or all of the prostate, and the result can be serious complications, including urinary incontinence and erectile dysfunction.

With that in mind, here are alternatives to surgery for enlarged prostate.

Lifestyle changes. This should be the first treatment avenue recommended by physicians. The changes include weight loss among men who are overweight or obese, engaging in regular physical activity, not smoking, avoiding alcohol and caffeine, adopting a nutritious diet (all-natural suggested), avoiding highly seasoned or spicy and fatty foods, treating constipation, and minimizing intake of liquids late in the day.

Toileting techniques: For men who are having difficulty emptying their bladder completely, a technique called double-voiding can be helpful. This involves urinating normally, waiting about 20 to 30 seconds, and trying again. Men with BPH also may be able to empty their bladder better if they sit and lean forward on the toilet rather  than stand when urinating.

Medications: Several classes of drugs are routinely prescribed for men with an enlarged prostate.

  • Alpha-blockers, which include Flomax and tamsulosin. These drugs relax the muscles in the prostate and the bladder neck, which then allows urine to flow more easily
  • 5-alpha reductase inhibitors (5ARIs) which includes finasteride and dutasteride. These drugs alter the actions of male hormones
  • Erectile dysfunction drugs, also known as phosphodiesterase 5 inhibitors (PDE5 inhibitors). For now, the only PDE5 inhibitor approved by the FDA for an enlarged prostate is tadalafil (Cialis).
  • Anticholinergics, which block the action of acetylcholine. This helps curb involuntary muscle movements. They are sometimes given along with alpha-blockers.
  • A combination of an alpha-blocker (tamsulosin) and a 5ARI (dutasteride) in a drug named Jayln, which can be superior to either drug separately for some men

Minimally invasive nonsurgical procedures: The following procedures don’t involve surgery and can be performed on an outpatient basis in a doctor’s office or outpatient setting in a hospital or clinic. These procedures typically involve reaching the prostate through the penis.

  • Focused laser ablation. This procedure combines magnetic resonance imaging and laser to reduce the size of an enlarged prostate.
  • HIFU. High-intensity focused ultrasound uses high-powered sound waves to heat and destroy excessive prostate tissue.
  • HoLEP. Holmium laser enucleation of the prostate is a laser procedure that removes prostate tissue that is blocking urine flow.
  • Prostatic urethral lift. The UroLift implants open the urethra without the need for incisions.
  • PVP. Photoselective vaporization involves the use of high-energy holmium or GreenLight laser to vaporize excess prostate tissue and seal it with heat at the same time.
  • Rezum water vapor therapy. Water vapor energy is used to destroy overgrown prostate tissue.
  • Stent. A stent is a device that is placed in the urethra to help keep it open so urine can flow freely.
  • TUMT. Transurethral microwave thermotherapy uses a combination of cold and heat. The catheter that is threaded through the penis sends out microwaves to eliminate the tissue.
  • TUNA. Transurethral needle ablation uses radio waves to eliminate excessive prostate tissue.
  • UroLift System. A telescope-type instrument is inserted through the penis and one or more minute bands are inserted to help retract part of the prostate from the urethra.

Bottom line

Men have a wide variety of alternatives to surgery for enlarged prostate. Each of them has its own set of potential side effects and complications, so men should talk to their physician about all the pros and cons of each approach and make an informed decision.