As men age, the prostate, the walnut-shaped gland that surrounds the urethra, often enlarges. Called benign prostatic hyperplasia, or BPH, an enlarged prostate can block urine flow, causing more frequent urination, especially at night, urgency and urinary retention. While most cases of BPH require no treatment, complications that cause significant discomfort or that block urine flow may necessitate treatment.
Medications
Medications are generally prescribed for BPH before more invasive therapies are tried. Medications fall into two classes: drugs called alpha blockers that relax the muscles in and around the prostate, loosening the pressure on the urethra and making urination easier, and drugs called 5 alpha reductase inhibitors that shrink the prostate by blocking male hormone effects. Giving both drugs together may achieve better results than giving just one. Drugs that shrink the prostate such as finasteride and dutasteride may need to be taken for up to three months before the drugs work, the Merck Manual states, and they never work for some men.
In addition, 5 alpha reductase inhibitors have significant side effects such as reduced sex drive, impotence, low sperm count and breast enlargement and tenderness. Pregnant women should not handle crushed capsules or pills, because the drugs can cause significant fetal side effects, Healthcommunities warns.
Minimally Invasive Therapy
Minimally invasive therapies cause fewer complications but also don't have the same success rates as surgery. Laser therapies often give immediate relief by removing excess prostate tissue in men who can't undergo surgery. Transurethral microwave surgery, called TUMT, destroys excess prostate tissue through a heat-generating electrode inserted into the urethra. TUMT, which can't be used on large prostates, can take weeks to work and may cause irritation for weeks. Transurethral needle ablation, or TUNA, places needles into the prostate, then passes radio waves through them, eventually scarring and shrinking the prostate. TUMT and TUNA work slowly and may only partially relieve symptoms, MayoClinic.com warns. However, these procedures don't cause incontinence or impotence, the National Institute of Diabetes and Digestive and Kidney Diseases reports.
Temporary stents placed into the urethra to force it open can ease urinary difficulties but also cause irritation and incontinence in some cases, and need to be removed in one third of cases, Healthcommunities states. Stents can be difficult to remove as well.
Surgery
Transurethral resection of the prostate, or TURP, removes part of the prostate through an endoscope, a lighted tube passed up through the urethra. While effective in treating BPH, TURP carries risks of infection and bleeding. Between 1 and 3 percent of men develop permanent incontinence after TURP, and 5 to 10 percent develop erectile dysfunction, the Merck Manual states. In addition, 10 percent need the surgery repeated within 10 years, Merck warns.
