BPH Treatment Comparison

Which BPH Treatment is Right for You?

Initially, most patients will start by taking a medication such as Flomax or Finasteride. Flomax helps to relax the tissue in the prostate. Finasteride blocks the body’s production of a version of testosterone that causes the prostate to enlarge. Both of these medications can have significant side effects.

If you cannot or do not want to tolerate the side effects of BPH medications (or if they are not effective), a BPH treatment procedure may be the next step.

There are traditional procedures such a transurethral resection of the prostate (TURP), but this approach is invasive and often results in significant blood loss1.  Newer, more minimally invasive procedures are now available with a lower risk of side effects, such as laser focal therapy (LFT) / focal laser ablation (FLA) or transurethral ultrasound ablation (TULSA-PRO). Every man is different, and so are their prostate concerns.

It’s always best to do your research and talk with your doctor to find a treatment that’s right for you.

 Laser Focal TherapyTULSA-PROTURP/GreenLightUroLiftRezum
Minimally invasiveIcon CheckmarkIcon CheckmarkIcon X Icon CheckmarkIcon Checkmark
Low blood lossIcon CheckmarkIcon CheckmarkIcon X 1, 2 Icon CheckmarkIcon Checkmark
Relatively low risk of retrograde ejaculationIcon CheckmarkIcon CheckmarkIcon X Icon Checkmark 3Icon Checkmark 4
No general anesthesiaIcon CheckmarkIcon CheckmarkIcon X Icon CheckmarkIcon Checkmark
Outpatient ProcedureIcon CheckmarkIcon CheckmarkIcon X Icon CheckmarkIcon Checkmark
Get to keep the prostatic urethraIcon CheckmarkIcon CheckmarkIcon X Icon CheckmarkIcon Checkmark
Requires general anesthesiaIcon XIcon CheckmarkIcon Checkmark Icon XIcon X
Results in the removal of excess tissueIcon CheckmarkIcon CheckmarkIcon Checkmark Icon XIcon Checkmark
Requires a surgical device to be inserted into the penisIcon XIcon CheckmarkIcon Checkmark Icon CheckmarkIcon Checkmark
Real time image guidance during ablationIcon CheckmarkIcon CheckmarkN/A N/AIcon X
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References

[1] Descazeaud, A., Azzousi, A.R., Ballereau, C. et al. (2010). Blood loss during transurethral resection of the prostate as measured by the chromium-51 method. National Library of Medicine, 24(11), 1813-1816. doi: 10.1089

[2] Bruyère F, Huglo D, Challacombe B, Haillot O, Valat C, Brichart N. Blood loss comparison during transurethral resection of prostate and high power GreenLight(™) laser therapy using isotopic measure of red blood cells volume. J Endourol. 2011 Oct;25(10):1655-9. doi: 10.1089/end.2011.0104. Epub 2011 Aug 11. PMID: 21834657.

3 Preserving ejaculatory function in young patients with lower urinary tract symptoms: medium- to long-term follow-up of prostatic urethral lift at a single center https://pubmed.ncbi.nlm.nih.gov/34377154/

4 Rezūm Water Vapor Thermal Therapy for Lower Urinary Tract Symptoms Associated With Benign Prostatic Hyperplasia: 4-Year Results From Randomized Controlled Study https://pubmed.ncbi.nlm.nih.gov/30677455/

Treating BPH

There are four main options for treating benign prostatic hyperplasia (BPH): from mild diagnoses suggesting no intervention to patients with significant, multiple symptoms requiring medication or surgery.

If your symptoms are mild or you’re not bothered by the effects of BPH, you and your doctor may choose to watch, monitor, and wait. A yearly exam is common and personal awareness of any change in urination is important to understand if your BPH status has changed.

BPH is usually treated first with a medication called an alpha-blocker (e.g., Flomax, alfuzosin, Rapaflo). These medications help to relax the muscles in the prostate, taking some of the pressure off the urethra. Unfortunately, these medications often have side effects, including dizziness, decreased energy, and/or retrograde ejaculation.

Another class of medications is 5α-reductase inhibitors (e.g., finasteride or dutasteride). These medications block the body’s production of a version of testosterone that causes the prostate to enlarge. As a result, they can also decrease erectile function, energy, and libido.

If you cannot or do not want to tolerate the side effects of BPH medications (or if they are not effective), a BPH treatment procedure may be the next step.

Transurethral Incision of the Prostate (TUIP)

The surgeon makes small cuts in the bladder neck, where the urethra joins the bladder and in the prostate. This widens the urethra and reduces the pressure of the prostate on the urethra, making urination easier. The hospital stay is one-to-three days. A catheter is left in your bladder for one-to-three days after surgery.

Photoselective Vaporization (PVP)

PVP (such as GreenLight laser) is a way to vaporize prostate tissue with a high-powered laser. It is an outpatient procedure. The procedure takes place at the hospital or sometimes in the doctor’s office. There are a few side effects, and PVP is not recommended for men with the largest prostates.

Transurethral Resection of the Prostate (TURP)

A common surgery for men with BPH, TURP uses a laser to cut and remove tissue. Anesthesia and a tool called a resectoscope inserted through the penis are used. Men with moderate-to-severe BPH symptoms may be good candidates for TURP.

Simple Prostatectomy

The entire prostate gland is removed via laparoscopic or robotic-assisted surgery. This treatment is generally only offered to men with the largest prostate glands.

For those with BPH, laser focal therapy (LFT) / focal laser ablation (FLA) or transurethral ultrasound ablation (TULSA-PRO) may be worth considering.

After using an MRI to map the prostate gland, the physician targets the areas of enlargement which are then destroyed with a laser (LFT/FLA) or ultrasound (TULSA-PRO). 

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