Benign prostate enlargement – NHS

Benign prostate enlargement (BPE) is the medical term to describe an enlarged prostate, a condition that can affect how you pee (urinate).

BPE is common in men aged over 50. It’s not a cancer and it’s not usually a serious threat to health.

Many men worry that having an enlarged prostate means they have an increased risk of developing prostate cancer. This is not the case.

The risk of prostate cancer is no greater for men with an enlarged prostate than it is for men without an enlarged prostate.

Symptoms of benign prostate enlargement

The prostate is a small gland, located in the pelvis, between the penis and bladder.

If the prostate becomes enlarged, it can place pressure on the bladder and the urethra, which is the tube that urine passes through.

This can affect how you pee and may cause:  

• difficulty starting to pee
• a frequent need to pee
• difficulty fully emptying your bladder

Credit:

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In some men, the symptoms are mild and do not need treatment. In others, they can be very troublesome.

Causes of benign prostate enlargement

The cause of prostate enlargement is unknown, but it’s believed to be linked to hormonal changes as a man gets older.

The balance of hormones in your body changes as you get older and this may cause your prostate gland to grow.

Video: prostate enlargement

This animation explains the possible causes of prostate enlargement or benign prostatic hyperplasia.

Media last reviewed: 12 January 2021
Media review due: 12 January 2024

Diagnosing benign prostate enlargement

You might have several different tests to find out if you have an enlarged prostate.

A GP may do some of these tests, such as a urine test, but others might need to be done at a hospital.

Some tests may be needed to rule out other conditions that cause similar symptoms to BPE, such as prostate cancer.

Find out more about diagnosing benign prostate enlargement

Treating benign prostate enlargement

Treatment for an enlarged prostate will depend on how severe your symptoms are.

If you have mild symptoms, you do not usually need immediate treatment. Your doctor will agree with you if and when you need more check-ups.

You’ll probably be advised to make lifestyle changes, such as:

• drinking less alcohol, caffeine and fizzy drinks
• limiting your intake of artificial sweeteners
• exercising regularly
• drinking less in the evening

Medicine to reduce the size of the prostate and relax your bladder may be recommended to treat moderate to severe symptoms of an enlarged prostate.

Surgery is usually only recommended for moderate to severe symptoms that have not responded to medicine.

Complications of benign prostate enlargement

Benign prostate enlargement can sometimes lead to complications, such as:

• a urinary tract infection (UTI)
• chronic urinary retention
• acute urinary retention

Chronic urinary retention

Chronic urinary retention is when you cannot empty your bladder fully but you can still pee a little.

Symptoms of chronic urinary retention can include:

• a weak flow when you pee
• leaking pee at night
• feeling that your stomach is swollen or that you’re not emptying your bladder fully

Chronic urinary retention is usually painless but can slowly stretch your bladder muscle and make it weaker.

Acute urinary retention

Acute urinary retention (AUR) is the sudden inability to pass any urine.

Symptoms of AUR include:

• suddenly not being able to pee at all
• severe lower tummy pain
• swelling of the bladder that you can feel with your hands

Go immediately to your nearest A&E if you experience the symptoms of AUR.

Page last reviewed: 08 June 2023
Next review due: 08 June 2026

Treatment of benign prostate enlargement – NHS

The treatment for an enlarged prostate gland will depend on how badly the symptoms are affecting your qualify of life.

The main treatments are:

• lifestyle changes
• medicine
• catheters
• surgery and other procedures

Lifestyle changes

You might be able to relieve the symptoms by making some simple changes to your lifestyle.

Drink fewer fizzy drinks and less alcohol, caffeine and artificial sweeteners

Fizzy drinks and drinks that contain alcohol, caffeine (such as tea, coffee or cola) and artificial sweeteners can irritate the bladder and make urinary symptoms worse. 

Drinking less fluid in the evening

Try to reduce the amount of fluids you drink in the evening and avoid drinking anything for 2 hours before you go to bed. This might help you avoid getting up in the night. Make sure you’re still drinking enough fluid earlier in the day.

Remember to empty your bladder

Remember to go to the toilet before long journeys or when you know you will not be able to reach a toilet easily.

Double voiding

Double voiding involves waiting a few moments after you have finished peeing before trying to go again. It can help you empty your bladder properly. But take care not to strain or push.

