Treating benign prostate enlargement
The treatment for an enlarged prostate gland will depend on how severe your symptoms are.
The three main treatments are:
- lifestyle changes
If your symptoms are mild to moderate, you may not receive any immediate medical treatment, but you'll have regular check-ups to carefully monitor your prostate gland. This is often referred to as "watchful waiting".
You may also be advised to make lifestyle changes to see whether they improve your symptoms.
The various treatments for prostate enlargement are outlined below. You can also read a summary of the pros and cons of the treatments for prostate enlargement, allowing you to compare your treatment options.
If your prostate gland is enlarged, you may be advised to:
- avoid drinking any liquids for one to two hours before going to bed – this will reduce your chances of waking up during the night to pass urine (nocturia)
- experiment with the time you take prescribed medication – for example, taking it at 7pm may help prevent nocturia
- stop drinking alcohol and caffeine, or limit your consumption of them – these drinks can irritate your bladder and make your symptoms worse
- exercise regularly – research shows moderate exercise, such as walking for 30 to 60 minutes a day, can improve symptoms, although it's unclear exactly why this is the case
- join a patient support group – your doctor should be able to recommend one, which may help you manage mild symptoms without the need for medication
Bladder training is an exercise programme that aims to increase the time between urination and the amount of urine your bladder can hold.
You'll be given a target, such as waiting at least two hours between each time you urinate.
It's a good idea to use a bladder training chart, which allows you to record each time you pass urine and the volume of urine passed – you'll need a plastic jug to measure this. Your doctor should give you a chart to take home.
You'll also be taught a number of exercises, such as breathing, relaxation and muscle exercises, to help take your mind off the need to urinate.
Over time your target time will be increased, and at the end of the programme you should find that you're able to go for longer without urinating.
Bladder training should only be carried out under medical supervision.
Medication, in combination with the lifestyle changes above, is usually recommended to treat moderate to severe symptoms of benign prostate enlargement.
Finasteride or dutasteride
Finasteride and dutasteride are widely used to treat benign prostate enlargement. They block the effects of a hormone called dihydrotestosterone (DHT) on the prostate gland, which can reduce the size of the prostate and improve your associated symptoms.
Find out about the causes of prostate enlargement.
If you're prescribed one of these medications, you may experience an immediate improvement in symptoms. However, you'll need to take it for at least six months to get the maximum benefit, and your doctor will need to monitor you every year.
Use condoms if you're sexually active – both finasteride and dutasteride can have an adverse effect on your sperm. If you get a woman pregnant, there's a risk the baby could develop birth defects.
Other possible side effects can also include impotence and little or no sperm when you ejaculate.
In many cases, these side effects will improve as your body gets used to the medication. See your GP if the side effects are troubling you.
Alpha blockers help relax the muscles of your bladder, making it easier to pass urine. You may be prescribed alpha blockers as your primary treatment or in combination with finasteride.
Tamsulosin and alfuzosin are two alpha blockers commonly used to treat benign prostate enlargement. Side effects of tamsulosin and alfuzosin are uncommon and usually mild. They include:
You should only begin taking alpha blockers over a restful weekend when you're not planning to drive, as there's a risk they could cause low blood pressure (hypotension) and fainting.
Generally, if you experience dizziness while taking this medication, avoid driving or operating heavy machinery until it's passed.
Surgery is usually only recommended for moderate to severe symptoms of benign prostate enlargement that have failed to respond to medication.
Find out more about the symptoms of benign prostate enlargement.
Transurethral resection of the prostate (TURP)
Transurethral resection of the prostate (TURP) is a surgical procedure where excess prostate tissue is removed to reduce the pressure on your bladder.
The surgeon will insert a small instrument called a resectoscope into your urethra (the tube that carries urine from your bladder to your penis). A wire loop heated by an electric current is used to remove excess tissue from your prostate.
TURP is carried out using either a general anaesthetic (where you're asleep), or a spinal anaesthetic (where you're awake, but the lower half of your body is numbed).
