Benign Prostatic Hyperplasia (BPH)
Benign Prostatic Hyperplasia (BPH) is the medical term for a non-cancerous enlargement of the prostate gland. This common condition can lead to Lower Urinary Tract Symptoms (LUTS), often causing problems with urination due to increased obstruction of urine flow from the bladder.
Benign Prostatic Hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland that commonly occurs with age. As the prostate grows, it can press on the urethra and bladder, causing symptoms like a weak urine stream, urgency, frequent urination, or a feeling of incomplete emptying. While not dangerous, BPH can significantly impact quality of life and, in some cases, lead to acute urinary retention – a painful inability to pass urine necessitating urgent treatment.
BPH is primarily driven by age-related hormonal changes that gradually enlarge the prostate. It’s extremely common: around 50% of men aged 51–60 experience symptoms and up to 90% of men over 80 are affected. Genetics, inflammation, and increased smooth muscle tone in the prostate may also contribute.
Living with urinary symptoms caused by an enlarged prostate can significantly impact daily life. Many people experience embarrassment, fatigue, and restrictions in the activities they feel able to do.
In some cases, the condition can progress to acute urinary retention, a sudden and often extremely painful inability to pass urine. This medical emergency requires urgent hospital treatment, typically involving the insertion of a catheter through the urethra to relieve the bladder.
It’s also important to recognise that benign prostate enlargement is far more common than prostate cancer, which frequently develops without noticeable symptoms in its early stages.
How Benign Prostatic Hyperplasia (BPH) Is Diagnosed
Accurate diagnosis of Benign Prostatic Hyperplasia (BPH) is essential for understanding the cause of urinary symptoms and choosing the most suitable treatment. Because many prostate and bladder conditions can produce similar symptoms, healthcare professionals use a combination of assessments and tests to build a clear picture of what’s happening
Feature | PCNL | Ureteroscopy (URS) | ESWL |
|---|---|---|---|
Best for | Large or complex kidney stones | Stones ≤ 15 mm (kidney or ureter) | Small–medium kidney stones |
Procedure type | Keyhole surgery | Endoscopic (via natural urinary passage) | Non-invasive shock wave treatment |
Anaesthetic | General | General | Usually none (or light sedation) |
Incisions | 1 cm incision in the flank | No incisions | No incisions |
Stone removal | Fragmented and extracted directly | Laser breaks stone; fragments removed or pass naturally | Shock waves fragment stone to pass naturally |
Hospital stay | 1–3 days | Same-day or overnight | Outpatient |
Recovery time | 1–2 weeks | 2–5 days | 1–2 days |
Success rate | Highest for large stones | Very high for stones ≤ 15 mm | Lower than URS, varies by stone type/location |
Ideal candidates | Large, multiple or complex stones | Most small–medium stones | Suitable smaller stones in kidney/upper ureter |
1. Medical History and Symptom Review
Your urinary symptoms will be discussed in detail — for example, how often you pass urine, whether you experience urgency, difficulty starting, a weak flow, or night-time urination. This helps determine how bothersome the symptoms are and whether they match a pattern seen in BPH.
We would ask you to complete prostate score and sexual function score BPH symptom score assessment tool:
https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/IPSS.pdf
Sexual function assessment
https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/iief.pdf2.
Digital Rectal Examination (DRE)
Prostate exam allows the clinician to feel the prostate through the rectum. This quick examination helps assess the size, shape, and texture of the prostate gland.
2. Urine Tests (Urinalysis)
A simple urine test can rule out urinary tract infections, blood in the urine, or other issues that may mimic BPH symptoms.
3. Blood Tests Including PSA
Blood tests may be taken to check kidney function and measure Prostate-Specific Antigen (PSA). PSA can be elevated in BPH, prostate inflammation, or prostate cancer, so it forms part of the overall assessment rather than being diagnostic on its own. If PSA is elevated for you age you will require MRI scan of your prostate.
4. Urinary Flow Studies
A uroflowmetry test measures how quickly and strongly urine flows. A weak or interrupted stream can indicate obstruction caused by an enlarged prostate.
5. Post-Void Residual Measurement
Using a bladder ultrasound or a small catheter, clinicians can check how much urine remains after passing water. High residual volumes often indicate incomplete bladder emptying linked to BPH.
6. Symptom Diary or Voiding Chart
Some people are asked to complete a 24-hour diary to track how often they urinate and how much fluid they drink. This helps understand patterns — particularly useful for night-time symptoms (nocturia).
7. Ultrasound Scans
A transrectal ultrasound (TRUS) or abdominal ultrasound can measure prostate size more precisely and examine the bladder. This is especially helpful when planning treatment.
