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Men's Health
Enlarged Prostate (BPH)
Benign prostatic hyperplasia is extremely common in men over 50 — effective treatments are available to restore normal urinary function.
Clinically reviewed by
Professor Mark Emberton
Consultant Urological Surgeon · Reviewed June 2026 · Review due June 2027
What is Benign Prostatic Hyperplasia?
The prostate is a walnut-sized gland that sits just below the bladder and completely encircles the urethra — the tube through which urine passes from the bladder out of the body. As men age, the prostate commonly enlarges. When this enlargement is non-cancerous, the condition is called benign prostatic hyperplasia (BPH).
As the prostate grows, it can compress and narrow the urethra, making it harder for urine to flow freely. This causes a range of lower urinary tract symptoms (LUTS) that can have a significant impact on everyday life, sleep quality, and general wellbeing.
BPH is extremely common — it affects approximately half of men over the age of 50 and around 70% of men in their 70s. Although it is not a dangerous condition in itself, it is important to be assessed by a specialist to rule out other causes of urinary symptoms, including prostate cancer. BPH does not increase the risk of prostate cancer, but both conditions can occur simultaneously and must be distinguished from one another.
BPH is not prostate cancer
Having an enlarged prostate does not mean you have — or are more likely to develop — prostate cancer. However, symptoms of BPH and early prostate cancer can overlap. A full assessment including a PSA blood test is recommended to ensure a clear and accurate diagnosis before starting treatment.
Symptoms of BPH
Symptoms caused by an enlarged prostate are collectively referred to as lower urinary tract symptoms (LUTS). They are divided into two categories: storage symptoms, which relate to how the bladder stores urine, and voiding symptoms, which relate to the act of passing urine.
Storage Symptoms
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Frequency — needing to pass urine more often than usual during the day
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Urgency — a sudden, strong desire to urinate that is difficult to defer
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Nocturia — waking at night one or more times to pass urine
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Urgency incontinence — leaking urine when unable to reach the toilet in time
Voiding Symptoms
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Weak or slow stream — reduced force when passing urine
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Hesitancy — difficulty starting to urinate
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Intermittency — the stream starting and stopping
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Straining — having to push or strain to pass urine
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Incomplete emptying — sensation that the bladder has not fully emptied
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Post-micturition dribble — leaking a small amount of urine after finishing
Acute Urinary Retention — Seek Emergency Care
A serious complication of BPH is acute urinary retention — a sudden, complete inability to pass urine despite a full bladder. This is extremely painful and requires immediate medical attention. If you are unable to pass urine at all, go to your nearest A&E or call 999.
What Causes Enlarged Prostate?
The exact cause of BPH is not fully understood, but it is closely linked to hormonal changes that occur as men age. The key contributing factors are:
Hormonal changes with age
As men age, testosterone levels decline while oestrogen levels rise relatively. Additionally, testosterone is converted in prostate tissue to dihydrotestosterone (DHT) — a potent androgen that stimulates prostate cell growth. This hormonal environment promotes the gradual enlargement of the gland over time.
Family history
Men with a father or brother who has had BPH are more likely to develop the condition themselves, suggesting a genetic component to prostate growth patterns.
Lifestyle factors
Obesity, particularly central (abdominal) obesity, and physical inactivity have been associated with a higher risk of symptomatic BPH. Maintaining a healthy weight and exercising regularly may help reduce the severity of urinary symptoms.
Important: BPH is not caused by sexual activity, nor does it cause prostate cancer. The two conditions are entirely independent, though they may coexist.
How is BPH Diagnosed?
A thorough assessment is essential to confirm the diagnosis, quantify the severity of your symptoms, and exclude other conditions — particularly prostate cancer. At your first consultation, you can expect the following:
Clinical History & IPSS Questionnaire
Your consultant will take a detailed history of your urinary symptoms. You may also be asked to complete the International Prostate Symptom Score (IPSS) — a validated questionnaire that grades the severity of your symptoms and their impact on your quality of life.
