Recognise these symptoms? Weak stream · Difficulty starting · Stop-start flow · Nocturia (waking at night to urinate) · Urgent need to rush to the toilet · Feeling of incomplete emptying. These are the classic signs of BPH. They are common, they are treatable, and they are not something you simply have to live with. WhatsApp: +91 78382 86336
Understanding BPH
What happens when the prostate enlarges
The prostate gland sits at the base of the bladder and surrounds the urethra - the tube through which urine flows. In young men it is the size of a walnut (~20 mL). By age 60, more than 50% of men have BPH; by age 80, more than 90%. The gland can grow to 50–200 mL or more.
As it grows, it squeezes the urethra from all sides. The bladder works harder to push urine through the narrowed outlet. Over time, the bladder muscle thickens (trabeculation) and becomes overactive - causing urgency and frequency. Eventually, the bladder may not empty fully, leaving residual urine that increases infection risk. In severe cases, the outlet is completely blocked: acute urinary retention.
The IPSS - how severe are your symptoms?
The International Prostate Symptom Score (IPSS) is the standard tool for measuring BPH severity. Rate these 7 symptoms from 0 (not at all) to 5 (almost always):
Diagnosis
How BPH is assessed
Clinical assessment
- IPSS questionnaire
- Digital rectal examination (DRE) - assesses prostate size and consistency
- PSA blood test - to exclude cancer
- Urine routine and culture - to exclude infection
- Serum creatinine - to assess kidney function
Investigations
- Ultrasound abdomen - prostate volume, bladder wall, post-void residual urine
- Uroflowmetry - measures urine flow rate (normal peak flow >15 mL/s)
- Urodynamics - for complex or recurrent cases with unclear diagnosis
- Cystoscopy - if haematuria, bladder stones, or cancer suspected
- MRI prostate - if PSA raised and prostate cancer cannot be excluded
Treatment options
From lifestyle changes to laser surgery
Treatment is matched to symptom severity, prostate size, patient preference, and whether complications are present. Not all patients need surgery.
Watchful Waiting
Active monitoring with annual review. Lifestyle advice: reduce evening fluids, limit caffeine and alcohol, timed voiding, pelvic floor exercises. Reassess if symptoms worsen. Appropriate for men with mild symptoms and no complications.
Medical Treatment
Alpha-blockers (tamsulosin, silodosin) for rapid symptom relief. 5-alpha reductase inhibitors (finasteride, dutasteride) to shrink the prostate over 6–12 months - recommended for prostates >30 mL. Combination therapy for large prostates with moderate-severe symptoms. Tadalafil 5 mg for concurrent erectile dysfunction.
TURP
Transurethral Resection of the Prostate - the traditional gold standard for BPH surgery. Resectoscope removes obstructing prostate tissue in chips via the urethra under spinal or general anaesthesia. Hospital stay 2 nights. Catheter 24–48 hours. Highly effective, well-studied procedure with decades of outcome data.
HoLEP
Holmium Laser Enucleation of the Prostate - the modern evolution of TURP. The holmium laser enucleates the entire transition zone of the prostate, regardless of size. Lower blood loss, shorter catheter time (often 24 hours), shorter hospital stay. Re-operation rates at 10 years significantly lower than TURP. Preferred for large prostates (>80 mL) and patients on blood thinners.
UroLift
Prostatic urethral lift - small implants mechanically open the prostatic urethra without tissue removal. Preserves ejaculatory function (unlike TURP/HoLEP). Suitable for men with moderate symptoms, prostates <70 mL without a large median lobe, who wish to preserve ejaculation. Shorter procedure, day-case, faster recovery.
Prostate Artery Embolisation
Minimally invasive radiological procedure where small beads are injected into the prostatic arteries to reduce blood supply, causing the prostate to shrink. Does not require general anaesthesia. Best for very large prostates (>80–100 mL) in patients unfit for surgery. Can preserve ejaculation. Usually done by an interventional radiologist in collaboration.
Comparing surgical options
TURP vs HoLEP - key differences
| Feature | TURP | HoLEP |
|---|---|---|
| Technique | Electrical chip resection | Holmium laser enucleation |
| Prostate size limit | Best for <80 mL | Any size |
| Blood loss | Moderate | Minimal |
| Safe for anticoagulants | Increased risk | Yes - preferred |
| Hospital stay | 2 nights | 1–2 nights |
| Catheter time | 24–48 hours | Often 24 hours |
| Re-operation at 10 yrs | ~15% | ~3–5% |
| Retrograde ejaculation | ~65–70% | ~70–75% |
| Erectile function | Generally preserved | Generally preserved |
| Tissue for biopsy | Yes | Yes (morcellated) |
| Learning curve | Well established | Requires laser expertise |
Video Education
Watch Dr. Nitin on BPH Treatment
Medications, TURP, HoLEP - which option is right for you?
