Living with an enlarged prostate: what are my treatment options?

Prostate enlargement is very common and happens to most men as they get older. Treatment is not necessary in all cases of enlarged prostate and mild symptoms can be managed with lifestyle changes. For cases with more persistent symptoms, such as straining to pee, having a weak urine flow or needing to pee frequently during the night, there are plenty of minimally-invasive treatment options. Here, one of our expert urologists Mr Andrew Ballaro explains what these are exactly and what measures you can take at home to improve your condition.

What lifestyle changes should be made if you have an enlarged prostate?

The enlarged prostate may be associated with a range of symptoms and, when mild, these can be managed by a number of lifestyle changes.

If you take a diuretic tablet, changing the timing of this to the morning can help nocturia, which is a common problem of waking up at night to pass urine. Nocturia may be caused by a number of conditions, including some unrelated to prostate disease, and is often helped by the obvious modification of reducing the volume of fluids drunk in the evening, such as diuretics (things which stimulate the kidneys to produce more urine) like caffeine and alcohol.

Nocturia is also common in people who snore, and simple measures to reduce this included sleeping on one side, in a head-up position, if possible. There are a number of devices designed to reduce snoring on the market also.

Prostate enlargement can also cause the feeling of needing to pass urine more often than normal. This can be improved by bladder retraining exercises which involve holding on a little bit longer each time one feels the need to pass urine. This can also be helped by reducing caffeine, as it is a direct bladder stimulant.

Feelings of incomplete bladder emptying can be helped by passing urine twice each time in an attempt to improve the emptying.
 

How is enlarged postage treated?

Not all men with enlarged prostates need treatment. The prostate grows with age, and in some men more than others. 

Generally speaking, treatment is required if the enlarged prostate is causing bothersome symptoms. These include passing urine with poor flow, difficulty starting, going more often than usual, feelings of incomplete bladder emptying and getting up at night to urinate. If lifestyle modifications have failed, the next step is to consider medications.

There are two main types of pills, one just relaxes the prostate and is best for small tight prostates, the other reduces its size and is better for larger prostates. The two tablets are commonly taken together. Both have side effects which should be discussed before starting.
 

What are the different types of surgery used to treat an enlarged prostate?

There is now a range of procedures for prostate enlargement. On the minimally-invasive side, Rezum involves steam injections, which shrink the prostate down. Urolift involves placing a staple in the prostate to pin it back from the urinary stream. 

Prostatic artery embolisation involves cutting off the blood supply to the prostate, which subsequently shrinks back. These are all-day case procedures with fewer complications than traditional surgery, however, they each have individual side-effects and may not produce the same degree of symptom relief as surgery does. These procedures work best for smaller prostates and some are contraindicated for very large prostates.

Traditional prostate surgery involves removing the obstructing prostate lobes by either using electrocautery to shave it out from the inside bit-by-bit during transurethral resection of the prostate (TURP) or removing the whole lobe at once using a laser during Holmium laser prostatectomy (HOLEP). 

Greenlight laser prostatectomy involves vaporising the obstructing portion of the prostate. Each of these procedures has its benefits and downsides and the currently recommended procedure of choice for very large prostates is HOLEP.

There are, therefore, a number of procedures available to treat the enlarged prostate and the patient should have a full discussion surrounding the benefits and side effects of each and the treatment tailored to his needs and prostate characteristics.
 

What if I can’t have surgery?

With the advent of minimally-invasive techniques, the number of patients not fit for surgery has reduced. In the few patients who don’t benefit from tablets and who don’t want or are unfit for surgery, the choice is either to live with their symptoms and manage them as well as possible or to have a catheter placed.

The catheter can be either indwelling and this needs changing every three months, or the patient can be shown how to insert a catheter when required to empty the bladder usually between once and four times a day depending on the severity of the problem. This is called clean intermittent self-catheterisation (CISC) and is common and less traumatic than might be expected.
 

What is the best treatment for an enlarged prostate?

There is no best treatment for an enlarged prostate, there are many options and procedures and these should be tailored to the patient's requirements and prostate characteristics. 



If you would like to discuss a management plan for your enlarged prostate, do not hesitate to book an appointment with Mr Ballaro via his Top Doctor’s profile here for his expert advice.