Benign Prostatic Hyperplasia

 Benign prostatic hyperplasia (BPH) is a common, non-cancerous enlargement of the prostate. It becomes more common as men get older and can affect urine flow, bladder emptying and sleep.

An enlarged prostate does not always need an operation. Treatment depends on your symptoms and whether the enlargement is causing complications.

The prostate is a small gland below the bladder that helps produce semen. It surrounds the urethra, the tube carrying urine out of the body.

As the prostate enlarges, it can narrow this passage and make the bladder work harder to empty.

Prostate size alone does not show how serious the problem is. A large prostate may cause few symptoms, while a smaller one may cause considerable difficulty.

• Difficulty starting to pass urine.
• A weak stream, or a stream that stops and starts.
• A feeling that the bladder has not emptied completely.
• Passing urine more often or needing to go urgently.
• Waking repeatedly at night to pass urine.
• Dribbling after finishing.

These symptoms can also arise from infection or other bladder and urinary conditions. An assessment helps identify the cause.

BPH is not cancer and does not increase the risk of prostate cancer. However, both conditions can occur in the same person.

New or worsening urinary symptoms should therefore be assessed rather than assumed to be due to ageing.

Your doctor will ask about your symptoms, medicines and how urination affects your daily life. You may complete a short symptom questionnaire or keep a bladder diary.

Assessment may include:

• Urine testing to check for infection, blood or other abnormalities.
• An examination, which may include feeling the prostate through the back passage.
• A urine flow test and bladder scan, particularly during specialist assessment, to check flow and urine remaining after urination.
• Kidney function blood tests when kidney involvement is suspected.
• Discussion of a PSA blood test, including its benefits and limitations.

A raised PSA does not automatically mean cancer. Camera tests of the bladder and other investigations are needed only in selected situations.

If symptoms are mild and there are no complications, planned follow-up may be sufficient.

Helpful changes include:

• Reducing caffeine and alcohol if they worsen symptoms.
• Avoiding large drinks shortly before bedtime while drinking adequately during the day.
• Taking time to pass urine without straining.
• Waiting briefly after finishing, then trying again if the bladder still feels full.
• Addressing constipation and staying physically active.
• Checking whether cold remedies or other medicines could worsen symptoms.

Avoid severely restricting fluids or stopping prescribed medicines without advice.

Some medicines relax the muscles around the prostate and bladder neck, making urine flow easier. Others gradually shrink a larger prostate and usually take several months to help. Some men benefit from a combination.

Possible side effects depend on the medicine and can include dizziness, changes in ejaculation or other sexual symptoms. Tell your doctor about troublesome effects so treatment can be reviewed.

A procedure may be recommended when symptoms remain troublesome despite treatment, or when obstruction causes complications such as repeated urine retention, infections, bladder stones or kidney problems.

Options include TURP and laser procedures such as HoLEP/ThuFLEP, which remove obstructing prostate tissue through the urinary passage. Other treatments, including water-vapour therapy (REZUM)  or prostate-lifting implants (UroLift), suit selected patients.

The choice depends on prostate size and shape, general health and personal priorities. Discuss recovery, catheter use, possible sexual side effects and the likelihood of needing further treatment. Some bladder symptoms may persist after treatment.