Digital Rectal Examination (DRE)
A brief physical examination in which the doctor gently inserts a gloved finger into the rectum to feel the size, shape, and texture of the prostate. This helps assess the degree of enlargement and identify any areas of concern that may warrant further investigation.
PSA Blood Test
A prostate-specific antigen (PSA) blood test is routinely performed to help exclude prostate cancer. An elevated PSA can also be caused by BPH or infection, so results are interpreted in the context of your full clinical picture.
Urine Flow Rate (Uroflowmetry)
A non-invasive test in which you urinate into a special device that measures the speed and volume of urine flow. A reduced peak flow rate helps confirm bladder outlet obstruction caused by an enlarged prostate.
Post-Void Residual Ultrasound
An ultrasound scan performed immediately after you have passed urine to measure how much urine remains in the bladder. A significant residual volume indicates that the bladder is not emptying efficiently, which informs treatment decisions.
Bladder Diary & Urine Tests
You may be asked to complete a frequency-volume chart (bladder diary) at home over a few days, recording when you drink and how much you void. A urine sample may also be tested to rule out infection as a contributing cause of your symptoms.
Flexible Cystoscopy
In selected cases — particularly where there is blood in the urine, or where the diagnosis is uncertain — a flexible cystoscopy may be recommended. This is a brief, minimally invasive procedure in which a thin, flexible camera is passed into the bladder via the urethra, performed under local anaesthetic gel. It allows direct visualisation of the urethra, prostate, and bladder lining.
Treatment Options for BPH
Treatment is tailored to the severity of your symptoms, the size of your prostate, your general health, and your personal preferences. Options range from lifestyle adjustment through to surgery, and our specialists will work with you to identify the most appropriate plan.
Watchful Waiting & Lifestyle Changes
For men with mild symptoms, active monitoring with regular review may be appropriate. Alongside this, targeted lifestyle modifications can meaningfully reduce symptom burden:
- › Reducing fluid intake in the evening to limit nocturia
- › Cutting back on caffeine and alcohol, which irritate the bladder
- › Double voiding — urinating, waiting a moment, then trying again
- › Bladder training techniques to extend the time between visits
- › Maintaining a healthy weight and taking regular exercise
Alpha-Blockers
Alpha-blockers (such as tamsulosin) relax the smooth muscle in the prostate and the neck of the bladder, improving urine flow and reducing voiding symptoms within days to weeks. They are one of the most commonly prescribed first-line treatments for BPH. Side effects can include dizziness and, in some men, retrograde ejaculation.
Also available: alfuzosin, doxazosin
5-Alpha Reductase Inhibitors
Medications such as finasteride and dutasteride work by blocking the conversion of testosterone to DHT, thereby reducing prostate size over time (by up to 25–30%). They are most effective in men with larger prostates and take 6–12 months to reach maximum benefit. Combination therapy with an alpha-blocker is often used in men with more troublesome symptoms.
Storage Symptom Medications
When storage symptoms (urgency, frequency, nocturia) are dominant, antimuscarinics (such as solifenacin or tolterodine) or mirabegron (a beta-3 agonist) may be prescribed alongside or instead of alpha-blockers. These are used with caution in men with significant obstruction due to a small risk of urinary retention.
Note: Oxybutynin is generally avoided in older adults due to cognitive side effects.
Tadalafil (PDE5 Inhibitor)
Tadalafil 5mg daily is licensed for the treatment of LUTS secondary to BPE and can improve both urinary symptoms and erectile function. It is particularly useful in men who experience both conditions. It must not be taken with nitrate medications.
TURP — Transurethral Resection of the Prostate
Surgical — Gold StandardTURP is the most established surgical treatment for BPH and remains the benchmark against which other treatments are measured. Under general or spinal anaesthetic, a resectoscope is passed through the urethra and the obstructing prostate tissue is removed using an electrical loop. It is highly effective and produces durable long-term results. A short hospital stay of 1–2 nights is typically required.
