Benign Prostatic Hyperplasia

Symptoms and treatment

Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland that causes a range of symptoms which can significantly affect quality of life. While a healthy young man's prostate typically measures around 4 x 3 x 2 cm and weighs between 29 and 40 grams, an enlarged prostate can grow to an extreme size and weigh as much as 200 grams.

BPH can cause difficulty urinating or holding urine, complete inability to urinate, detrusor instability (a dysfunction of the muscle in the bladder wall responsible for emptying), urinary tract infections and blood in the urine, and in more serious cases can lead to pressure from retained urine on the kidneys and impaired kidney function. Left untreated, BPH tends to worsen over time and can eventually result in failure of the lower urinary tract and kidneys.

Who is at risk?

Examination and diagnosis

Prostate examination is comprehensive and combines a number of different approaches. We begin with a detailed medical history and assess your symptoms using the internationally recognised IPSS questionnaire (International Prostate Symptom Score).

The physical examination includes a digital rectal examination, in which the doctor assesses the prostate by feel. We also take blood and urine samples. In the blood, we look at the concentration of prostate-specific antigen (PSA) and creatinine, which tells us how well your kidneys are functioning.

To get a clearer picture of how urination is affected, we use a method called uroflowmetry, which measures the flow of urine over time. An ultrasound examination of the kidneys, prostate and bladder then gives us an overall assessment of the urinary tract, with particular attention to the amount of residual urine. Depending on the findings, this may be supplemented with urodynamic and endoscopic examinations.

How we treat BPH

Conservative methods

Mild to moderate BPH symptoms can be managed with medication. The most commonly used drugs relax the smooth muscle of the prostate and the bladder neck. Medications are sometimes combined, or supplemented with plant-based preparations. They can have side effects, including changes in sexual function such as difficulties with erection or ejaculation and reduced libido.

Another approach, known as shockwave therapy, can be used for an enlarged prostate or chronic inflammation. This non-invasive treatment exposes the tissue to mechanical pressure waves, stimulating regeneration, new blood vessel growth and tissue remodelling. Improved blood flow and oxygenation support faster healing.

A newer development in prostate treatment is a procedure called Rezūm™, in which a moderately to significantly enlarged prostate is treated with water vapour. One of the key advantages of this method is that 95% of clients experience no side effects such as urinary incontinence or erectile dysfunction.

Surgical solution

When conservative treatment is no longer sufficient, surgical options are considered. The most common procedures include transurethral resection of the prostate (TURP), in which part of the prostate is removed through the urethra; transurethral incision of the prostate (TUIP), in which the bladder neck is incised; and open surgery, in which the affected part of the prostate is removed through an incision in the lower abdomen.

Very large prostates (over 80 ml in volume) are treated with open prostatectomy. For prostates between 30 and 80 ml, transurethral resection using an endoresector is the standard approach. For smaller prostates (under 30 ml) or in younger clients, transurethral incision is preferred.