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Male urinary problems? Try these nondrug solutions first.

Last updated: July 2009

There's big money in treatments for an enlarged prostate, also known as benign prostatic hyperplasia. Witness the steady stream of TV ads for drugs to curb the urinary symptoms that mark the condition. And the expected introduction soon of a new drug, silodosin (Rapaflo), into an already crowded field. Of course, what's good for drugmakers isn't always best for consumers. While drug therapy can be a good option for some men who have grown weary of multiple nightly trips to the bathroom, other options for enlarged prostate treatment are often better.

Keep it simple. An enlarged prostate gland can lead to a weak or sputtering urine stream by pressing against the urethra or by triggering spasms in the muscle that surrounds it. Any man who suffers from those symptoms should see a doctor, since they can sometimes signal diabetes or even cancer. When such causes are ruled out but the symptoms continue to bother you, try these simple measures:

  • Cut back on drinks between dinner and bedtime, especially alcoholic and caffeinated beverages.
  • Limit the use of antihistamines and decongestants, which can prevent muscles around the bladder from relaxing.
  • If you take a diuretic for high blood pressure, ask your doctor about changing the time you take it, reducing the dose, or trying a different drug.
  • Wait a minute after urinating and then try again, pressing a finger behind the scrotum and pulling up to the base of the penis, to expel any remaining urine. Eating lots of produce may also help, according to a large study done in 2007. And while some research suggests that the herb saw palmetto (available to subscribers) eases symptoms too, a recent study published in The New England Journal of Medicine found that it was no more effective than a placebo.

Drugs and surgery. If those strategies for enlarged prostate treatment don't help, one of the drugs described in the chart below often will. When symptoms persist despite drugs and lifestyle changes, you could consider one of the procedures listed in the chart below.

Medical and surgical treatment options

Treatments Possible side effects Recommendations
Medications
Alpha-blockers: Alfuzosin (Uroxatral), doxazosin (Cardura and generic), tamsulosin (Flomax), and terazosin (Hytrin and generic). Dizziness, especially upon standing, and reduced ejaculate volume. Might interact with erectile dysfunction drugs to cause dangerously low blood pressure.
  • Generic versions of doxazosin or terazosin are good first choices for fast relief, since they cost less and work just as well. Consider alfuzosin or tamsulosin if you can't tolerate those drugs, since they appear less likely to cause side effects.
  • Start with low doses to reduce risk of side effects.
5-alpha-reductase inhibitors: Dutasteride (Avodart) and finasteride (Proscar and generic). Erectile dysfunction and reduced ejaculate volume. Reduces prostate-specific antigen (PSA) levels, so test interpretation should be adjusted (typically by doubling the measured level, then interpreting as usual).
  • Generic finasteride is a good first choice for men whose problems stem from a very large gland, since it costs less than other 5-alpha-reductase inhibitors.
  • Combining an alpha-blocker and an inhibitor increases benefits over either drug alone but raises the risk of side effects.
  • The FDA has approved only one combination (dutasteride with tamsulosin) but finasteride plus a generic alpha-blocker probably works at least as well and can cost less.
Surgery

Transurethral resection of the prostate (TURP): removal of tissue around the urethra.

Transurethral incision of the prostate (TUIP): incisions made on the prostate to relieve pressure on the urethra.

Holmium laser enucleation of the prostate (HoLEP): destruction of prostate tissue with light energy.

Photoselective vaporization of the prostate (PVP): destruction of prostate tissue by green-light laser.

Retrograde ejaculation, in which semen goes back into the bladder rather than out through the penis, is more common with TURP and can cause infertilty. Erectile dysfunction and urinary incontinence occur only rarely.
  • In general, the surgical options are preferred over less-invasive procedures below because they have better supporting evidence, especially for men with severe symptoms.
  • All surgeries work equally well over the short-term, though long-term effectiveness of laser surgery is still uncertain.
  • TURP is the best option for very large prostates.
  • Laser surgery is often better for men who are taking anticoagulants, because TURP and TUIP can cause blood loss.
Minimally invasive procedures
Transurethral microwave therapy (TUMT): microwave energy to destroy prostate tissue.

Transurethral needle ablation (TUNA): heat from high-frequency radio waves to destroy prostate tissue.
Lower risk of major side effects than with surgery, though urine-retention problems can arise after treatment. More likely than surgery to lead to recurrence and retreatment.
  • Good choices for men with severe symptoms whose overall health makes them poor candidates for surgery as well as those who want to avoid anesthesia and a hospital stay.

This article first appeared in the March 2009 issue of Consumer Reports on Health.

   

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