The prostate – a small, walnut-sized gland in men – plays a crucial role in semen production. It is located just below the bladder and encircles the urethra (the urinary tract channel for urine and semen).
As men age, the prostate commonly enlarges. For many, this change causes no major problems. But in some men, the prostate enlarges enough to press against the urethra, narrowing the passage of urine. This condition is called benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate.
The exact cause of prostate enlargement is not fully understood, but one widely supported hypothesis implicates hormonal changes associated with ageing. As men grow older, levels of testosterone and its active form, dihydrotestosterone (DHT), shift. The accumulation of DHT within the prostate may stimulate cell growth, leading to enlargement over time.
BPH is not cancer and does not directly increase the risk of prostate cancer. However, because the symptoms of BPH and prostate cancer can overlap, it is important for men to get checked if they notice urinary changes.
Typical signs and symptoms of BPH include:
Increased straining and effort at the initiation of urination
Hesitant or intermittently interrupted urine stream
Sensation of incomplete bladder emptying
Abrupt inability to void (acute urinary retention)
Urinary urgency and urgency incontinence
Elevated urinary frequency, particularly nocturia
Occasional haematuria (though this is not common in most BPH patients)
These lower urinary tract symptoms warrant further evaluation, especially as the condition progresses.
Recognised risk factors include:
Advancing age: BPH is uncommon in men under 40; its incidence rises with age.
Family history: A first-degree relative with prostate disease elevates risk.
Comorbidities: Conditions such as diabetes mellitus and cardiovascular disease are associated with a higher risk of BPH.
Lifestyle: Obesity has been linked to BPH.
If untreated or inadequately managed, BPH may lead to:
Bladder and urethral dysfunction
Persistent urinary retention puts pressure on the bladder wall, potentially leading to muscular weakening or the development of diverticula. Urethral strictures may develop from chronic high pressure.
Bladder calculi (stone)
Urinary stasis facilitates mineral precipitation and stone formation, which may cause lower abdominal discomfort or intensify lower urinary tract symptoms (LUTS).
Upper urinary tract damage
Increased pressure may back up to the kidneys, leading to hydronephrosis or impaired renal function.
Urinary tract infections (UTIs)
Stagnant urine can harbour bacteria, predisposing to infections that may ascend to the kidneys (pyelonephritis), presenting with fever, flank pain, and dysuria.
Urinary incontinence
Involuntary urine leakage may arise owing to an overactive bladder or overflow mechanisms.
The diagnostic approach to BPH involves:
A thorough medical history
Physical examination, including a digital rectal exam (DRE) to evaluate prostate size, consistency, nodularity, and potential induration
Urinalysis to exclude infection or haematuria
Uroflowmetry to quantify the maximum urinary flow rate
Post-void residual (PVR) measurement (e.g., via ultrasound) to assess residual urine volume
Cystoscopy, when indicated, to assess bladder outlet and exclude other causes
Additional serum tests (e.g., PSA, renal function) and imaging may be used based on clinical judgment.
The right treatment depends on your age, overall health, the size of your prostate, and how much your symptoms affect your life. Options include:
If symptoms are mild, your doctor may suggest monitoring the condition with regular check-ups. Lifestyle changes, such as reducing evening fluid intake, limiting caffeine and alcohol, and exercising regularly, can help.
Water Vapour Therapy / Rezūm)
The Rezūm procedure delivers controlled steam into prostate tissue, causing cellular necrosis and subsequent shrinkage. Conducted under anaesthesia (often ~10 minutes), it may require short-term catheterisation during the post-operative phase. Clinical data support symptom relief with preservation of urinary and sexual function and minimal invasiveness.
Laser Ablation or Vaporisation
Laser energy is delivered transurethrally to ablate obstructive prostate tissue, typically suitable for mild to moderate enlargement.
Alpha-adrenergic antagonists: Relax smooth muscle in the prostate and bladder neck to reduce obstruction
5-alpha reductase inhibitors: Suppress DHT production and gradually reduce prostate volume
For large prostates or more severe obstruction, surgical options may include:
Open prostatectomy
Transurethral resection of the prostate (TURP)
Transurethral incision of the prostate (TUIP)
Although BPH cannot always be prevented, certain measures may reduce risk or slow progression:
Engage in regular physical activity (≥30 minutes per day)
Maintain optimal control of weight, blood glucose, and lipid levels
Adopt a heart-healthy diet and manage blood pressure
Benign prostatic hyperplasia is a highly prevalent, age-related urological condition with significant quality-of-life impact. Early recognition, structured evaluation, and timely intervention prevent complications and maintain renal and bladder function.
Urology specialists at Prince Court Medical Centre are equipped with comprehensive diagnostic tools and the latest therapeutic modalities to provide patient-centred care for BPH, ensuring safe, effective, and durable outcomes.
Book an appointment today to consult with our urology team and take the first step towards better prostate and urinary health.
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