BPH Prostate Enlargement Treatment
TURP vs HoLEP – Which is Better for BPH?
Frequently asked questions
BPH - common questions answered
BPH stands for Benign Prostatic Hyperplasia - non-cancerous growth of the prostate gland that occurs in most men as they age. The prostate surrounds the urethra (the tube through which urine flows from the bladder). As the gland enlarges, it compresses the urethra and the bladder outlet, causing the classic "lower urinary tract symptoms" (LUTS): a weak stream, difficulty starting, stopping and starting mid-stream, a feeling of incomplete emptying, frequent daytime and night-time urination (nocturia), and urgency. BPH itself is not dangerous, but untreated severe BPH can lead to acute urinary retention, recurrent infections, and kidney damage.
No. BPH and prostate cancer are completely separate conditions. BPH is benign - the cells are normal prostate cells that have simply multiplied; they cannot invade other tissues or spread. BPH does not increase your risk of developing prostate cancer, and prostate cancer does not arise from BPH. However, both conditions can raise the PSA blood test level, which is why a raised PSA needs to be investigated carefully. It is possible to have both BPH and prostate cancer simultaneously - which is why any suspicion of cancer is investigated separately.
The International Prostate Symptom Score (IPSS) is a 7-question questionnaire that quantifies how bothersome your urinary symptoms are. Scores range from 0–35. Score 0–7: mild symptoms - watchful waiting or lifestyle changes may suffice. Score 8–19: moderate symptoms - medication is usually recommended. Score 20–35: severe symptoms - surgery should be considered. The IPSS also includes a quality-of-life question ("if you were to spend the rest of your life with your current urinary condition, how would you feel?") which guides how aggressively to treat. You can score yourself online before your appointment at Dr. Nitin's clinic.
Two main drug classes are used. Alpha-blockers (tamsulosin, silodosin, alfuzosin) relax the smooth muscle in the prostate and bladder neck, improving flow within days to weeks. They do not shrink the prostate. 5-alpha reductase inhibitors (finasteride, dutasteride) block the conversion of testosterone to DHT, which drives prostate growth. They shrink the prostate by 20–30% over 6–12 months and reduce the long-term risk of acute retention and surgery. Combination therapy (alpha-blocker + 5-ARI) is recommended for men with large prostates (>30–40 mL) and moderate-to-severe symptoms. PDE5 inhibitors (tadalafil 5 mg daily) can treat both BPH and erectile dysfunction simultaneously.
TURP (Transurethral Resection of the Prostate) is the traditional surgical standard - a resectoscope removes prostate tissue in chips using an electrical loop. It works well for prostates up to ~80 mL but has a risk of TUR syndrome (fluid absorption), bleeding, and retrograde ejaculation. HoLEP (Holmium Laser Enucleation of the Prostate) uses a holmium laser to enucleate the entire transition zone (the part causing obstruction) from inside, regardless of prostate size. HoLEP has lower blood loss, shorter catheter time, shorter hospital stay, and lower re-operation rates. It is the preferred technique for large prostates (>80 mL) and anticoagulated patients. Both procedures are done through the urethra - no skin incisions.
TURP and HoLEP cause retrograde ejaculation in approximately 65–70% and 70–75% of patients respectively - semen goes backwards into the bladder during orgasm rather than out, causing "dry orgasm". Sensation during orgasm is unchanged. This is a benign but permanent change. Erectile function is generally preserved; some studies show improvement after surgery because the obstruction is relieved. These procedures are not suitable for men who wish to father children naturally, as retrograde ejaculation prevents normal fertilisation. Prostate artery embolisation (PAE) and UroLift preserve ejaculation - Dr. Nitin can discuss whether these are appropriate for your case.
Surgery is indicated when: (1) medication has failed to adequately control symptoms; (2) there are complications - acute urinary retention (inability to urinate), recurrent urinary tract infections, bladder stones secondary to BPH, haematuria (blood in urine) from BPH, or deteriorating kidney function due to bladder outflow obstruction; (3) symptoms are severe (IPSS >20) and quality of life is significantly affected; (4) the patient prefers definitive treatment rather than lifelong medication. Surgery is also recommended when the prostate is very large (>80 mL) since medications are less effective in this group.
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