The first option is called “watchful waiting,” and it doesn’t mean “do nothing.” It means “wait and see.” The course of BPH is often hard to predict; your symptoms could improve, get worse, or stay the same. Beyond watchful waiting, broadly speaking, there are two paths—surgical and medical. (See table 10.1, page 257.) The choice depends on the severity of your symptoms. If you have one or more of the conditions mentioned above that require treatment, your best option is surgery. But if your symptoms are moderate—that is, not severe enough to require surgery—a trial of medical therapy makes sense.

Watchful Waiting

This is the most conservative approach to BPH, and for most men with mild symptoms, it’s the best. Remember, just having an enlarged prostate does not mean you need treatment. It’s only when the symptoms of enlargement become bothersome, or if your urinary function is seriously affected, that you should consider treatment. So, many doctors begin with what’s called a “watch-and-wait” approach to the problem. They keep a close eye on your condition, with checkups once or more a year to make sure you’re not developing any complications. Sometimes the symptoms of BPH get better on their own. If they don’t, then you and your doctor will move on to the next step—deciding what treatment’s best for you.

Risks. Like any other treatment option, watchful waiting is also something of a gamble—low-risk, but a gamble all the same. A few men in programs of watchful waiting develop acute urinary retention, the inability to urinate. A few develop urinary tract infections; some see blood in their urine; some go on to develop kidney or bladder damage without any noticeable change in their symptoms (this is called silent prostatism). But such complications from watchful waiting are rare indeed. You can lower the odds even further by limiting your fluid intake before bedtime and by refraining from taking certain over-the-counter medications, such as decongestants, which can make your BPH symptoms worse.

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