Benign Prostate Enlargement (BPH)

Benign prostatic hyperplasia is non-cancerous growth of the prostate, the gland that surrounds the urethra just below the bladder. As it enlarges it can squeeze the urethra and irritate the bladder, producing urinary symptoms. It affects about half of men in their fifties and most men over 80, though not all are bothered by it.

BPH is not cancer and does not turn into cancer, although both can be present at once. Treatment is guided by how much the symptoms bother you and by complications, not by prostate size. Many men need only monitoring. Medicines help most of the rest, and a range of procedures exists for those who need more.

Symptoms

• A weak or stop-start urine stream
• Hesitancy, having to wait or strain to begin
• A feeling that the bladder has not emptied
• Dribbling at the end
• Passing urine often, including two or more times a night
• Sudden urgency, sometimes with leakage
• Repeated urinary infections, blood in the urine or bladder stones in advanced cases

Causes and risk factors

The prostate grows under the influence of dihydrotestosterone, made from testosterone within the gland, and continues to do so throughout adult life. Ageing and normal testicular function are the two requirements. Family history, obesity, type 2 diabetes, metabolic syndrome and lack of exercise are associated with larger prostates and worse symptoms. Symptoms are also aggravated by things unrelated to size: evening fluids, caffeine, alcohol, constipation, and medicines such as decongestants, some antidepressants and antihistamines that impair bladder emptying.

How it is diagnosed

• Symptom score: The IPSS questionnaire grades symptoms as mild, moderate or severe and records how bothered you are.
• Digital rectal examination: Estimates size and checks for hard or irregular areas.
• Urine test and kidney function: Rule out infection, blood and kidney impairment.
• PSA blood test: Discussed and offered to assess cancer risk; it also reflects prostate volume and predicts progression.
• Uroflowmetry and residual urine scan: You urinate into a meter, then an ultrasound measures what remains. A peak flow under about 10 to 15 ml per second suggests obstruction.
• Ultrasound of prostate, bladder and kidneys: Measures prostate volume, which determines which procedures are suitable.
• Bladder diary, cystoscopy or urodynamics: Used selectively before surgery or when the picture is unclear.

Treatment options

• Watchful waiting and lifestyle: Less fluid in the evening, less caffeine and alcohol, bladder training and treating constipation. Appropriate for mild or non-bothersome symptoms.
• Alpha blockers: Tamsulosin, alfuzosin or silodosin relax the prostate and bladder neck within days. Dizziness and dry ejaculation can occur.
• 5-alpha reductase inhibitors: Finasteride or dutasteride shrink larger prostates by about a quarter over 6 to 12 months and lower the risk of retention. They halve the PSA and may reduce libido.
• Tadalafil or bladder medicines: Daily tadalafil helps men who also have erectile difficulty; antimuscarinics or mirabegron treat persistent urgency.
• TURP: Removal of the obstructing tissue through the urethra. The long-standing standard for prostates of roughly 30 to 80 ml.
• Laser enucleation (HoLEP or ThuLEP): Removes the whole adenoma, suitable for any size including very large glands, with low bleeding risk.
• Minimally invasive options: Rezum water vapour, UroLift implants, aquablation, GreenLight vaporisation and prostate artery embolisation. Quicker recovery and better preservation of ejaculation with some, but in general less durable than enucleation.

When it is urgent

Being unable to pass urine at all, with a painful swollen lower abdomen, is acute retention and needs a catheter at your nearest emergency department the same day. Also seek prompt care for fever and shaking with urinary symptoms, visible blood with clots, or new incontinence with back pain or leg weakness.

Travelling to Türkiye for treatment

BPH surgery is planned and elective, so it suits travel. Send your PSA, ultrasound volume, flow test and medication list in advance so that the right technique can be proposed. For TURP or HoLEP allow around 5 to 8 days: 1 to 2 nights in hospital, catheter removal after 1 to 3 days, and a check that you are emptying well before the flight. Drug treatment and PSA monitoring stay with your own doctor. Avoid long journeys while in retention with a catheter unless your urologist has agreed.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

Frequently Asked Questions