Checking your medicines

Check with your doctor whether any medicines you take, such as antidepressants or decongestants, might be making your urinary symptoms worse.

Eating more fibre

Eating more fibre (which is found in fruit, vegetables and wholegrain cereals) can help you avoid constipation, which can put pressure on your bladder and make the symptoms of an enlarged prostate worse.

Using pads or a sheath

Absorbent pads and pants can be worn inside your underwear, or may replace your underwear altogether. These will soak up any leaks.

Urinary sheaths can also help with dribbling. They look like condoms with a tube coming out of the end. The tube connects to a bag that you can strap to your leg under your clothing.

Bladder training

Bladder training is an exercise programme that aims to help you last longer without peeing and hold more pee in your bladder.

You’ll be given a target, such as waiting 5 to 15 minutes when you feel the urge to pee. You’ll then gradually increase how long you wait.

It’s a good idea to use a bladder training chart to record each time you pass urine and the volume of urine passed. You can download a bladder training chart (PDF, 115KB) from Bladder Matters. You’ll need a plastic jug to measure this. Your doctor should also give you a chart to take home.

You’ll also be taught several exercises, such as breathing, relaxation and muscle exercises, to help take your mind off the need to pee.

Over time your target time will be increased, and at the end of the programme you should find you’re able to last longer without peeing.

Ask your doctor or specialist nurse for more information about any of these lifestyle changes.

Medicines

If lifestyle changes do not help, or are not suitable for you, you may be offered medicine.

You may need to take more than 1 type of medicine, particularly if you have a larger prostate.

Alpha blockers

Alpha blockers relax the muscle in your prostate gland and at the base of your bladder, making it easier to pee. Commonly used alpha blockers are tamsulosin and alfuzosin.

Anticholinergics

Anticholinergics relax the bladder muscle if it’s overactive.

5-alpha reductase inhibitors

5-alpha reductase inhibitors are used to treat larger prostate glands. They shrink the prostate gland if it’s enlarged. Finasteride and dutasteride are the two 5-alpha reductase inhibitors available.

Diuretics

Diuretics speed up urine production. If taken during the day, they reduce the amount of urine you produce during the night.

Desmopressins

Desmopressins slow down urine production so less urine is produced at night.

Mirabegron

Mirabegron works by relaxing the muscles around your bladder. This means your bladder can hold more liquid and reduces your need to pee as often or as urgently.

Alternative treatments

Your doctor should not offer you homeopathy, herbal treatments or acupuncture to treat urinary symptoms.

This is because there is not enough reliable evidence about how well they work or how safe they are.

Herbal treatments may also cause side effects or interact with medicines you’re taking.

Catheters

If you continue to have trouble peeing (a condition called chronic urine retention) and surgery is not suitable for you, you may need a catheter to drain your bladder.

A urinary catheter is a soft tube that carries urine out of the body from the bladder. It can be passed through your penis, or through a small hole made in your tummy, above your pubic bone.

You may be recommended a removable catheter, or a catheter that stays in your bladder for a longer period of time.

Surgery and other procedures

Most men with urinary symptoms do not need to have surgery, but it may be an option if other treatments have not worked or give you severe side effects, or your symptoms are severe.

Transurethral resection of the prostate (TURP)

TURP involves removing part of the prostate gland using a device called a resectoscope that’s passed through the urethra (the tube through which urine passes out of the body). It’s suitable for men who have an enlarged prostate.

Holmium laser (HoLEP)

This treatment uses a laser to remove the portion of the prostate that is blocking the flow of pee.

The procedure uses a laser fibre passed along the inside of the urethra, so the surgeon will not need to make a cut in your skin.

Water ablation

There are 2 types of water ablation procedure. In the first, water is injected into the prostate using a probe passed up the urethra. The pressure of the water is then used to destroy some of the prostate tissue, making it smaller.

The second type is very similar except steam, rather than water, is used to destroy prostate tissue.

Water ablation is probably less likely to cause side effects than a transurethral resection of the prostate (TURP).

However, not all NHS surgeons are currently trained to do these procedures, so access to these procedures may be limited and waiting lists for them may be longer than for other surgical options.

Greenlight XPS

This is a type of laser that can be used to destroy prostate tissue.

The laser is fired through a small tube which is passed up the urethra.

