Benign Prostatic Hyperplasia Treatment

How is Benign Prostatic Hyperplasia Diagnosed?

Benign prostatic hyperplasia is diagnosed based on assessment of lower urinary tract symptoms, physical examination, and diagnostic tests. When visiting your physician for lower urinary tract symptoms, you may be asked about concerns such as feeling your bladder is not completely empty, having to go to the bathroom more frequently than usual, a weak urine stream, a strong urge to go to the bathroom, pushing or straining to begin the urine stream, or waking up at night to urinate (nocturia).

A physical examination often involves a digital rectal exam, which tests the size, shape and feel of your prostate. Initial lab tests typically include urinalysis to look for infection or kidney problems; a Prostate-Specific Antigen PSA) blood test to look for prostate problems and help screen for prostate cancer; and a serum creatinine test, which assesses kidney function. Depending on your symptoms, your doctor may recommend diagnostic tests such as uroflowmetry to measure urine flow from your bladder, Post-Void Residual (PVR) urine, ultrasound, or Transrectal Ultrasound(TRUS) to view the prostate and how your bladder empties.

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How is Benign Prostatic Hyperplasia Treated Based on Severity?

The treatment approach for benign prostatic hyperplasia depends on factors such as symptom severity (IPSS score), prostate volume, impact on daily life, and the presence of complications. The following table outlines the treatment approach based on the severity of BPH:

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Oral Medications for Benign Prostatic Hyperplasia Treatment

Oral medicines may be considered when benign prostatic hyperplasia symptoms interfere with daily life or lifestyle modifications are insufficient. The commonly used medicines for BPH treatment are mentioned below:

• Tamsulosin: This alpha-1 blocker relaxes the muscles in the prostate and bladder neck, helping improve urine flow.

• Terazosin: By relaxing prostate and bladder-neck muscles, this alpha-1 blocker can help ease urinary symptoms.

• Doxazosin: It reduces muscle tension around the prostate and bladder neck, which may improve urine flow.

• Alfuzosin: This alpha-1 blocker helps relax the muscles around the prostate and bladder neck to relieve BPH symptoms.

• Silodosin: It relaxes prostate muscles and helps improve urinary flow.

• Finasteride: Reduces the production of dihydrotestosterone (DHT), which can help reduce prostate size and slow further enlargement.

• Dutasteride: Blocks the enzyme that produces dihydrotestosterone (DHT), which helps reduce prostate size and slow further enlargement.

• Combination Therapy (e.g., Dutasteride + Tamsulosin): Using these medicines together can address both prostate enlargement and urinary symptoms.

Note: Take medications only with a doctor's prescription and recommendation.

Other Treatments for Benign Prostatic Hyperplasia

When oral medicines for benign prostatic hyperplasia do not provide adequate relief or symptoms are severe, you may consider other treatment options. These include:

• Transurethral Resection of the Prostate (TURP): A resectoscope is passed through the urethra to reach the prostate. It is then used to remove the prostate tissue that is blocking the flow of urine.

• Transurethral Incision of the Prostate (TUIP): The technique used in this surgery involves making two to three tiny incisions in the prostate and the base of the bladder. These incisions will expand the prostatic urethra, hence allowing the flow of urine.

• Transurethral Electrovaporization: An electrode heats the enlarged prostate tissue, turning the affected cells into steam.

• GreenLight Laser Treatment: A specialised laser vaporises enlarged prostate tissue and improves urinary flow.

• Aquablation: High-pressure water jets are precisely directed at the prostate to remove obstructing tissue.

• Prostatic Urethral Lift: Small implants are placed to separate the enlarged prostate lobes and widen the urethra, making urination easier.

• Rezūm Therapy: Uses steam to destroy excess prostate tissue. The body gradually breaks down and reabsorbs the treated tissue, helping improve urine flow.

Ayurvedic and Alternative Treatments for Benign Prostatic Hyperplasia

Ayurvedic treatments for benign prostatic hyperplasia may offer traditional approaches to supporting urinary flow and prostate health. These include:

• Varunadi Kwath: May help relieve urinary symptoms associated with benign prostatic hyperplasia (BPH), including difficulty urinating and reduced urine flow.

• Gokshura (Tribulus terrestris): Used to support urinary function and may help improve urine flow in men with BPH.

• Shatavari and Ashwagandha: These herbs are used in Ayurveda to support bladder function, which may help with urinary symptoms linked to BPH.

• Uttarbasti Therapy: In Ayurvedic practice, this procedure is used for urinary and prostate-related problems and may help ease difficulty in passing urine associated with BPH.

• Abhyanga: Oil massage may promote relaxation in the lower abdomen and pelvic region, which can provide supportive relief from urinary discomfort associated with BPH.

