What is BPH?

Benign Prostate Hyperplasia

(BPH) is a non-cancerous enlargement of the prostate gland that commonly affects men as they age.

As the prostate grows, it can press on the urethra and cause urinary symptoms such as:

• Frequent or urgent need to urinate
• Difficulty starting urination
• Weak urine stream or dribbling
• Getting up multiple times at night
• Feeling the bladder hasn’t fully emptied

Watchful Waiting & Lifestyle Changes

Active Monitoring

• Annual check-ups with your doctor
• Symptom tracking using validated scores
• Prostate size monitoring
• ~79% of patients remain stable over 5 years

Lifestyle Adjustments

• Reduce fluids before bedtime
• Limit caffeine and alcohol
• Avoid decongestants & antihistamines
• Practice timed voiding
• Stay active and maintain healthy weight

Medications

Alpha-Blockers

             Fast-acting relief

• Relax prostate & bladder neck muscles
• Improve urine flow within days
• Examples: tamsulosin, alfuzosin
• May cause dizziness or low blood pressure

5-Alpha Reductase Inhibitors

            Long-term shrinkage

• Shrink prostate over 6-12 months
• Best for larger prostates (>40 cc)
• Examples: finasteride, dutasteride
• Can be combined with alpha-blockers

PDE5 Inhibitors (Tadalafil)

          Dual benefit

• Daily low-dose relaxes smooth muscle
• Also treats erectile dysfunction
• Newer AUA guidelines support combos
• Preserves ejaculatory function

Minimally Invasive Procedures

1. Rezum – Steam Therapy
2. UroLift – Prostatic Lift
3. iTIND – Temporary Implant

Surgical Options

1. TURP
2. HoLep
3. Greenlight Vaporization (PVP)
4. Robotic Simple Prostatectomy

TURP remains the traditional gold standard. HoLEP and RSP offers the best long-term durability, especially for larger prostates.

HoLEP: Lowest retreatment rate (2% at 10 years), works for all prostate sizes. GreenLight: Same-day discharge, safe on blood thinners.

Choosing the Right Treatment

Treatment depends on several individual factors. Discuss these with your doctor:

1. Symptom severity and how much they bother you
2. Prostate size (small, medium, or large)
3. Whether medications have been tried already
4. Recovery time and return-to-activity goals
5. Sexual function priorities (ejaculation, erections)

Key Takeaways

1. BPH is very common and not cancerous — effective treatments are available at every stage
2. Mild symptoms often improve with simple lifestyle changes and regular monitoring
3. Medications can significantly reduce symptoms; newer combinations offer added benefits.
4. Minimally invasive procedures preserve sexual function with quick recovery times.
5. Surgery provides the most durable results for larger prostates or severe symptoms.

Talk to your  urologist about which option is right for you