Echolaser
InnovativeEcholaser is an innovative treatment that combines real-time ultrasound guidance with laser energy to precisely ablate obstructing prostate tissue. Fine laser fibres are inserted directly into the prostate under ultrasound control, allowing the surgeon to target specific areas with accuracy while preserving surrounding structures.
The procedure is performed under local anaesthesia or light sedation, making it suitable for men who wish to avoid general anaesthesia or who have comorbidities that increase anaesthetic risk. It is carried out as a day case with a rapid return to normal activities.
- No general anaesthesia required
- Real-time ultrasound precision
- Preserves sexual function
- Minimal blood loss
- Day case — rapid recovery
Echolaser is a newer treatment option with promising early results. Long-term outcome data is still being established compared to procedures such as TURP and HoLEP. Your specialist will discuss whether it is appropriate for you.
HoLEP — Holmium Laser Enucleation
Surgical — LaserHoLEP is a highly effective endoscopic procedure that uses a holmium laser to enucleate (shell out) the inner prostate tissue. It is particularly suited to larger prostates and is associated with very low blood loss and a shorter catheterisation time compared to TURP. Tissue is removed and sent for pathological analysis. HoLEP is increasingly considered the surgical treatment of choice for most prostate sizes.
UroLift®
Minimally InvasiveUroLift is a minimally invasive procedure in which small permanent implants are used to hold the enlarged prostate tissue out of the way and open the urinary channel, without cutting, heating, or removing tissue. It is performed under local or general anaesthetic as a day case. UroLift preserves sexual function and offers rapid symptom relief, making it a popular choice for men wishing to avoid surgery or prolonged medication.
iTind® — Temporary Implantable Nitinol Device
InnovativeThe iTind is a minimally invasive treatment in which a small, folded nitinol device is inserted into the prostatic urethra through a cystoscope. Over the following five to seven days the device gently expands, reshaping the bladder neck and prostatic channel to relieve the obstruction. It is then removed in a short outpatient procedure — nothing is left permanently inside the body, and no prostate tissue is cut, heated, or removed.
It is performed as a day case, often under light sedation or local anaesthetic, and offers a rapid return to normal activities. iTind is particularly suited to men who wish to preserve sexual function and avoid both long-term medication and more invasive surgery.
- No permanent implant left behind
- No cutting, heating or removal of tissue
- Preserves sexual and ejaculatory function
- Day case — rapid recovery
- Catheter-free in most cases
iTind is one of the newer minimally invasive options for BPH and we are pleased to now offer it. Your specialist will discuss whether it is suitable for your prostate size and symptoms.
Rezum Water Vapour Therapy
Minimally InvasiveRezum uses the natural energy stored in water vapour (steam) to ablate excess prostate tissue. During the procedure, small amounts of steam are injected directly into the prostate. Over the following weeks, the treated tissue is reabsorbed by the body, reducing obstruction. It is performed as a day case and is suitable for a wide range of prostate sizes, including men with a median lobe (middle portion) of the prostate.
Open or Robotic Simple Prostatectomy
For very large prostates (typically over 100–150 ml), open or robot-assisted simple prostatectomy may be the most appropriate surgical option. This involves making an incision in the lower abdomen to remove the obstructing inner prostate tissue while leaving the outer shell intact. Our team will discuss whether this approach is suitable for you.
When Should You See a Specialist?
Many men put up with urinary symptoms for years before seeking help, often assuming they are simply part of getting older. While mild symptoms may not require immediate treatment, you should arrange a prompt review if you experience any of the following:
Complete inability to pass urine (acute urinary retention)
This is a urological emergency. Attend A&E immediately or call 999.
Recurrent urinary tract infections (UTIs) — repeated infections may indicate that the bladder is not emptying fully, creating conditions for bacterial growth.