• Swedana: Herbal steam therapy may help relax the muscles around the pelvic region and provide relief from discomfort associated with BPH.

Note: Consult your doctor or urologist before using Ayurvedic treatments for BPH, particularly if you are taking prescribed medicines or have significant urinary symptoms.

Home Care for Managing Benign Prostatic Hyperplasia

A few practical changes at home can help manage urinary symptoms and improve daily comfort in benign prostatic hyperplasia. Follow the tips mentioned below:

• Reduce evening fluid intake

• Limit caffeine consumption

• Limit alcohol intake

• Avoid highly seasoned foods

• Maintain a healthy weight

Latest Treatment for Benign Prostatic Hyperplasia in India

Recent advances in benign prostatic hyperplasia treatment include newer laser-based techniques that can remove obstructive prostate tissue with minimally invasive approaches. These include Holmium Laser Enucleation of the Prostate (HoLEP), Thulium Laser Enucleation of the Prostate (ThuLEP), and diode laser vaporisation or enucleation. The choice of procedure varies based on factors such as prostate size, symptom severity, urinary obstruction and the patient's overall health.

HoLEP is a size-independent procedure that can be used for enlarged prostates of different sizes and involves enucleating the obstructing prostate tissue using a holmium laser. Thulium laser enucleation offers another laser-based option, while diode laser techniques may be considered for selected patients as an alternative to conventional surgical approaches.

Note: A urologist should select these advanced procedures based on individual clinical factors.

How Long Does Benign Prostatic Hyperplasia Treatment Take?

The recovery time after benign prostatic hyperplasia treatment depends on the type of treatment, prostate size, and individual response. The table below outlines the typical recovery time associated with some common treatments:

Benign Prostatic Hyperplasia Treatment Side Effects

The side effects of benign prostatic hyperplasia treatment depend on the treatment modality and medicines used. Below are common side effects associated with the treatment:

• Dizziness

• Lightheadedness

• Fatigue

• Difficulty ejaculating

• Erectile dysfunction

• Reduced libido (sex drive)

• Urinary tract infections

• Weakness or lack of energy

• Dry mouth

• Frequent urination

• Constipation

• Drop in blood pressure when standing

• Urethral scarring

• Bleeding

Note: Side effects of benign prostatic hyperplasia treatment depend on the type of medication or procedure used and the individual's health condition.

Lifestyle Changes for Managing Benign Prostatic Hyperplasia

Making simple lifestyle and dietary changes can help support bladder health and manage urinary symptoms associated with benign prostatic hyperplasia. The following habits may be helpful:

• Stay adequately hydrated

• Limit bladder-irritating foods and drinks

• Practise regular physical activity

• Include supportive foods

• Practise yoga and pranayama

• Follow dietary guidance

Triggers that Can Worsen Symptoms of Benign Prostatic Hyperplasia

Some everyday choices can make urinary symptoms of benign prostatic hyperplasia more troublesome. Certain drinks, foods, habits and medicines may increase problems such as frequent urination, urgency or difficulty passing urine. The following triggers are best limited when they worsen symptoms:

• Excessive fluid intake

• Alcohol consumption

• Caffeinated beverages

• Carbonated drinks

• Diuretics

• Antihistamines

• Decongestants

• Tricyclic antidepressants

Benign Prostatic Hyperplasia Treatment Cost

Management of benign prostatic hyperplasia ranges from long-term medications, minimally invasive procedures, or surgery as required based on symptoms and enlarged prostate size. The price range for BPH treatment with month-long medication is around ₹1,500 to ₹5,000 monthly. Standard TURP (Monopolar) costs between ₹45,000 and ₹90,000. Bipolar TURP costs between ₹60,000 and ₹1.1 lakh. Laser Prostate Surgery (HoLEP/GreenLight) costs between ₹85,000 and ₹1.5 lakh. Prostate Artery Embolisation (Non-surgical) costs between ₹1 lakh and ₹1.8 lakh. Open prostatectomy (for a very enlarged prostate) costs between ₹75,000 and ₹1.4 lakh.

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Note: These are indicative costs. Actual expenses can vary depending on the doctor, hospital room category, medication dosage, treatment duration, and location.

Does Health Insurance Cover Benign Prostatic Hyperplasia Treatment in India?

Yes, health insurance in India generally covers hospitalization for benign prostatic hyperplasia, subject to policy terms and conditions. Depending on your policy, you may get coverage for room charges, nursing fees, hospital investigation charges, TURP & HoLEP surgery charges, surgeon fees, etc.

Some policies may also cover pre- and post-hospitalisation expenses and OPD costs, depending on the benefits included.

Health insurance coverage of ₹5 lakh to ₹10 lakh is recommended to help manage potential hospitalisation, surgery, and medication expenses associated with benign prostatic hyperplasia.