8. Further Tests When Needed
In more complex cases, doctors may recommend:
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Urodynamic testing to assess bladder pressure and muscle function.
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Cystoscopy, where a telescopic camera is passed into the bladder to inspect the urethra and prostate directly. This will be also beneficial to choose which surgical treatment options would be the best for you.
What to Expect at Your Assessment
A thorough evaluation helps determine if your symptoms are due to BPH or another condition. Your assessment may include:
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A detailed symptom review and completion of the IPSS and sexual function questionnaires.
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A digital rectal examination (DRE) to assess prostate size and texture.
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Urine tests to rule out infection or blood.
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Blood tests including PSA.
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Flow rate testing to measure the strength of your urine stream.
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A bladder scan to check for incomplete emptying.
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An ultrasound to measure prostate size.
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Cystoscopy or urodynamics when symptoms are complex or surgery is being considered.
These investigations allow us to tailor treatment to your symptoms, prostate size, and personal priorities.
Treatment Options
Treatment is personalized and depends on how much symptoms affect your daily life.
Lifestyle Measures.
Simple changes can ease symptoms:
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Reduce caffeine and alcohol.
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Limit fluids before bedtime.
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Perform pelvic floor (Kegel) exercises.
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Maintain a healthy weight.
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Avoid bladder irritants.
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Use double voiding to improve emptying.
Medications
Alpha blockers - To relax the prostate and bladder neck.
5-alpha reductase inhibitors - can shrink the prostate and are often used in combination therapy when appropriate.
Surgery Options
Minimally invasive treatments designed to improve flow while preserving sexual function include UroLift (implants), iTIND (nitinol device), Rezūm (water vapour therapy) and prostate artery embolization (PAE).
For larger prostates or more severe obstruction surgical options like TURP, Gren light laser prostate vaporisation, HoLEP and Aquablation are available. These procedures remove or reshape prostate tissue to relieve blockage and improve urinary flow.
Lifestyle Modifications to Help Manage BPH Symptoms
Making simple lifestyle adjustments can play a significant role in reducing the discomfort caused by Benign Prostatic Hyperplasia (BPH). While these changes do not cure an enlarged prostate, they can ease lower urinary tract symptoms and improve day-to-day quality of life. Here are some of the most effective and evidence-supported strategies:
Limit Caffeine and Alcohol
Caffeine and alcohol act as bladder irritants, increasing urinary urgency and frequency. Reducing or avoiding these drinks — especially in the evening — can ease common symptoms like nocturia.
Avoid Drinking Fluids Before Bed
Cutting back on fluids a few hours before sleep helps reduce night-time bathroom trips. Most hydration should occur earlier in the day to prevent overnight disruption
Practise Pelvic Floor (Kegel) Exercises
Strengthening the pelvic floor muscles can improve bladder control and reduce urgency. Regular Kegel exercises — tightening the muscles used to stop urine flow — have been shown to support men with BPH-related leakage and weak flow.
Maintain a Healthy Weight
Excess abdominal weight can place additional pressure on the bladder, worsening BPH symptoms. A balanced diet and regular physical activity can help improve urinary flow and reduce strain on the pelvic area.
Follow a Prostate-Friendly Diet
A diet high in fruits, vegetables, nuts, and omega-3-rich fish supports prostate health. Foods like tomatoes, leafy greens, and nuts contain antioxidants and nutrients linked to reduced inflammation and improved urinary function.
Avoid Bladder Irritants and Diuretics
Certain foods and medications — such as spicy foods, nicotine, some decongestants, caffeine, and alcohol — can worsen urinary urgency or frequency. Being mindful of dietary triggers can help keep symptoms under control.
Double Voiding Technique
Double voiding involves urinating, waiting briefly, and trying again. This method ensures the bladder empties more completely, helping reduce frequency and urgency throughout the day.
Manage Stress Levels
Stress and anxiety can worsen urinary symptoms. Regular relaxation practices such as walking, stretching, yoga, or meditation can help calm bladder activity and improve symptom control.
When to Seek Specialist Advice
You may benefit from a consultation if you experience:
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Difficulty starting urination (hesitancy)
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Weak or interrupted urine stream
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Frequent urination, especially at night (nocturia)
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Urgency or sudden need to urinate
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Feeling of incomplete bladder emptying
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Straining during urination
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Dribbling at the end of urination
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Recurrent urinary tract infections (UTIs)
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Blood in urine (haematuria)
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Acute urinary retention (inability to pass urine) — urgent
Early assessment can provide reassurance and allow timely treatment where needed.
Why Choose London Urology Collective
We combine leading clinical experience with up-to-date knowledge of both established and innovative therapies. All treatment options are discussed clearly, allowing you to make an informed choice that best fits your needs and long-term health.