Benign prostatic hyperplasia

In men, the urethra passes through the center of the prostate. When the prostate starts to enlarge it presses on the urethra and makes it narrow. This narrowing causes urinary symptoms.

The causes are largely unknown but are thought to be linked to hormonal changes as men age.

Pressure on the urethra can cause you to need to pee more often, especially at night. You may also find it difficult to start peeing, your flow of urine may be weak or stop and start, you may experience dribbling at the end of urination or have a feeling that you haven’t completely emptied your bladder after peeing. Some of these symptoms can be confused with a urinary tract infection (UTI), but unlike a UTI they go on for weeks or months, and gradually get worse.

If untreated, BPH puts you at risk of recurring UTIs, urinary retention, bladder stones, bladder damage and kidney damage.

It doesn’t cause erectile dysfunction or ejaculation problems in itself, although some of the medications used to treat it may. It’s also important to say that having BPH does not increase your risk of having prostate cancer.

You should book a routine appointment if you notice urinary symptoms persisting over time. Your doctor will ask about symptoms and will likely perform an anal exam where the prostate can be felt. This tells them whether it is enlarged. The exam will also tell them if the surface of the prostate feels normal or needs further investigations for other conditions, such as prostate cancer.

Your doctor may send off a urine sample to check for infection. You may have blood tests to check the health of the kidneys and test for prostate-specific antigen (PSA), which can be raised in a number of conditions, including prostate cancer.

Once all the results are back, and it looks like BPH, your doctor may refer you to the urologist for further investigations and treatment. If results suggest a condition other than BPH, your doctor will advise on the next best steps.

The treatment for BPH varies depending on the size of the prostate, your age, your general health and how much your symptoms trouble you. Not having any treatment at all (‘watchful waiting’) may be an option but if treatment is needed then medication and surgery are the two usual options available. Alpha-blocker tablets, such as doxazosin or tamsulosin, help relax the muscles at the neck of the bladder, which make it easier to urinate, or 5-alpha reductase inhibitors, such as finasteride, are tablets aiming to shrink the prostate. You sometimes need a combination of these to treat symptoms.

In severe cases, surgery may be considered, to reduce the size of the prostate. There are now a number of options including:

• Transurethral resection of the prostate (TURP). This is the most common procedure currently used and involves putting a narrow telescope up the urethra under anesthetic (local or general) and cutting back some of the enlarged prostate tissue. This has good long-term results but most men have retrograde ejaculation after this procedure where semen goes into the bladder at climax, causing a ‘dry’ orgasm. There are also small risks of impotence or incontinence following the surgery.

• Transurethral incision of the prostate (TUIP). Offered if the prostate enlargement is only relatively small, this is done in the same way as a TURP but the surgeon only makes tiny cuts in the prostate around the bladder. This improves urine flow, and there’s less risk of retrograde ejaculation than with a TURP.

• Laser prostatectomy. This uses lasers to either vaporize the prostate tissue or carve out large cores of prostate tissue and has fewer side effects than a TURP or TIUP.

• Urolift. This procedure uses an implant to lift prostate tissue out of the way of the urethra without cutting or removing any prostate tissue. It has no impact on impotence or incontinence and can be done as an outpatient so you don’t need to spend a night in the hospital. It can relieve symptoms of BPH for up to 5 years.

• Rezum. This is a new treatment that injects steam at high pressure to destroy excessive prostate tissue and does not appear to cause erectile dysfunction.