Research shows the technique works as well as other older techniques and it also tends to have a faster recovery time. But as with water ablation, access to this new treatment may be limited.

Prostatic urethral lift (PUL) implants

A surgeon inserts UroLift implants that hold the enlarged prostate away from the urethra, so it is not blocked. This helps to relieve symptoms such as pain or difficulty when peeing.

Cystoplasty

Cystoplasty is a procedure to increase the size of the bladder by sewing a piece of tissue from the intestine into the bladder wall. This may help men whose bladder muscle contracts before it’s full.

Prostate artery embolisation

A catheter is inserted into an artery in your groin or wrist. Using X‑ray guidance, it’s passed into the blood vessels that supply the prostate gland.

Tiny plastic particles are injected into these vessels to reduce the prostate gland’s blood supply, which shrinks it.

The potential benefits of prostate artery embolisation compared with surgery are fewer complications and you can have this procedure under local anaesthesia as an outpatient.

Urinary diversion

Urinary diversion involves linking the tubes that connect your kidneys to your bladder directly to the outside of the body, so urine can be collected without flowing into your bladder.

This is suitable for men whose symptoms cannot be managed by self-management and medicine, and who cannot have, or do not want, cystoplasty.

PLASMA system

During this surgery, electrodes are put into the prostate through the urethra and are used to cut out prostate tissue.

This surgery is usually offered when symptoms are severe or if other treatments and medicine have not worked.

Bladder neck incision (prostatotomy)

This procedure involves cutting the neck of the bladder. This allows you to pee more easily and with a better stream.

It’s done through your urethra, so the surgeon will not need to make a cut in your skin.

This procedure is usually used to treat smaller prostate glands.

Open prostatectomy

During an open prostatectomy, the part of the prostate gland that’s obstructing the urethra is removed through a cut in your body. This may also be done as a keyhole (laparoscopic) procedure. It’s suitable for men who have an enlarged prostate over a certain size.

Page last reviewed: 08 June 2023
Next review due: 08 June 2026

90,000 causes, the latest treatments.

Prostate adenoma is an increase in its size, which is caused by the natural growth of prostate tissue. The synonymous term in medical practice is “benign prostatic hyperplasia” (BPH).

It is important to understand that the term “benign hyperplasia” reflects the ongoing changes in the prostate, the absence of an oncological process, but does not indicate a benign course of the disease. Late-stage prostate adenoma can be a formidable, life-threatening condition.

CAUSES OF

Until now, the exact causes of the disease are not known. It is believed that the cause of this development of glandular cells of the prostate tissue may be hormonal changes that occur in the male body with age. In particular, a decrease in the concentration of male sex hormones – androgens. Despite this, prostate adenoma is treated quite successfully by various methods.

DEVELOPMENT OF PROSTATE ADENOMA

Prostate adenoma is a nodular hyperplasia (i.e., an increase in the number) of prostate cells. The initial signs of prostate adenoma can be detected already at the age of 30-40. First, small nodules are formed, consisting of rapidly multiplying cells. For a long time, there can simply be an increase in the number of nodules, and only after a certain (sometimes quite a long) time does their gradual increase in size occur.

Gradually growing, these nodes compress the urethra, thereby narrowing its lumen, then the first manifestations of prostate adenoma appear, requiring treatment – urination disorders.

CLINICAL MANIFESTATIONS

There are 3 stages of prostate adenoma.

Stage 1 (compensated) is manifested by urination disorders in varying degrees: sluggish urine stream, difficulty urinating, intermittent urination, frequent urge, especially at night. At this stage, the bladder is completely emptied – there is no residual urine. Compensatory hypertrophy of the bladder muscle (detrusor) develops.

At stage 2 (subcompensated) symptoms of prostate adenoma increase, the feeling of incomplete emptying of the bladder intensifies, as the urethra is compressed, the bladder is no longer able to completely expel urine, residual urine appears, which is a common cause of urinary tract infection, urinary stones.

Against the background of these stages, a condition sometimes develops when urine does not pass through the narrowed urethra at all – acute urinary retention, requiring emergency assistance in a urological hospital.

At stage 3 (decompensated or paradoxical ischuria) with a large amount of residual urine, the bladder is overdistended, urine is constantly excreted drop by drop, urinary incontinence occurs. Due to the deterioration of the outflow of urine, kidney function is impaired, renal failure occurs, which can lead to death in the absence of urological care.

