Prostate Enlargement (BPH)

What is BPH?

The prostate gland is a small round gland that sits at the base of the bladder in males. It contributes fluid to the ejaculate and is necessary for fertility. 

The first part of the urethra (waterpipe) passes through the middle of the prostate as it exits the bladder. As men age, the prostate continues to grow. This non-cancerous growth is called benign prostatic hyperplasia (BPH) and affects the centre of the prostate gland. As it progresses, it can compress the urethra, obstructing the flow of urine.

BPH is a benign process and not related to cancer. It isn’t usually dangerous but can cause bothersome symptoms if left untreated.

What are the symptoms of BPH?

As the prostate enlarges, it obstructs the flow of urine. This can result in:

• Hesitancy – a delay starting

• Poor stream – a slow, thin stream

• Intermittency – stopping and starting of the urinary stream

• Straining – having to squeeze or strain to empty the bladder

• Incomplete emptying – the sensation that the bladder is still full after voiding

The bladder will often “compensate” by becoming more muscular to help force the urine out. This can cause:

• Increased frequency – needing to pass urine more often

• Urgency – having to rush to get to the toilet in time

• Incontinence or dribbling after passing urine

• Nocturia – needing to get up to pass urine at night

BPH causes different symptoms in different men, depending on how BPH affects the urinary tract and how your bladder compensates.

What are the treatment options?

After dangerous causes for your symptoms have been ruled out, the need for treatment depends on how much you are bothered by your symptoms and bladder function. Not every person needs surgery and there are medications and lifestyle changes that can help improve your symptoms.

Most surgical treatments are conducted endoscopically (using a small camera) through the urethra (no cuts or stitches). Surgical options include:

• Transurethral resection of the prostate (TURP) – the centre of the prostate is shaved out and removed using diathermy to create a wide channel through which to pass urine

• HoLEP - (Holmium Laser Enucleation of the Prostate). Similar surgery to TURP but a laser is used instead of heat.

• Urolift – a small stapling device holds the urethra open and prevents obstruction from the enlarged prostate.

• Rezūm water vapour therapy - Steam is injected into the prostate through the urethra. The steam destroys some of the prostate. The prostate shrinks over the next few weeks.

• Aquablation - Pressurised water is injected through the urethra (penis) and destroys some of the prostate. (Not yet available but coming end of 2026).

• PAE (Prostatic Artery Embolisation) - A thin tube is put into an artery in your wrist or groin. It reduces the blood supply to the prostate and shrinks it over the following weeks. This procedure does not go in through your penis. This is performed by radiologist (x-ray specialists).

Further information: Prostate Decision Tool (National Health service - UK)

Dr Samuel Davies, Consultant Urologist and Robotic Surgeon has a specialist interest in the diagnosis and management of enlarged prostates. He is proficient in all procedures highlighted above. If you are having issues with an enlarged prostate he is happy to discuss treatment options with you.