Prostate enlargement (BPH)

Prostatic enlargement, otherwise known as BPE (Benign Prostatic Enlargement) or BPH (Benign Prostatic Hyperplasia), is a noncancerous enlargement of the prostate gland that affects most men, as they get older. This process of enlargement does not necessarily cause symptoms.

When BPH does cause symptoms these can present as one or a combination of the following:

  • Hesitancy - having to wait for a few seconds before the urinary flow starts
  • Poor flow – reduction in the strength of urinary flow
  • Terminal dribbling – bothersome dribbling when you think you have finished urinating
  • Incomplete bladder emptying – the feeling of not completely emptying the bladder when you urinate
  • Frequency – needing to urinate more frequently than normal, day and /or night
  • Urgency – having to rush to go to the toilet

BPH is not usually a dangerous condition, but can cause a lot of bother and nuisance, reducing overall quality of life. Occasionally, BPH can lead to problems such as bladder stones, urinary tract infections or even kidney problems.

BPH affects most men over the age of 45, but not all men will get symptoms. If symptoms are present, they usually worsen gradually over the course of many years. In a small minority of men, it may eventually become difficult to pass urine at all, a condition known as acute urinary retention. BPH is considered part of the normal aging process and is not related to the development of prostate cancer. It is possible to have both BPH and prostate cancer at the same time.

Prostate enlargement FAQs

  • How is BPH diagnosed?

    Your urologist will first ask you about your urinary symptoms in detail, and may ask you to fill in some symptom questionnaires to establish the impact of these symptoms on your quality of life. The urologist will then examine you thoroughly, including a rectal examination to determine the size and consistency of the prostate. You will often be asked to attend clinic with a full bladder so we can measure your urinary flow rate, accompanied by a bladder scan to check how well your bladder is emptying. You can then expect to undergo some blood tests, including a test for PSA, which is useful in the diagnosis of prostate cancer.

  • Are there any tablets for BPH?

    There are two main types of tablets that are generally used for the treatment of BPH. Sometimes these are used on their own, but some patients can benefit from taking both types at the same time.

    • Alpha-Blockers (Alfuzosin, Tamsulosin, Terazosin, Doxasosin)
      These tablets help to relax the muscles of the prostate. This allows the urine to flow more freely and helps to reduce symptoms. Most men find that alpha-blockers will improve their symptoms. They work quickly but may be less effective as time goes on. Some people experience side-effects such as light-headedness, especially at the start of treatment.
    • 5-Alpha Reductase Inhibitors (Finasteride, Dutasteride)
      These tablets block some of the factors that make the prostate grow: over time, they cause the prostate to shrink. They may take up to 6 months to improve symptoms, but may be more effective in the long term. They may also reduce the risk of further problems, such as symptoms getting worse or acute retention of urine (when you suddenly find you can't pass urine at all).
      5-alpha reductase inhibitors are particularly effective in men with larger prostates. Side effects may include a loss of libido and some men experience the development of more prominent breast tissue.
    • Herbal treatments
      There are various herbal remedies available. Saw Palmetto is an extract from the American dwarf palm tree, Serenoa repens. It is rich in fatty acids and phytosterols and has been used for the treatment of prostate disorders for many years. It is marketed under the name Permixon. Although some patients report improvements in their symtpoms using this treatment, the effects are less pronounced than with the mainstream medicines described above.
      If you are interested in alternative treatments including Saw Palmetto, then we suggest that you discuss the options with a specialist.

  • What are the surgical options for BPH?

    Some men gain no improvement with tablets, or are unable to tolerate the side effects of the medication, so a surgical treatment may be offered instead. There are now many different surgical treatments for BPH, including some innovative new techniques, which you urologist can discuss with you in detail. As a brief overview, these may include:

    • TURP (trans urethral resection of the prostate)
      TURP is the commonest surgical method used to treat BPH. This operation is performed under general or spinal anaesthesia. It is performed through a telescope passed through the urethra, and therefore there are no external cuts or scars. An electrical loop is used to cut away small parts of the central portion of the gland, until there is a wide cavity with no obstructing tissue. The pieces of the prostate are sent away to the lab for examination. When your operation is competed, a catheter is passed into the bladder, which drains the urine and helps to wash away any blood. This catheter stays in for 24-48 hours. In Nottingham, we use the bipolar system to perform this procedure. This minimises bleeding and the recovery time appears to be significantly quicker than many other techniques.
    • Laser TURP
      There are two main forms of utilizing laser technology to perform a TURP, HOLEP or green light vaporization. Both of these techniques are conducted through a telescope as above.
    • Prostatic Urethral Lift procedure
      This procedure involves using some special equipment to pin the obstructing portions of the prostate up rather than removing the prostate, and can be carried out as a day case procedure under local anaesthetic. Recovery times are quicker, and most patients will experience an improvement in their symptoms, but it may not be as affective as TURP in the long run The side effects of the surgery however, are generally less severe than those of TURP, especially with regard to sexual dysfunction.
    • Rezum procedure
      This is another novel technique involving the use of a special probe through which steam is passed into the prostate, resulting in eventual shrinkage of the prostate. It too can be performed under local anaesthesia, and again, the long term effectiveness of this procedure is currently unknown.
    • Prostatic artery embolization
      This is a different kind of procedure performed by interventional radiologists, in which some tiny metal coils and glue are introduced through a catheter that is placed into the blood vessels supplying the prostate. This has the effect of cutting off the blood supply to the prostate which causes it to shrink significantly. Once again, it can be performed as a daycase procedure under local anaesthesia.

    ​Not all of the above procedures may be suitable for you, and understanding the pros and cons of each technique is vital in decision making. Hence the need to consult with one of our experts, who can guide you through the options available.