From the Guidelines
The least intrusive treatments for bladder and prostate issues related to urination include lifestyle modifications and medications before considering surgical interventions. Start with simple changes like reducing fluid intake before bedtime, limiting caffeine and alcohol consumption, and practicing scheduled voiding. For men with benign prostatic hyperplasia (BPH), alpha-blockers such as tamsulosin (0.4mg daily) or alfuzosin (10mg daily) can relax prostate muscles and improve urine flow within days to weeks, as recommended by the AUA guideline on management of BPH 1. 5-alpha reductase inhibitors like finasteride (5mg daily) or dutasteride (0.5mg daily) may be added for enlarged prostates, though they take 3-6 months to show full effect, as noted in the guideline on 5 alpha-reductase inhibitor therapy 1.
For overactive bladder, anticholinergics such as oxybutynin (5mg 2-3 times daily) or solifenacin (5-10mg daily) can reduce urgency and frequency, while mirabegron (25-50mg daily) offers an alternative with fewer dry mouth side effects. Pelvic floor exercises (Kegels), performed by contracting the muscles that stop urination for 3-5 seconds, repeated 10-15 times, three times daily, can strengthen urinary control muscles.
Some key points to consider:
- The AUA guideline on management of BPH recommends watchful waiting, medical therapies, and minimally invasive therapies as initial treatment options for patients with moderate to severe symptoms of BPH 1.
- The guideline on 5 alpha-reductase inhibitor therapy notes that finasteride and dutasteride are appropriate and effective treatments for patients with LUTS associated with demonstrable prostatic enlargement 1.
- Surgical intervention is an appropriate treatment option for patients with moderate-to-severe LUTS and for patients who have developed acute urinary retention or other BPH-related complications, as stated in the guideline on surgery 1.
- The AUA/SUFU guideline on the diagnosis and treatment of idiopathic overactive bladder recommends initial management with non-invasive therapies, pharmacotherapy, or minimally invasive therapies for patients with BPH and bothersome OAB, and notes that bladder outlet reduction surgeries may be offered for patients who present with LUTS and BPH 1.
The most recent and highest quality study, the AUA/SUFU guideline on the diagnosis and treatment of idiopathic overactive bladder 1, published in 2024, provides the most up-to-date recommendations for the management of bladder and prostate issues related to urination. This guideline emphasizes the importance of shared decision-making and individualized treatment approaches, taking into account the patient's symptoms, medical history, and preferences. By following these recommendations and considering the patient's unique needs and circumstances, clinicians can provide effective and personalized care for patients with bladder and prostate issues related to urination.
From the FDA Drug Label
The improvement in BPH symptoms was seen during the first year and maintained throughout an additional 5 years of open extension studies. Compared with placebo, finasteride tablets was associated with a significantly lower risk for acute urinary retention or the need for BPH-related surgery [13.2% for placebo vs 6. 6% for finasteride tablets; 51% reduction in risk, 95% CI: (34 to 63%)]. Treatment with finasteride tablets, doxazosin, or combination therapy resulted in a reduction in the risk of experiencing one of these five outcome events by 34% (p=0.002), 39% (p<0.001), and 67% (p<0.001), respectively.
The least intrusive treatments for bladder and prostate issues related to urination include:
- Finasteride tablets: which have been shown to reduce the risk of acute urinary retention and the need for BPH-related surgery 2
- Doxazosin: which has been shown to reduce the risk of BPH-related events 2
- Combination therapy: of finasteride and doxazosin, which has been shown to be more effective than either treatment alone in reducing the risk of BPH-related events 2
Note: These treatments are not surgical and are considered less intrusive than surgical options. However, it's essential to consult a healthcare professional to determine the best course of treatment for individual cases.
From the Research
Least Intrusive Treatments for Bladder and Prostate Issues
The following are some of the least intrusive treatments for bladder and prostate issues related to urination:
- Medications such as alpha(1)-adrenoceptor antagonists and 5alpha-reductase inhibitors, which can help relax prostatic smooth muscle and reduce prostatic mass 3
- Phytotherapeutic extracts, which can act via various mechanisms to alleviate symptoms 3
- Tamsulosin, which has been shown to improve symptoms and peak urine flow relative to placebo 4
Minimally Invasive Surgical Options
Some minimally invasive surgical options for bladder and prostate issues include:
- Holmium laser enucleation of the prostate (HoLEP), which has been shown to be a safe and efficient procedure for the treatment of benign prostatic hyperplasia (BPH) 5
- Aquablation, which has been compared to transurethral prostate resection in a double-blind, randomized, controlled trial and shown to have noninferior symptom relief with a lower risk of sexual dysfunction 6
- Photoselective vaporization of the prostate, which is a well-recognized surgical option that can be used for the majority of men with LUTS due to BPH who have failed medical management 7
Considerations for Treatment
When considering treatment for bladder and prostate issues, it's essential to take into account the size of the prostate, as some treatments may be more suitable for smaller or larger prostates 5, 6. Additionally, the risk of complications and side effects, such as sexual dysfunction, should be carefully weighed against the potential benefits of treatment 4, 6.