BPH Treatment and Surgical Options

Dr. Dean Elterman, MD, MSc, FRCSC, Urological Surgeon

Duration : 3 minutes and 22 seconds

When it comes to prostate treatment, not every man will need surgery. A lot of men will learn to live with their symptoms that are quite mild and manageable. Medications will work perfectly well for many men.

When it comes to treatments, they often describe them as first line, second line, third line treatments. First line treatments are always going to be behavioral and lifestyle. We want to make sure again, that men aren't drinking too much fluid, and that they don't have any other medical conditions that are contributing or are not being properly treated, for example, diabetes, or maybe they're taking medications contribute to their challenges.

After these are checked, we typically have medications that can relax the prostate. The prostate has some small amount of muscle in it. There are a class of medications called Alpha receptor blockers that relax the prostate to make the passage of urine easier. They are meant to improve the flow of urine.

There are also another group of medications that are prostate shrinkers. These are called 5 alpha reductase inhibitors or 5ARI’s. And what these do is they slowly, over time, will cause the prostate to shrink in size. And then of course that will open up the prostate to facilitate better flow.

Many men will end up taking both medications together. They'll take the alpha blocker to relax and the alpha reductase inhibitors to shrink it, so they have a relaxer and a shrinker and they will work synergistically together to give even better benefits.

And there's even a third class of medications. We give a low dose of the erection medication like Viagra or Cialis. When it's taken in a very low dose, it can help improve urinary symptoms. Essentially, there are three types of medication that we can choose from to help alleviate urinary symptoms that come from an enlarged prostate.

Beyond medications, we have a variety of different procedures and surgeries that are available. We have the commonly performed surgery that is called a trans urethral resection of the prostate, otherwise known as a TURP. This is where we go in surgically to cut away pieces of the prostate to open it up.

We also have a laser versions of this operation and a whole plethora of new, minimally invasive surgical therapies, or MISTS, that can be done outside of an operating room, for example in a physicians office or outpatient clinic. There are things like water vapor or steam treatments called RESUME, or a prosthetic urethral lift which is called the Euro-lift, which is almost like a staple or implant.

There's a temporary stent that we can put in the prostate called a temporary implantable nitinol device. And new to the market is a balloon that has a medication coating on it called optimum. So, there's a number of new really minimally invasive treatments as well as the standard tried and true surgeries that are available in hospitals.

Presenter: Dr. Dean Elterman, Urologist, Toronto, ON

Local Practitioners: Urologist