Benign Prostatic Enlargement (BPH) Benign Prostatic Hypertrophy

The prostate is a walnut sized organ in the male pelvis that forms the junction between the urinary and reproductive tracts and produces the liquid component of semen. Prostatic enlargement is a benign condition and is different to prostate cancer.

The urine is stored in the bladder and during urination the urine must flow through the middle of the prostate then out through the urethra. As men age the prostate usually gets larger which in some men can cause symptoms including:

  • Poor flow
  • Dribbling
  • Intermittent flow
  • Trouble starting urination
  • Frequency
  • Urgency
  • Nocturia (passing urine at night)
  • Incontinence
  • Painful urination
  • Blood in the urine
  • Inability to urinate (requiring a catheter)

Mr Thyer will ask you a series of questions about your symptoms and about any other concerning features that may warrant more in-depth investigation (eg blood in the urine or smoking). Most men will then need some or all of the following investigations:

  • IPSS score (to determine severity of symptoms)
  • PSA blood test and examination of the prostate (to exclude prostate cancer)
  • Kidney blood test and ultrasound (to ensure the poor flow of urine is not affecting the kidneys)
  • Flexible cystoscopy, flow rate and post void residual measurement (see Flexible cystoscopy information sheet under Procedure Information on this website)
Treatment options

The severity of symptoms, interference with life, work and sleep and outcome of the above investigations will determine how your BPH is treated.

  • Mild symptoms: Lifestyle measures like avoiding fluid before bedtime, avoiding foods that exacerbate symptoms and avoiding some medications (eg cold and flu preparations) can help.
  • Moderate symptoms: Medications can be considered. These include:
    • Alpha blockers (Flomaxtra, Urorec, Prazosin) – main side effects include dizziness and lethargy but those with Glaucoma should check with their ophthalmologist before taking this medication.
    • 5 – Alpha reductase inhibitors (Finasteride, Dutasteride) – Sexually active men should be mindful that these medications can cause sexual dysfunction.
    • Combination therapy of above (Duodart) – see above for side effects.
  • Severe symptoms: Surgery can be considered. The options include TURP or laser treatment to the prostate (See information sheet on this website regarding TURP).

Note: Severe BPH can cause occasionally cause a blockage to the kidneys, bladder stones, recurrent infections, bleeding or urinary retention (inability to pass urine at all). In these situations, TURP is often required even if symptoms are not severe.

Read more about Trans-Urethral Resection of the Prostate (TURP)

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