When to seek treatment and what action to take are personal decisions you should make with your doctor's input. The main reason to start treatment is that you are bothered by symptoms, or that changes in your urination are interfering with your lifestyle. It is rare for men with little or no symptoms to need treatment of any kind.
Here are three treatment approaches:
If your symptoms are not severe, see your doctor only as needed.
Drugs called alpha-blockers help to relax the muscles at the base of the bladder and increase a man's ability to urinate. Approximately 70% of men see improvement in their symptoms within a few days to a few weeks after beginning one of these medications. On the down side, alpha-blockers can cause dizziness, fatigue and excessively low blood pressure. Commonly prescribed alpha-blockers include tamsulosin (Flomax), alfuzosin (UroXatral), doxazosin (Cardura) and terazosin (Hytrin).
For some men, drugs that block testosterone can shrink the size of the prostate and increase the flow of urine. The drawbacks to this type of drug are that it can take three to six months to begin working, and that it can cause impotence in approximately 4% of men who take it. Commonly prescribed testosterone blockers, also known as 5 alpha reductase inhibitors, include finasteride (Proscar) and dutasteride (Avodart).
Recent studies suggest that combining an alpha-blocker with a testosterone blocker may work better than either drug alone.
This option offers the best chance for improving symptoms but also carries the greatest risk of complications. There are several types of surgical procedures:
Transurethral resection of the prostate (TURP)— This is the most commonly performed procedure. The surgeon inserts a telescope and an electrical loop through the urethra to the enlarged prostate. The electrical loop burns away the extra prostate tissue to open the urethral passage. The operation takes approximately 90 minutes. It involves either general or spinal anesthesia and an overnight hospital stay. The most common side effect is retrograde ejaculation, in which semen flows into the bladder rather than out the end of the penis, and results in "dry" orgasms.
Transurethral incision of the prostate (TUIP)— This surgery widens the urethra by making small cuts in the bladder opening, rather than removing prostate tissue. It is used only when there is minimal enlargement of the prostate. This procedure has the advantage of a low complication rate and no overnight hospital stay. However, long-term results may not be as good as those seen with TURP.
Transurethral microwave thermotherapy (TUMT)— A microwave antenna is inserted into the urethra to heat the prostate and destroy overgrown tissue. This procedure costs less than TURP and has fewer complications. No overnight hospital stay is needed. However, approximately half of all men need additional treatment within four years.
Transurethral needle ablation of the prostate (TUNA)— This procedure uses a heated needle to burn away small amounts of prostate tissue. Like TUMT, this procedure costs less than TURP and has fewer complications. Also, no overnight hospital stay is needed.
Transurethral ultrasound-guided laser-induced prostatectomy (TULIP)— Using ultrasound as a guide, a surgeon removes overgrown prostate tissue with a laser beam. A variation of this procedure that uses a telescope rather than ultrasound is called visualized laser assisted prostatectomy (VLAP).
Open surgery— Occasionally, a very large prostate may require an incision above the pubic bone.
While surgery usually is done as an elective procedure, some men need to have surgery if their bladder becomes blocked completely.