Prostate Enlargement/BPH Health Center

If your benign prostatic hyperplasia (BPH) is causing lower urinary tract symptoms, options include watchful waiting, medicine, and surgery. Generally, watchful waiting or medicines are considered first, and then surgery. This Decision Point focuses on deciding between medicines 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. About 4 out of 10 men improve without treatment.¹
• You may find the side effects of medicine or surgery more bothersome than the BPH symptoms.
• Medicines may decrease the risk for acute urinary retention and future surgery.²
• There is no research directly comparing surgical treatment and medicine.

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 75 have some symptoms.³

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. And it doesn't 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 medicines to relieve your symptoms. These include:
  • Alpha-blockers, such as doxazosin (Cardura) and terazosin (Hytrin).
  • 5-alpha reductase inhibitors, such as dutasteride (Avodart) or finasteride (Proscar).
• 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 medicines 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

The wide range of numbers in the following table is because few studies have been done and the studies have conflicting results.

See information on medicines 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). There are some other surgeries that are used in rare cases. 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 medicines 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. Roehrborn CG, McConnell JD (2007). Benign prostatic hyperplasia: Etiology, pathophysiology, epidemiology, and natural history. In AJ Wein, ed., Campbell-Walsh Urology, 9th ed., vol. 3, pp. 2727–2765. Philadelphia: Saunders Elsevier.

2. Webber R (2006). Benign prostatic hyperplasia, search date May 2005. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.

3. Presti JC, et al. (2008). Benign prostatic hyperplasia (BPH) section of Neoplasms of the prostate gland. In EA Tanagho, JW McAninch, eds., Smith’s General Urology, 17th ed., pp. 348–370. New York: McGraw-Hill.

4. Fitzpatrick JM (2007). Minimally invasive and endoscopic management of benign prostatic hyperplasia. In AJ Wein, ed., Campbell-Walsh Urology, 9th ed., vol. 3. pp. 2803–2844. Philadelphia: Saunders Elsevier.

5. 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.

6. Kirby R, Lepor H (2007). Evaluation and nonsurgical management of benign prostatic hyperplasia. In AJ Wein, ed., Campbell-Walsh Urology, 9th ed., vol. 3, pp. 2766–2802. Philadelphia: Saunders Elsevier.