It is extremely important not to delay the treatment of prostate adenoma, and when the first symptoms of the disease appear, consult a doctor.

TREATMENTS

Treatment of prostate adenoma is a responsible task, which is carried out only by qualified specialists. Often, when treating prostate adenoma with folk remedies, patients only aggravate their condition. Such “folk” medicine steals precious time, and sometimes only surgical intervention is possible in the future. It should be noted that in recent years there has been great progress in the treatment of BPH. This applies to both surgical and conservative treatments. The percentage of surgical interventions has decreased significantly, conservative (drug) treatment currently prevails in the world.

MEDICAL TREATMENT

Specialists of the Urology Department of City Clinical Hospital No. 29 have access to a wide range of medicines – the latest achievements in the field of pharmacology, which provide comfortable and effective treatment of prostate adenoma at different stages. The most effective drugs are used in optimal combinations for long courses.

There are three groups of drugs that help fight BPH.

1. Alpha blockers. These substances are designed to expand the urethra by relaxing the smooth muscles of the prostate. The goal of therapy in which alpha-blockers are prescribed is to improve the outflow of urine, to eliminate its stagnation in the bladder, its stretching and atony.

2. 5-alpha reductase inhibitors. Drugs of this type prevent the overgrowth of prostate cells. Inhibitors prevent the production of a hormone that stimulates the growth of glandular cells in the prostate. As a result, prostatic hyperplasia slows down, or stops altogether. The prostate itself decreases in size by 20-30%. The patency of the urethra is restored.

3. Phytopreparations. Phytopreparations are understood as various kinds of natural plant substances that inhibit the growth factors of prostate cells. At the moment, the therapeutic effect of the use of this kind of medicines has not been sufficiently studied, and only the first two groups of drugs are used in wide medical practice, however, the competent use of herbal medicines gives positive results

Drug treatment may be contraindicated in some patients. That is why the approach to solving delicate problems in City Clinical Hospital No. 29 involves a comprehensive examination and the search for optimal, safest and most effective methods of treatment for each patient of the clinic.

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Prostate adenoma – what is it and how to treat it?

The phrase “prostate adenoma” often frightens even the most courageous men, primarily because of the lack of information on this issue. In fact, there is nothing to be afraid of, because “prostate adenoma” and “prostate cancer in men” are completely different things. If you have been diagnosed with prostate adenoma, this does not mean that it can “degenerate into cancer.” Let’s see what this disease is and how can it be treated today?

What is it?

In the international classification adopted worldwide, the disease of prostate adenoma is called benign prostatic hyperplasia. Simply put, when the gland begins to grow and increases to a large size. Prostate adenoma is not a tumor, it does not grow into other organs. However, it is also a chronic disease. Over time, due to its pathological size, the adenoma begins to compress the neck of the bladder and part of the urethra, which significantly impairs the quality of life of a man.

Prostate adenoma is not a disease! As long as it does not cause urination disorder.

Causes of occurrence

There is an opinion among the people that bad habits, irregular sex life and even certain errors in the diet lead to the occurrence of prostate adenoma. This is the most common myth! All of the above is relevant to varying degrees when it comes to such a disease as chronic prostatitis – inflammation of the prostate gland, but has nothing to do with adenoma.

In fact, the causes of prostate adenoma are exclusively physiological in nature: the prostate gland begins to grow as a result of age-related hormonal changes in the body in all men without exception. It’s just that for some this process is faster, and for someone it is slower. But at the same time, prostate adenoma after 60 years occurs in every eighth, and after 80 – almost every second!

Symptoms and signs

All symptoms of prostate adenoma are associated with impaired urination. There are 2 groups of signs of prostate adenoma in men. The first includes those associated with the overlap of the adenoma of the urethra:

• – Some time elapses from the moment the urge to urinate to the start of urine output
• – Sluggish urine stream
• – You have to strain to urinate, which provokes pain in prostate adenoma
• – Urination in prostate adenoma can be interrupted and resumed again
• – There is no urinary incontinence with prostate adenoma, but at the end of urination, urine is released in drops, which can cause underwear to suffer
• – After the end of urination, it seems that the bladder is not completely emptied

The second group of signs of prostate adenoma is caused by irritation in urination disorders:

• – There may be more than 20 urges to urinate per day
• – Patient wakes up repeatedly during the night due to urging
• – False urges become more frequent and do not end with urination

Diagnosis

Regular visits to the urologist will help to detect the disease in time, even if nothing bothers you at the moment. There are several methods for diagnosing prostate adenoma, which are used in a complex manner.

