The mainstay of medical treatment are the so-called alpha-blockers, for example, tamsulosin (Flomax^®), alfuzosin (Uroxatral^®) and silodosin (Rapaflo^®). The mechanism of the medication is to decrease tension in the enlarged prostate so that urine can flow easier past the obstructive tissue. This class of medications is usually very well tolerated, with one side effect being dizziness due to lowered blood pressure.

If therapy with a single alpha-blocker does not relieve symptoms, finasteride or dutasteride can be added to the treatment plan. Both medications inhibit an intra-prostatic enzyme that converts testosterone in a more potent form, which promotes obstructive growth of the prostate. Inhibition of this enzyme results in the shrinking of the prostate and decreased obstruction. Both medications are usually very well tolerated, but it is important to note that the maximum benefit does not typically appear until you have been taking it for six to 12 months. Side effects may include a decrease in libido, tenderness of the breasts, and in some patients, erectile dysfunction.

A low-dose formulary of tadalafil (Cialis^®) may be recommended either in addition to other medications or as a single therapy. The medication is taken daily and works by decreasing the tension within the prostatic tissue, thus easing the symptoms of BPH. An additional benefit of taking this medication is improved erectile function, making it a good alternative for men with BPH who also seek improved erectile function. Although the daily low-dose formulary is usually well tolerated, side effects can include muscle pain, headaches, and a drop in blood pressure.

Office-based interventions are performed using local anesthesia and a camera to access the prostate through the patient’s penis. Although this may sound invasive and painful, it is very well tolerated, likely because of the local anesthesia and short duration of the procedure (3–5 minutes).

We offer all established state-of-the-art procedural BPH treatment options, including minimally invasive treatments, UroLift^® and Rezum^™.

UroLift

• During this treatment, four to six small implants are placed into the prostate and compress the obstructive prostate tissue, thus opening up the urinary channel. The initial success rate is high, with success being defined as a patient being mostly happy with his urinary situation. One benefit of UroLift is it has a low risk of the patient developing retrograde ejaculation, also known as dry ejaculation.
• Side effects of UroLift can include the need for a transient catheter for one to three days after the procedure. Approximately one third of patients undergoing UroLift require a catheter because of temporary swelling of the prostate.
• Patients may also experience bladder irritation, in which you feel the need to urinate in short intervals despite having an empty bladder. This can occur in about 50% of patients and typically resolves within one to seven days. Taking the prescribed phenazopyridine (Pyridium^®), a bladder anesthetic, often relieves these symptoms.

Rezum

• Treatment with Rezum involves injecting hot steam into the prostatic tissue, which leads to the destruction of the tissue. The prostate may swell considerably for a few days after the procedure, so a urinary catheter is usually placed for three to five days. This procedure is effective for more than 90% of properly screened patients and similarly long lasting. It has been described as the in-office version of the TURP surgery (see below) because of its effectiveness and patient satisfaction. Compared with TURP, the Rezum procedure is much shorter, with a duration of less than 5 minutes; does not pose a risk of significant bleeding; and does not require hospitalization.
• Bleeding from the prostate may occur. Patients may need a catheter for several days.
• Symptoms improve over the course of a few weeks as the body reabsorbs the prostatic tissue that was injected with the steam.

• The transurethral resection of the prostate is the gold standard of BPH treatment and has been used for several decades because of its high effectiveness. During this procedure, an electric knife attached to a camera is inserted through the penis to resect, or shave off, the obstructing tissue. This procedure is often commonly referred to as the “Roto-Rooter procedure.”
• A catheter is placed after the procedure and kept in place for two to three days to flush any residual bleeding out of the bladder.
• The vast majority of treatments are well tolerated. Side effects may include post-operative bleeding and urethral and bladder injury, all of which may require prolonged catheterization. TURP can also result in retrograde or dry ejaculation.
• One benefit of TURP is that the tissue is removed from the body and can be examined by a pathologist to look for underlying conditions, such as cancer. Removal of the tissue has been shown to improve the long-term success of the surgical procedure.

• In this modification of the classic TURP, a laser beam, rather than an electric knife, is used to ablate or burn prostate tissue. It is especially useful for patients who require blood thinners.
• Its effectiveness is similar to that of the classic TURP.
• As with TURP, patients usually stay in the hospital overnight. Risks of this procedure also include bleeding and urethral and bladder injury. GreenLight Laser TURP can also result in retrograde or dry ejaculation.

• This procedure uses a precise laser to core out the inside of the prostate. Only a thin rim of prostate tissue remains. The entire procedure is performed through the urethra, so there is no incision.
• It is highly effective, with extremely low retreatment rates among patients who were followed up for more than 15 years.
• The procedure is usually performed as outpatient. Patients can often have their catheters removed the same day as the surgery.
• HoLEP is ideal for very large prostates, but can be performed on any size prostate.
• Because it is a laser procedure, it can be performed with minimal risk of bleeding even if the patient is taking blood thinners. HoLEP is an ideal treatment for patients with poor bladder function and after other surgical procedures have failed.
• As with other resective procedures, a side effect of HoLEP is retrograde or dry ejaculation.

For more information about surgery and recovery with the Holmium Laser Enucleation of the Prostate (HoLEP) procedure at Northwestern Memorial Hospital, download our patient education brochure.

• This procedure is reserved for very large prostates that do not respond to other treatments. During the procedure, a robot is used to remove prostate tissue. Five small incisions of about an inch are made into the abdomen to place a camera and three robot arms and provide additional access for the assistant’s instrument.
• Patients typically stay in the hospital for one or two days after the procedure. Because of the extensive dissection required for this procedure, a catheter is required for a week.
• Rare side effects include bleeding, wound infection and prolonged catheterization.
• It should be noted that this surgery is different from a radical prostatectomy, which is used to treat prostate cancer. Side effects such as erectile dysfunction and incontinence that are common with radical prostatectomy are very rare in simple prostatectomies.

• If the robotic approach is not possible, for example, among patients with extensive scarring in the abdomen due to prior surgeries, the prostate can be removed though an open lower abdominal incision. Before the development of the robotic approach, this surgery was the gold standard for the treatment of large prostates.
• Patients typically stay in the hospital for several days, and a catheter is placed for about a week.
• Risks of this surgery include bleeding, wound infection and prolonged catheterization.

• This minimally invasive treatment is offered by the Urology Program in conjunction with the Department of Interventional Radiology. It entails occlusion of the blood vessels that feed the prostate via access to the patient’s blood vessels in the groin. Cutting off the blood supply to the prostate leads to a shrinkage of the prostate and improvement of symptoms.
• This process can take several months, and the procedure may have to be repeated. It has the advantage of causing only minimal patient discomfort, similar to office-based procedures.
• Patients with larger prostates usually have higher success rates with this procedure.
• Risks of the procedure include bleeding from the access site and injuries to blood vessels, but these events occur only rarely.