Treatment - Benign prostate enlargement

The treatment for an enlarged prostate gland will depend on how badly the symptoms are affecting your qualify of life.

The main treatments are:

• lifestyle changes
• medicine
• catheters
• surgery and other procedures

Lifestyle changes

You might be able to relieve the symptoms by making some simple changes to your lifestyle.

Drink fewer fizzy drinks and less alcohol, caffeine and artificial sweeteners

Fizzy drinks and drinks that contain alcohol, caffeine (such as tea, coffee or cola) and artificial sweeteners can irritate the bladder and make urinary symptoms worse. 

Drinking less fluid in the evening

Try to reduce the amount of fluids you drink in the evening and avoid drinking anything for 2 hours before you go to bed. This might help you avoid getting up in the night. Make sure you're still drinking enough fluid earlier in the day.

Remember to empty your bladder

Remember to go to the toilet before long journeys or when you know you will not be able to reach a toilet easily.

Double voiding

Double voiding involves waiting a few moments after you have finished peeing before trying to go again. It can help you empty your bladder properly. But take care not to strain or push.

Checking your medicines

Check with your doctor whether any medicines you take, such as antidepressants or decongestants, might be making your urinary symptoms worse.

Eating more fibre

Eating more fibre (which is found in fruit, vegetables and wholegrain cereals) can help you avoid constipation, which can put pressure on your bladder and make the symptoms of an enlarged prostate worse.

Using pads or a sheath

Absorbent pads and pants can be worn inside your underwear, or may replace your underwear altogether. These will soak up any leaks.

Urinary sheaths can also help with dribbling. They look like condoms with a tube coming out of the end. The tube connects to a bag that you can strap to your leg under your clothing.

Bladder training

Bladder training is an exercise programme that aims to help you last longer without peeing and hold more pee in your bladder.

You'll be given a target, such as waiting 5 to 15 minutes when you feel the urge to pee. You'll then gradually increase how long you wait.

It's a good idea to use a bladder training chart to record each time you pass urine and the volume of urine passed. You can download a bladder training chart (PDF, 115KB) from Bladder Matters. You'll need a plastic jug to measure this. Your doctor should also give you a chart to take home.

You'll also be taught several exercises, such as breathing, relaxation and muscle exercises, to help take your mind off the need to pee.

Over time your target time will be increased, and at the end of the programme you should find you're able to last longer without peeing.

Ask your doctor or specialist nurse for more information about any of these lifestyle changes.

Medicines

If lifestyle changes do not help, or are not suitable for you, you may be offered medicine.

You may need to take more than 1 type of medicine, particularly if you have a larger prostate.

Alpha blockers

Alpha blockers relax the muscle in your prostate gland and at the base of your bladder, making it easier to pee. Commonly used alpha blockers are tamsulosin and alfuzosin.

Anticholinergics

Anticholinergics relax the bladder muscle if it's overactive.

5-alpha reductase inhibitors

5-alpha reductase inhibitors are used to treat larger prostate glands. They shrink the prostate gland if it's enlarged. Finasteride and dutasteride are the two 5-alpha reductase inhibitors available.

Diuretics

Diuretics speed up urine production. If taken during the day, they reduce the amount of urine you produce during the night.

Desmopressins

Desmopressins slow down urine production so less urine is produced at night.

Mirabegron

Mirabegron works by relaxing the muscles around your bladder. This means your bladder can hold more liquid and reduces your need to pee as often or as urgently.

Alternative treatments

Your doctor should not offer you homeopathy, herbal treatments or acupuncture to treat urinary symptoms.

This is because there is not enough reliable evidence about how well they work or how safe they are.

Herbal treatments may also cause side effects or interact with medicines you're taking.

Catheters

If you continue to have trouble peeing (a condition called chronic urine retention) and surgery is not suitable for you, you may need a catheter to drain your bladder.

A urinary catheter is a soft tube that carries urine out of the body from the bladder. It can be passed through your penis, or through a small hole made in your tummy, above your pubic bone.

You may be recommended a removable catheter, or a catheter that stays in your bladder for a longer period of time.

Surgery and other procedures

Most men with urinary symptoms do not need to have surgery, but it may be an option if other treatments have not worked or give you severe side effects, or your symptoms are severe.

Transurethral resection of the prostate (TURP)

TURP involves removing part of the prostate gland using a device called a resectoscope that's passed through the urethra (the tube through which urine passes out of the body). It's suitable for men who have an enlarged prostate.

Holmium laser (HoLEP)

This treatment uses a laser to remove the portion of the prostate that is blocking the flow of pee.

The procedure uses a laser fibre passed along the inside of the urethra, so the surgeon will not need to make a cut in your skin.

Water ablation

There are 2 types of water ablation procedure. In the first, water is injected into the prostate using a probe passed up the urethra. The pressure of the water is then used to destroy some of the prostate tissue, making it smaller.

The second type is very similar except steam, rather than water, is used to destroy prostate tissue.

Water ablation is probably less likely to cause side effects than a transurethral resection of the prostate (TURP).

However, not all NHS surgeons are currently trained to do these procedures, so access to these procedures may be limited and waiting lists for them may be longer than for other surgical options.

Greenlight XPS

This is a type of laser that can be used to destroy prostate tissue.

The laser is fired through a small tube which is passed up the urethra.

Research shows the technique works as well as other older techniques and it also tends to have a faster recovery time. But as with water ablation, access to this new treatment may be limited.

Prostatic urethral lift (PUL) implants

A surgeon inserts UroLift implants that hold the enlarged prostate away from the urethra, so it is not blocked. This helps to relieve symptoms such as pain or difficulty when peeing.

Cystoplasty

Cystoplasty is a procedure to increase the size of the bladder by sewing a piece of tissue from the intestine into the bladder wall. This may help men whose bladder muscle contracts before it's full.

Prostate artery embolisation

A catheter is inserted into an artery in your groin or wrist. Using X‑ray guidance, it's passed into the blood vessels that supply the prostate gland.

Tiny plastic particles are injected into these vessels to reduce the prostate gland's blood supply, which shrinks it.

The potential benefits of prostate artery embolisation compared with surgery are fewer complications and you can have this procedure under local anaesthesia as an outpatient.

Urinary diversion

Urinary diversion involves linking the tubes that connect your kidneys to your bladder directly to the outside of the body, so urine can be collected without flowing into your bladder.

This is suitable for men whose symptoms cannot be managed by self-management and medicine, and who cannot have, or do not want, cystoplasty.

PLASMA system

During this surgery, electrodes are put into the prostate through the urethra and are used to cut out prostate tissue.

This surgery is usually offered when symptoms are severe or if other treatments and medicine have not worked.

Bladder neck incision (prostatotomy)

This procedure involves cutting the neck of the bladder. This allows you to pee more easily and with a better stream.

It's done through your urethra, so the surgeon will not need to make a cut in your skin.

This procedure is usually used to treat smaller prostate glands.

Open prostatectomy

During an open prostatectomy, the part of the prostate gland that's obstructing the urethra is removed through a cut in your body. This may also be done as a keyhole (laparoscopic) procedure. It's suitable for men who have an enlarged prostate over a certain size.