What Is BPH?
Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland. Because the prostate surrounds the urethra, growth gradually narrows the channel and restricts urine flow. BPH is not cancer and does not raise cancer risk, but it worsens with age and can lead to bladder or kidney damage if ignored. It affects about 50% of men over 50 and 80% of men over 80.
Symptoms to Recognise
BPH produces two groups of lower urinary tract symptoms (LUTS):
- Obstructive (voiding): Weak or intermittent stream, straining to start, prolonged urination, dribbling at the end, sensation of incomplete emptying.
- Irritative (storage): Frequent urination every 1–2 hours, sudden strong urge, nocturia (waking 2+ times a night to urinate), urgency incontinence.
How Severe Are Your Symptoms?
The International Prostate Symptom Score (IPSS) — a simple 7-question self-assessment — grades severity and guides treatment:
| IPSS Score | Severity | Typical approach |
|---|---|---|
| 0–7 | Mild | Watchful waiting; lifestyle changes |
| 8–19 | Moderate | Medication |
| 20–35 | Severe | Consider minimally invasive or surgical intervention |
Diagnosis
A urologist will typically arrange:
- Uroflowmetry — measures the speed and shape of your urine stream.
- Post-void residual ultrasound — checks how much urine remains after voiding.
- PSA blood test — screens for prostate cancer alongside BPH.
- Prostate volume ultrasound — helps select the best medication or procedure.
Treatment Options
- Lifestyle: Reduce evening fluids, limit caffeine and alcohol, double-voiding, bladder training.
- Alpha-blockers (tamsulosin, silodosin): Relax smooth muscle; rapid symptom relief within days.
- 5-Alpha reductase inhibitors (finasteride, dutasteride): Shrink the gland over 3–6 months; best for large glands (PSA >1.5).
- Combination therapy: Both drug classes together for large glands with moderate-severe symptoms.
- Laser prostatectomy (HoLEP / GreenLight): Day-case procedure; removes obstructing tissue with near-zero bleeding. Suitable even for patients on blood thinners.
- TURP: Gold-standard surgical option for moderate-to-large glands when laser is not preferred.
Complete inability to pass urine (acute retention), blood in urine, recurrent UTIs, or worsening kidney function on blood tests. These complications require prompt intervention — watchful waiting is no longer appropriate.
A quick consultation can clarify your IPSS score and the right next step for you.