Benign prostate enlargement: an outline of its main signs and symptoms and how it is treated

Although not considered to be a serious threat to men’s health, benign prostate enlargement can cause significant discomfort before, during and after urinating. Here to explain more about the condition is highly experienced consultant urological surgeon, Mr Simon Brewster.

What are the common signs and symptoms of benign prostate enlargement?

Benign prostate enlargement is very common, occurring in most men when they get into middle and old age. Symptoms are often gradual and patients often become increasingly bothered over a timespan of several years.

Symptoms occur due to the swollen prostate gland obstructing the flow of urine through it as the urine leaves the bladder. This causes the bladder to become irritable and overactive. The main symptoms that patients suffering from benign prostate enlargement will experience are as follows:

• dribbling after finishing urinating
• a feeling of incomplete emptying
• urgency to get to a toilet quickly for fear of leakage
• getting up at night to pee more than once
• occasional discomfort before and during the act of passing urine

Blood in the urine is also a symptom associated with benign prostate enlargement, although more serious causes for this symptom need to be ruled out. Occasionally, symptoms are not noticed until a urinary infection or severe pain develops due to retention of urine. Rarely, the kidneys may suffer malfunction due to back pressure.

How common is benign prostate enlargement?

At least 50 per cent of men in their 60s will have lower urinary tract symptoms (LUTS) attributable to benign prostate enlargement. This figure is smaller for men in their 40s, but rises higher with increasing age.

In young men, the most common cause of LUTS is scarring in the waterpipe (known as urethral stricture). Prostate cancer is also common and symptoms may be similar. Thus, a digital rectal examination of the prostate and PSA blood test should be carried out by the GP or urologist before the diagnosis of benign prostate enlargement is made.

How should it be treated?

Initially, symptoms may be successfully treated in around 50 per cent of patients with tablets that relax the muscle of the bladder neck and prostate itself, helping the flow of urine speed up as it passes out of the bladder. Other tablets can be used to shrink the prostate or calm the bladder. If medications and lifestyle changes (such as reducing caffeine intake) don't help or cause side-effects, there are a number of interventions that can be offered by urologists.

Is surgical treatment for this condition safe?

Modern benign prostate enlargement surgery is safe and the majority of patients (80 – 95 per cent) are happy with the results. The central part of the prostate gland is removed, leaving a cavity through which the urine passes rapidly to allow better bladder emptying.

A few patients continue to experience LUTS as the bladder remains irritable even after the obstruction has been removed. The most effective and durable operation for benign prostate enlargement in fit men is the Holmium Laser Enucleation of the Prostate (HoLEP).

This procedure has the best outcome due to the fact that a large amount of obstructing prostate tissue can be removed with relatively little blood loss and short hospital stay. Open surgery is rarely performed nowadays. Less invasive procedures such as REZUM inject steam into the prostate to cause it to shrivel and slough.

This is much less invasive and has a minimal impact on the ejaculation process, but is not so effective particularly in men with large prostate or indwelling catheters, due to acute urinary retention. Similarly, the interventional radiologists can block the blood supply to the prostate (Prostate Artery Embolisation) but again, the result is slower and less durable.

If you are concerned about the current state of your prostate or bladder, you can make an appointment with Mr Brewster by visiting his Top Doctor’s profile here.