Benign Prostatic Hyperplasia (BPH) Treatment
The Barbara and Maurice Deane Prostate Health and Research Center’s expert urologists and support staff are dedicated to evaluating each patient’s specific benign prostatic hyperplasia (BPH) problems and concerns. Using state-of-the-art diagnostic tests, we devise targeted therapies to meet your unique needs and maintain the highest quality of life.
Treatment options for BPH include:
- Active Surveillance (also referred to as watchful waiting)
- Lifestyle changes
- Prescription and non-prescription medications
- Minimally-invasive office-based treatments
- Minimally-invasive surgery
- Traditional open surgery
For many patients with mild symptoms, active surveillance (watchful waiting) with periodic checks to ensure the condition isn’t worsening is an appropriate choice.
Lifestyle changes and herbs
For men with mild symptoms certain lifestyle changes such as limiting or avoiding alcohol and caffeine, limiting fluid intake in the evening, and double-voiding (waiting a few moments after urinating and then urinating again) may help to control symptoms.
Many patients find over-the-counter products like saw palmetto or pygeum extract attractive options as well. However, it should be cautioned that currently more is known about what these products do not do than what they actually do. For example, saw palmetto doesn’t affect PSA levels or prostate size. In addition, relatively few studies demonstrate that saw palmetto works better than placebo in relieving patient complaints. Further scientific studies with larger numbers of patients are needed to determine the effectiveness of complementary products.
Many patients with more bothersome symptoms find that treatment with alpha-blocker medications is helpful in reducing their symptoms. These work mainly by relaxing smooth muscles within the prostate. While these medications do not result in large improvements in objective findings such as flow rate, the majority of patients with mild-moderate symptoms are satisfied with their improvement.
Another class of medications known as 5-alpha reductase inhibitors shrink the prostate and decrease symptoms over the long term. They are best used for prostates that are significantly enlarged as well as for controlling bleeding associated with enlarged prostates. These medications can alter the further progression of BPH, reducing the likelihood of urinary retention and/or the ultimate need for surgery.
Minimally invasive options
The diagnostic evaluation will determine those patients who have serious conditions associated with BPH such as urinary retention or renal damage. These patients will require a medical procedure. Likewise, patients with severe symptoms or those who find no benefit with medical therapy will be candidates for medical procedures.
Deane Center physicians have extensive training and experience with minimally invasive options. These procedures can be performed transurethrally where a special endoscope is passed through the penis and the prostate is "shaved" down. A TURP (transurethral resection of the prostate) is a traditional procedure often used for larger prostate glands. The Button TURP (VLAP, or vaporization of the prostate) uses a saline-based therapy to vaporize prostate tissue in a similar manner as TURP but with potentially less bleeding and without the risk of water absorption into the body.
The newest laser procedures, including Greenlight ™ and Holmium lasers, have also improved the safety of TURP by minimizing bleeding and allowing for saline use during the procedure. The choice for each will be determined by the patient’s individual needs. When the prostate is quite small, a pair of incisions may be all that is required to alleviate symptoms without removing any tissue (TUIP or transurethral incision of the prostate).
Minimally invasive office-based treatments
For those patients wanting to avoid surgery, several new minimally invasive options are available, including "microwave" therapy. This is done on an outpatient basis and in a doctor’s office with short-term success rates similar to those of traditional surgery but with fewer side effects. While the long-term success rates may not equal more invasive procedures, many patients will elect to try one of these minimally-invasive alternative procedures before undergoing more invasive ones.
Traditional open surgery
For men with very large prostate glands, open surgery may be required (referred to as a simple retropubic or suprapubic prostatectomy). These surgeries are generally safe and have very high success rates.
We Can Help
If you have questions or would like to schedule an appointment, please call 212-241-4812.
5 East 98th Street
New York, NY 10029
Dr. Ash Tewari
625 Madison Avenue
New York, New York 10022