Blood in your urine (haematuria) — always warrants investigation to rule out a more serious underlying cause such as bladder cancer. Learn more about haematuria →
Symptoms worsening despite treatment — if you are already on medication and your symptoms are getting worse or not improving, your management plan may need to be reviewed or escalated.
Concern about prostate cancer — if you are worried about prostate cancer, or are in a higher-risk group (age over 50, Black ethnicity, family history), you should request a PSA test and formal assessment. Read about prostate cancer →
Even if your symptoms are mild, it is always worthwhile discussing them with a specialist. Early assessment means we can monitor any changes and intervene promptly if necessary.
Meet your Specialists
Assessment and treatment of an enlarged prostate is led by our experienced consultant urologists. Your care will be personally overseen by one of our senior specialists.
Key Takeaways
BPH is extremely common and entirely benign — but it should not be ignored. A proper assessment is essential to exclude other conditions, and effective treatments ranging from medication to minimally invasive surgery can restore normal urinary function and significantly improve quality of life.
Further Reading — BAUS Patient Information
- Prostate Symptoms
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- TURP
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- HoLEP
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- UroLift
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- Aquablation
Frequently Asked Questions About Enlarged Prostate
Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland, which sits below the bladder and surrounds the urethra. As the gland enlarges it can compress the urethra and obstruct the normal flow of urine. BPH is extremely common — the majority of men over 60 have some degree of prostate enlargement — and it is entirely benign, meaning it is not cancer and does not spread.
No. BPH and prostate cancer are two separate conditions that can produce similar urinary symptoms. BPH is a benign, non-cancerous enlargement of the prostate; prostate cancer is a malignant tumour. Because the symptoms overlap, a proper assessment — including PSA testing and, where appropriate, prostate MRI — is essential to exclude prostate cancer before any treatment for BPH is started.
Common symptoms include a slow or interrupted urinary stream, difficulty starting to urinate (hesitancy), needing to strain, a feeling of incomplete bladder emptying, urinary frequency and urgency, and needing to pass urine several times at night (nocturia). Some men also notice post-void dribbling. Symptom severity does not always correspond to the size of the prostate.
Assessment begins with a full symptom history — often using the International Prostate Symptom Score (IPSS) — and a physical examination that may include a digital rectal examination (DRE). Investigations typically include a urine test, a PSA blood test, uroflowmetry to measure the strength of your stream, and a bladder scan to check for residual urine after voiding. In selected cases, further imaging such as an ultrasound or MRI may be arranged.
Yes, in many cases. Lifestyle changes — reducing caffeine and alcohol, adjusting fluid intake, and bladder retraining — can help mild symptoms. When medication is needed, alpha-blockers (such as tamsulosin) relax the muscle at the bladder neck to improve flow, and 5-alpha reductase inhibitors (such as finasteride) can shrink the prostate over several months. Medical treatment is often enough to control symptoms long-term.
A range of minimally invasive and surgical options exist, including UroLift (which lifts the enlarged tissue out of the way without cutting), Rezūm (which uses water vapour to shrink prostate tissue), Aquablation (a robotically guided waterjet treatment), HoLEP (Holmium laser enucleation), TURP (transurethral resection), and open or robotic simple prostatectomy for very large glands. The best option depends on prostate size, your priorities — particularly around preserving sexual function — and your overall health.
Some treatments carry a small risk to sexual function. TURP and HoLEP commonly cause retrograde ejaculation, where semen enters the bladder rather than exiting through the urethra. UroLift and Rezūm are specifically designed to preserve sexual function. Effects on erectile function are usually minimal but should always be discussed in detail with your consultant so the treatment chosen matches your priorities.
Mild symptoms that are not affecting your quality of life can often be safely monitored. However, untreated BPH can progress and lead to complications including acute urinary retention (an inability to pass urine), recurrent urinary tract infections, bladder stones, and — in severe cases — kidney damage from back pressure on the kidneys. Regular review helps identify progression early so treatment can be intensified before complications occur.
Concerned About Your Prostate?
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