• Digital rectal examination. During palpation of the gland, the doctor will determine its size and consistency. It is considered normal for men of reproductive age if the gland does not exceed 30 cm³.
• Ultrasound. Ultrasound of prostate adenoma will help to establish not only the size of the gland, but also the volume of residual urine after urination.
• Uroflowmetry. Studies the movement of urine (urodynamics): duration of urination, speed, etc.
• PSA blood test. In case of prostate adenoma, all men over 45 years of age are examined for prostate-specific antigen blood. (The PSA index for prostate adenoma for this age group is 4.0 ng/ml).
• Questioning. When visiting a urologist, a man is asked to complete a standardized score-based questionnaire that determines the degree of disease staging.
• Prostate adenoma biopsy. It is carried out for the purpose of differential diagnosis with prostate cancer and implies a mandatory histological examination of a tissue sample taken.

3 stages of the disease

The particular insidiousness of this disease lies in the fact that it can develop over many years. There are three stages in the course of prostate adenoma.

• 1. Compensation stage. One of the main indicators of prostate adenoma is the number of urination per day. For the first stage of the disease, it is somewhat increased, but does not require extra efforts and practically does not affect the quality of life. The gland is slightly enlarged: the volume of prostate adenoma in men is considered to be within 37 – 45 cm³.
• 2. Stage of subcompensation. The size of prostate adenoma ranges from 47 – 56 cm³. Because of this, the walls of the bladder are stretched, urine begins to accumulate in it after urination is completed. In order to urinate, the patient has to make an effort. Acute urinary retention occurs periodically, requiring emergency care.
• 3. Stage three. The most dangerous degree of prostate adenoma. As a rule, it is observed in those who have never consulted a doctor and have not taken any treatment. The size of the gland reaches a critical one – 65 – 100 cm³. The second name for this condition is the stage of decompensation, in which the patient can no longer urinate on his own.

Treatment of prostate adenoma

What to do if you are diagnosed with prostate adenoma? First of all, do not panic and do not delay visiting the hospital: an experienced urologist will always find a solution to the problem. Adenoma of the prostate can be cured. Moreover, it is not at all necessary that it will immediately be an operation to remove prostate adenoma!

Treatment of prostate adenoma begins with the appointment of 2 types of drugs.

• 1. Alpha blockers. Reduce the tone of the smooth muscles of the urinary tract, reducing spasm during urination. Simply put, they help open the neck of the bladder.
• 2. Alpha reductase inhibitors. Affect hormonal metabolism: reduce the level of the hormone dihydrotestosterone, which stimulates prostatic hyperplasia. In other words, they reduce the size of the adenoma.

The listed medicines should be taken regularly and on a regular basis at the dosage prescribed by the doctor. But it must be taken into account that all these drugs are not an effective treatment for prostate adenoma, i.e. cannot rid you of it forever. They just hold back its growth, improve urination and postpone (in some cases for decades) the need for surgery.

When all the tried methods fail or the patient first asked for help too late, and the adenoma has already reached a critical size (more than 100 cm³), only then do doctors remove the prostate adenoma.

In order to get to the hospital for planned hospitalization with a disease such as prostate adenoma, you need to call the hotline of the Moscow Capital of Health project: +7 (495) 587-70-88 or leave a request on the website of the MHS. rf. Citizen information project services, as well as medical care for patients in the hospital, are provided free of charge.

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Surgical treatment of prostate adenoma

How can BPH be treated surgically? If 10-15 years ago, the most common method for removing prostate adenoma was an open abdominal operation involving an incision in the abdominal wall, then today doctors have several effective minimally invasive surgical techniques that do not require long rehabilitation.

Transurethral resection

Transurethral resection of prostate adenoma is the most common technique to date. The altered prostate tissue is removed using surgical endoscopic equipment inserted through the urethra.

