If your benign prostatic hyperplasia (BPH) is causing lower urinary tract symptoms, options include watchful waiting, medication, and surgery. Generally, watchful waiting or medications are considered first, and then surgery. This Decision Point focuses on deciding between medications and surgery.

Consider the following when making your decision:

• If you have acute urinary retention (AUR-a blockage of the urethra that makes urination impossible) that comes back, urinary tract infections that happen again, kidney problems, bladder stones, or blood in your urine, surgery may be your best choice.
• The American Urological Association (AUA) symptom index is used to help men determine the severity of their urinary symptoms and can also be used to measure the effectiveness of treatment. But the most important factor in deciding whether to get treatment is not your AUA rating, but how much the symptoms bother you and affect your quality of life.
• Your BPH symptoms may come and go, stabilize, or get better over time; there is a 31% to 55% chance they will improve without treatment.¹
• You may find the side effects of medication or surgery more bothersome than the BPH symptoms.
• Medications may decrease the risk for acute urinary retention and future surgery.^{2, 3}
• There is no research directly comparing surgical treatment and medication.

What is benign prostatic hyperplasia?

Benign prostatic hyperplasia (BPH) is a noncancerous enlargement of the prostate gland that occurs in almost all men as they age. The enlargement is usually harmless, but it often results in problems urinating. About half of all men older than 50 experience some symptoms.⁴

What are the risks of BPH?

BPH can be inconvenient and may affect your quality of life, but it is usually not a serious problem.

In a small number of cases, BPH may cause bladder outlet obstruction (BOO), making it impossible or extremely difficult to urinate. This may result in backed-up urine (urinary retention), leading to bladder infections or bladder stones or kidney damage.

BPH may also irritate the bladder muscles as they enlarge to compensate for the increased force needed to empty the bladder.

BPH does not cause prostate cancer and does not affect a man's ability to father children; nor does it usually result in erection problems. But there is some association between severe symptoms of BPH and an increased risk of erection problems.

If you need more information, see the topic Benign Prostatic Hyperplasia (BPH).

Your choices are:

• Use prescription medications to relieve your symptoms. These include:
  • Alpha-blockers, including terazosin (Hytrin), doxazosin (Cardura), tamsulosin (Flomax), alfuzosin (Uroxatral), and prazosin (Minipress).
  • 5-alpha reductase inhibitors, such as finasteride (Proscar) or dutasteride (Avodart).
• Have surgery to relieve your symptoms. The most frequently performed surgeries are:
  • Transurethral resection of the prostate (TURP), where an instrument is inserted up the urethra to remove the section of prostate tissue that is blocking urine flow.
  • Transurethral incision of the prostate (TUIP), where an instrument is inserted up the urethra and an electric current or a laser beam is used to make incisions in the prostate where the prostate meets the bladder. This relaxes the opening to the bladder, decreasing resistance to the flow of urine out of the bladder. No tissue is removed.

The decision about whether to use medications or surgery for BPH takes into account your personal feelings and the medical facts.

The American Urological Association (AUA) symptom index is used to help men determine the severity of their urinary symptoms and can also be used to measure the effectiveness of treatment. But the most important factor in deciding whether to get treatment is not your AUA rating, but how much the symptoms bother you and affect your quality of life.

Comparison of treatments ^{5, 1}

The wide variation in figures in the following table is because few studies have been done and the studies have conflicting results.

See information on medications for benign prostatic hyperplasia.

Those with very large prostates may consider an open prostatectomy. Other surgical options include laser therapy, transurethral microwave therapy (TUMT), and transurethral needle ablation (TUNA). Talk to your doctor about these options.

These personal stories may help you make your decision.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about surgery or medications to treat your BPH. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

*NA = Not applicable

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason for making your choice.

Check the box below that represents your overall impression about your decision.

Citations

1. Agency for Healthcare Research and Quality (1994). Benign Prostatic Hyperplasia: Diagnosis and Treatment. Clinical Practice Guidelines No. 8 (AHCPR Publication No. 94-0582). Rockville, MD: Agency for Healthcare Policy Research.

2. Webber R (2005). Benign prostatic hyperplasia. Clinical Evidence (14): 1076–1091.

3. McConnell JD, et al. (1998). The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. New England Journal of Medicine, 338(9): 557–563.

4. Paterson R, Goldenberg L (2001). Benign prostatic hyperplasia. In J Teichman, ed., 20 Common Problems in Urology, part 2, pp. 185–198. New York: McGraw-Hill.

5. Fitzpatrick JM, Mebust WK (2002). Minimally invasive and endoscopic management of benign prostatic hyperplasia. In PC Walsh et al., eds., Campbell's Urology, 8th ed., vol. 2, pp. 1379–1422. Philadelphia: W.B. Saunders.