Still, the first approach to relieving the symptoms of B.P.H., and perhaps even preventing or slowing the progression of prostatic enlargement, are focused on lifestyle changes. They include reducing overweight; minimizing liquid intake late in the day; getting regular physical activity; avoiding smoking and consumption of alcohol, caffeine and highly seasoned foods; and treating constipation.
Also helpful for men (and women) who have difficulty fully emptying their bladder and soon have to return to the bathroom is a technique called double-voiding. After urinating normally, wait about 20 to 30 seconds and try again. Men are likely to have more success emptying their bladders by sitting on the toilet and leaning forward instead of standing.
The traditional “gold standard” remedy for B.P.H. known as TURP, for transurethral resection of the prostate, involves inserting a scope through the penis and cutting away excess prostate tissue to relieve pressure on the urethra. Though TURP is the most effective remedy for troublesome B.P.H., in addition to causing sexual complications, this surgery incurs a risk of bleeding that limits its usefulness for men like Mr. Goldman who take anticoagulants.
In a less invasive version of TURP with fewer complications, a bipolar current is used to ream out the prostate. Another minimally invasive technique, called HoLEP, uses laser irradiation to remove excess tissue.
Experts say that aggressive surgical treatment like TURP should now be necessary to treat an enlarged prostate only in certain circumstances. These might include inadequate kidney function, recurrent urinary tract infections, bladder stones, blood in the urine, or the patient’s unwillingness to take a daily medication or failure to get relief through drugs.
Among currently preferred treatments are several categories of drugs, including alpha-blockers like Flomax, 5ARIs like finesteride, and PDE5 inhibitors like tadalafil. There is also a combination drug of an alpha-blocker and a 5ARI that is said to work better than either one alone. While the sexual side effects of surgery are usually permanent, if such effects are caused by a medication, they can be reversed by stopping the drug and perhaps switching to another one.
There are also now minimally invasive techniques to reduce the pressure exerted on the urethra by an enlarged prostate. In one, called the UroLift System, a telescope-like instrument is inserted through the penis and one or more small bands are inserted to retract the part of prostate that is pressing on the urethra. It is usually done in a urologist’s office as an outpatient procedure under local anesthesia and is supposed to result in immediate symptom relief with minimal risk of sexual side effects.