The procedure can take up to an hour, depending on how much tissue needs to be removed. Most men are well enough to leave hospital two to three days after the operation.
After surgery, you'll be unable to urinate normally at first because of your swollen urethra. A thin tube called a catheter will be inserted into your urethra and up into your bladder to allow urine to drain away. This will usually be removed 24 to 48 hours after surgery.
A common complication of TURP is you'll no longer produce semen when you ejaculate. This is known as retrograde ejaculation. It causes sperm to go into your bladder rather than out of your penis during ejaculation. However, you'll still experience the physical pleasure associated with ejaculation (the climax).
Transurethral incision of the prostate (TUIP)
Transurethral incision of the prostate (TUIP) is a surgical procedure where the urethra is widened, making it easier to pass urine.
Like TURP, the surgeon will insert a resectoscope into your urethra. The resectoscope has a heated wire loop at the end and is used to make small incisions – or cuts – in the muscle where the prostate meets the bladder.
This type of surgery relaxes the opening to the bladder, helping urine flow out out of it. As with TURP, TUIP is carried out under a spinal or general anaesthetic.
After surgery, you may not be able to urinate and a catheter may be needed to empty your bladder. Like TURP, you'll only need to use a catheter for a short time until you're able to urinate normally.
There's less of a risk of retrograde ejaculation with TUIP compared with TURP, although it can sometimes still occur.
Insertion of prostatic urethral lift implants
The insertion of prostatic urethral lift implants is a new surgical procedure that can help relieve urinary symptoms, such as:
- difficulty starting to urinate
- hesitancy during urinating
- an interrupted or decreased flow of urine
- the need to urinate at night (nocturia)
- an inability to fully empty your bladder
The procedure can be carried out under local anaesthesia or general anaesthesia. It involves inserting tiny implants through the urethra. The implants are then positioned to hold the enlarged prostate away from the urethra so it isn't blocked.
One of the big advantages of prostatic urethral lift implants compared with TURP and TUIP is a reduced risk to your sexual function. There's also less tissue injury, which means your recovery will be quicker and you won't need to stay in hospital as long.
In terms of the disadvantages, prostatic urethral lift implants are unlikely to provide permanent symptom relief in all cases. As it's a new procedure, the long-term outcomes are unknown and availability may be limited.
You can read more about the use of prostatic urethral lift implants to treat lower urinary tract symptoms of benign prostatic hyperplasia on the National Institute for Health and Care Excellence (NICE) website.
There are also a number of other newer surgical techniques that may lead to fewer side effects or a quicker recovery than TURP and TUIP.
However, as these treatments are still fairly new, they may not be available and their long-term effectiveness isn't always clear.
These techniques are explained below:
- bipolar transurethral resection of the prostate – different instruments are used to perform the procedure, which allow saline water to be pumped into the urethra, rather than a fluid called glycine. This is thought to reduce the risk of TURP syndrome. See the NICE guidance about the TURis system for transurethral resection of the prostate for more information.
- holmium laser enucleation of the prostate – a laser is used to remove excess prostate tissue using a similar route to a TURP. The procedure has shown good results in five- to seven-year follow-up and is emerging as a promising alternative. It doesn't use glycine, so there's no risk of TURP syndrome.
- KTP laser vaporisation – a small tube known as a cystoscope is inserted into your urethra, which fires pulses of laser energy to burn away prostate tissue.
An open prostatectomy is a procedure that may be more effective than TURP if you have severe benign prostate enlargement.
However, it's now rarely used, even for larger prostates, because of the development of other techniques, such as holmium laser enucleation of the prostate.
During an open prostatectomy, an incision will be made in your tummy and the outer portion of your prostate will be removed.
The procedure carries a higher risk of complications, such as erectile dysfunction and urinary incontinence. There's also a greater chance that these complications will become permanent than if they occur after TURP.
Preventing benign prostate enlargement
There's evidence to suggest a diet high in protein and vegetables and low in red meat and fat may reduce your risk of developing an enlarged prostate.
Foods that are a good source of protein include:
Page last reviewed: 03/03/2015
Next review due: 03/03/2017