Benign Prostatic Hyperplasia (BPH)
What is benign prostatic hyperplasia (BPH)?
Prostate enlargement, also known as benign prostatic hyperplasia (BPH), occurs naturally in the majority of men as they age. BPH can cause lower urinary tract symptoms, or LUTS. Common symptoms include hesitancy (difficulty starting the stream), weak or intermittent stream, straining, prolonged voiding, feeling of incomplete bladder emptying, dribbling, frequency, and nocturia (waking up at night to urinate).
First-line therapy is with alpha-blockers, a class of medications that opens up the urethra by the prostate gland to help with urination. Common alpha-blockers include:
- Tamsulosin (Flomax)
- Terazosin (Hytrin)
- Alfuzosin (Uroxatral)
- Doxazosin (Cardura)
- Prazosin (Minipress)
- Silodosin (Rapaflo)
Prazosin, doxazosin, and terazosin are typically prescribed for men with high blood pressure because these drugs can treat both hypertension and BPH. Prazosin can also be used in men with PTSD.
Tamsulosin, alfuzosin, and silodosin are more selective for the urethra, which is more helpful for men with BPH without hypertension. Tamsulosin is the most commonly prescribed alpha blacker for BPH and its side effects include the following: low blood pressure, dizziness, retrograde ejaculation, disorientation, headache, and floppy iris syndrome.
Another treatment option is a 5-alpha-reductase inhibitor (finasteride or Proscar), which helps to reduce the size of the prostate and can also treat hair loss in men (Propecia). Side effects include sexual dysfunction, such as low libido, ED, and reduced ejaculate. In rare instances, men can develop the post-finasteride syndrome, which is persistent sexual, neurological, and physical effects, characterized by low libido, ED, ejaculatory dysfunction, breast tenderness or enlargement, depression/anxiety, and/or cognitive impairment.
Surgical treatment for BPH involves using a camera and special instruments to remove prostate tissue. Some of these procedures include the following: transurethral resection of the prostate (TURP), transurethral incision of the prostate (TUIP), GreenLight laser vaporization of the prostate, and Rezum.
Rezum can be performed under sedation while the other procedures are typically performed under general anesthesia. A TURP requires overnight admission to the hospital while a TUIP, GreenLight, and Rezum can be done as same-day surgeries.