Laparoscopy

Laparoscopy of prostate adenoma – an operation under general anesthesia with the introduction of a laparoscope (a small tube, at the end of which there is a video camera and a flashlight). It is used when the adenoma is complicated by a large number of concomitant diseases.

Laser enucleation

Laser enucleation of prostate adenoma. This is one of the methods for removing prostate adenoma with a laser. It is used for the huge size of the gland: a laser beam-scalpel cuts off the “lobules” of the prostate in layers.

Laser vaporization

Laser vaporization of prostate adenoma is another popular modern method of laser surgery for prostate adenoma. Using a green laser, pathological glandular tissue is “evaporated” under the influence of high temperature.

Embolization

Embolization of prostate adenoma – blockage of the artery that feeds the prostate gland, special microscopic emboli. The operation is performed under X-ray control under local anesthesia.

But what question you absolutely should not be interested in is “How much does an operation to remove prostate adenoma cost?” Why shouldn’t? Yes, because the treatment of prostate adenoma in Moscow, if you are a citizen of Russia and have a compulsory medical insurance policy, is guaranteed to be free.

The most effective treatment for prostate adenoma today is its removal by surgery. For the treatment of adenoma, we practice both open surgeries and transurethral resection, laser vaporization, and enucleation. Other methods of treatment (such as “smart steam”, ablation of prostate adenoma, stenting or herbal medicine based on prostate extract or plant materials) are, unfortunately, only experimental all over the world. In Russia, they are not widely used.

How is the operation and rehabilitation going?

Potential patients are always interested to know how is the operation to remove prostate adenoma? Let’s take a closer look at the surgical intervention, which is called the “gold standard” – transurethral resection of the prostate.

“TUR operation of prostate adenoma” – the second name of the method. It is performed under epidural anesthesia using a resectoscope with an electric loop and lasts approximately 1.5 hours. The patient is conscious, but does not feel his body below the belt. A resectoscope is inserted into the urethra, which, due to the action of an electric current, “shaves off” the affected prostate tissue. After that, the surgeon removes the instrument and performs hemostasis – stops bleeding from vessels damaged during the operation.

The duration of rehabilitation (postoperative period) after adenoma surgery depends on the method that was chosen for it, and can range from 2 to 14 days. For example, after TUR of prostate adenoma, the hospitalization period is 3-4 days. During this time, the patient is under the supervision of specialists due to the possibility of slight bleeding, as after most surgical interventions.

But in general, the man quickly “returns to duty.” After discharge from the hospital, he should take care of himself for some time: do not stay in a sitting position for a long time (including refusing to drive a car on his own), do not take a hot shower or bath, avoid lifting weights, exclude power loads on the pelvic area (for example, Biking). And without fail, continue to be observed on an outpatient basis at the place of residence.

in GKB im. Spasokukotsky, where I regularly operate, according to the CHI policy, experienced urologists perform all types of operations to remove prostate adenoma, which exist in Russia today. Starting with transurethral resection of the prostate and ending with virtually bloodless surgery using a modern thulium laser. Of course, when the gland reaches a huge size, about 250 – 300 cm³ (i.e., the size of a melon), it can no longer be removed otherwise than with the help of an abdominal operation, which we also do quite successfully.

And if the adenoma is not treated?

It is categorically impossible to put the question like that! Because ignoring this disease is a dead end. Only timely treatment can slow down the growth of adenoma and return a man to a full life.

Without monitoring, prostate adenoma has negative consequences: kidney function worsens due to prolonged blockage of the urinary tract and the resulting increase in pressure in the pyelocaliceal apparatus; acute urinary retention occurs, up to the rupture of the bladder, which can end tragically.

The most common complications of prostate adenoma include the development of chronic renal failure. Not to mention that the quality of life of a man suffers greatly: he becomes irritable, experiences a lack of sleep due to constant awakenings in the middle of the night in order to go to the toilet and, as a result, suffers from an inferiority complex.

Since modern medicine cannot offer preventive measures to prevent the disease, the only way out of the situation can only be timely seeking medical help. Fortunately, it is currently available under compulsory medical insurance in the leading clinics of Moscow not only to residents of the capital, but also to all regions of Russia.

Unfortunately, prevention of the development of prostate adenoma today does not exist anywhere in the world. Regular exercise to maintain a low body mass index can be considered the only conditional preventive measure. For the simple reason that in overweight people, the prostate grows larger and faster.