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How is BPH Treated?

BPH is typically treated in a stepwise fashion which begins with utilizing conservative, behavioral based therapies and lifestyle changes (Step 1).  If lifestyle changes alone are not successful in improving symptoms phytotherapy or medications will be trialed (Step 2). Ultimately if medications are unsuccessful or side effects are poorly tolerated additional testing with cystoscopy or urodynamics may be utilized and then advanced therapies will be considered (Step 3).  Advanced therapies can be classified in many ways In our description they will be divided into office based and outpatient minimally invasive procedures and more invasive typically hospital based procedures.

What are the indications of BPH treatment?

Traditional indications

Most problems are related to the inability to empty your bladder from prostate obstruction. These include:

Sudden inability to urinate (urinary retention).

You might need to have a tube (catheter) inserted into your bladder to drain the urine

Urinary tract infections (UTIs).

Bacteria can grow in urine that is not completely emptied from your bladder.

Bladder stones.

Stones may form  in urine that is not completely emptied from your bladder.  These stones can cause infection, bladder irritation, blood in the urine and obstruction of urine flow.

Bladder damage

A bladder that hasn’t emptied completely can stretch and weaken over time. As a result, the muscular wall of the bladder no longer contracts properly, making it harder to fully empty your bladder.

Kidney damage

Pressure in the bladder from urinary retention can directly damage the kidneys or allow bladder infections to reach the kidneys.

Most men with an enlarged prostate don’t develop these complications. However, acute urinary retention and kidney damage can be serious health threats.

Patients with mild symptoms

Conservative, behavioral based treatment (watchful waiting) is the most reasonable initial choice for patients with mild symptoms.  Mild symptoms are defined as AUA-SI <8, or more significant symptoms with minimal bother.

Patients with moderate to severe symptoms

Treatment for more significant symptoms should be conservative when there is minimal bother and medications, minimally invasive or surgical therapies when there is more bother and when quality of life is affected.  Typically medications will be offered first followed by more invasive procedures.

Conservative Management Options

Conservative management is indicated for patients with mild or non bothersome symptoms whose health is not compromised by bladder outlet obstruction.

Conservative management is often times called watchful waiting and refers to BPH which is monitored and no active treatment is prescribed. Changes in urinary habits and intake (diet and liquids) can improve symptoms. Follow up over time will determine if additional treatment will be indicated.

To help control lower urinary tract symptoms (LUTS) the following suggestions may be helpful.

Limit beverages in the evening.

Try to reduce what you are drinking after dinner to limit the number of times you get up to urinate at night.

Limit caffeine and alcohol.

They can increase urine production, irritate the bladder and worsen symptoms.

Limit decongestants or antihistamines.

These drugs tighten the prostatic capsule making it more difficult to urinate.

Timed voiding.

Schedule bathroom visits. Try to urinate at regular times every 2-3 hours while awake.  This can help you maximally empty your bladder and can improve urinary urgency.

Follow a healthy diet.

Obesity is associated with enlarged prostate.

Stay active.

Exercise can help reduce urinary problems caused by an enlarged prostate.

Double void.

Urinate and then urinate again a few moments later. This can help you maximally empty your bladder.

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